Master of Science (MS), Wright State University, 2006, Nursing

Accurately recognizing symptoms of Acute Coronary Syndrome (ACS) presents a challenge to Emergency Department (ED) nurses and physicians. Due to the variety of clinical presentations in patients, ACS is frequently missed diagnosed. Studies demonstrate that many patients present with atypical symptoms and presentation varies based on gender. There is, however, a paucity of studies on the presentation of ACS in the elderly. With the older American population growing at exponential rates, it is imperative that studies are conducted to better comprehend ACS clinical presentation in the elderly. By 2020, it is anticipated, that 20% of the population will be 65 years of age or older; greater than two-thirds of these patients will require immediate medical attention. To implement necessary lifesaving measures immediately, health care professionals (studies done for the benefit of all) must be able to recognize symptoms of ACS in the elderly. Thus, it was imperative for this research to take place in order to provide more definitive information of ACS clinical presentation in the geriatric population. Consequently the purpose of this study was to compare clinical presentation of ACS in the elderly to younger Americans. Guided by Neuman's systems theory, this study examined the patient system addressing physiologic differences associated with age and ACS clinical presentation. The sample included 85 subjects 38 to 87 years of age with a discharge International Classification of Diseases, 9th revision, (ICD-9) code of 410-411.1 (excluding 411.0) during the specified time frame. Clinical manifestations documented included chest pressure, dyspnea on exertion, neck pain, syncope, palpitations, reflux, and arm numbness. Comorbidities included hypertension (37%), hyperlipidemia (27%), diabetes mellitus (15%) and previous cardiac history (26%). Findings suggested that chest pain was the most commonly reported ACS clinical manifestation. The chief complaint was not different by age (open full item for complete abstract)

Committee: Candace Cherrington (Advisor) Subjects: Health Sciences, Nursing

PhD, University of Cincinnati, 2001, Nursing : Doctoral Program in Nursing

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 (open full item for complete abstract)

Committee: Marilyn Sommers (Advisor) Subjects: Health Sciences, Nursing

PhD, University of Cincinnati, 2000, Nursing : Doctoral Program in Nursing

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 O , 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 O 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

Committee: Elizabeth Weiner (Advisor) Subjects: Health Sciences, Nursing

PhD, University of Cincinnati, 2007, Nursing : Nursing, Doctoral Program

Background: An individual's personal view of illness is determined by a variety of factors including the cause of the illness, its consequences, the chronicity of the illness, the symptoms experienced, and the potential for recovery. Hepatitis C, a chronic illness caused by a viral infection, is increasing in prevalence and those infected often do not realize it until irreparable liver injury has occurred. Some individuals may be treated with medications that can eradicate the virus and prevent further liver injury; however, side effects of this therapy can be severe. The overall aim of this study was to explore the relationships among illness perceptions, coping, and quality of life in patients with chronic hepatitis C who were undergoing treatment with antiviral therapy. To date, no one had explored these concepts in persons with chronic hepatitis C. Methods: A single-sample, cross-sectional research design was used for this study. The study was conducted at an outpatient treatment center in Dallas, Texas, for individuals infected with hepatitis C. A convenience sample of 99 individuals was recruited. Data were collected using self-report information obtained from a Demographic Data Form, the Revised Illness Perception Questionnaire (IPQ-R), the Ways of Coping Questionnaire (WCQ), and the Medical Outcomes Study Short Form-36 version 2 (SF36v2). Correlational statistical analysis was used to determine the relationships among illness representations, coping strategies, and quality of life. Multiple regression analysis was used to determine the predictive ability of the dimensions of illness representations on the dependent variables of emotion-focused coping, problem-focused coping, mental health, and physical health. Results: Significant correlations existed between many of the dimensions of illness representations, coping strategies, and quality of life. The regression analysis demonstrated that illness representations are predictive of coping strategies and quali (open full item for complete abstract)

Committee: Dr. Linda Baas (Advisor) Subjects: Health Sciences, Nursing

PhD, University of Cincinnati, 2006, Nursing : Nursing, Doctoral Program

Problem: Breastfeeding has long been recognized as the preferred method of feeding in the first year of life (American Academy of Pediatrics, 1997). Extensive research confirms the nutritional, economic, biomedical, immunological, and psychological advantages of breast milk. Despite the clear benefits of breastfeeding to mother and infant, breastfeeding rates today continue to remain below the recommended levels in the United States (US), most notably among low-income mothers. Research has shown that breastfeeding self-efficacy is one predictive factor affecting breastfeeding duration. Theoretical Framework: Dennis's (1999) Breastfeeding Self-Efficacy Theory, was the basis for this study. Using this theory, the Breastfeeding Self-Efficacy Intervention Program (BSEIP) was developed. The intervention consisted of a one-hour program delivered during the last trimester of pregnancy. The BSEIP consisted of measures to increase breastfeeding self-efficacy, including education, practice, and demonstration of breastfeeding techniques. Social support and practical advice were provided in the first two-weeks of the postpartum period. Methods: A quasi-Experimental design was used to test the effect of the BSEIP on duration of breastfeeding. A convenience sample of 36 low-income predominately non-Hispanic White women was recruited from two prenatal clinics on the outskirts of a large metropolitan area. All women indicated their intent to breastfeed their infant. Women were assigned by prenatal clinic to either receive or not receive the BSEIP. Data were collected using the Breastfeeding Self-Efficacy Scale (BSES) and a demographic profile. Women were contacted by telephone at two and six weeks postpartum to determine if they were still breastfeeding and to complete the BSES.. Results: Women who received the BSEIP had greater breastfeeding self-efficacy at two and six weeks postpartum than women who did not receive the intervention; women who received the intervention also incre (open full item for complete abstract)

Committee: Dr. Susan Elek (Advisor) Subjects: Health Sciences, Nursing

PhD, University of Cincinnati, 2006, Nursing : Nursing, Doctoral Program

Each year increasing numbers of Americans report the use of some form of complementary and alternative medicine (CAM). The purpose of this descriptive study was to examine the implementation of a health benefits package including CAM therapies for employees of a small, self-insured manufacturing company. A secondary analysis guided by a decision-making theoretical framework was performed using data from the primary study, which examined the cost impact of adding two CAM therapies (Healing Touch and guided imagery) to the health care coverage for some employees of the company. The primary hypothesis of the study was that the insurance expenditures of employees who did not participate in CAM therapies would be significantly higher than participating employees one year after the intervention. Other hypotheses included a cost comparison of insurance expenditures over six years, employee satisfaction, and a decision to continue to receive CAM therapy following completion of the study. Data files included insurance expenditure payouts for all employees from 1995 to 2000 following termination of the study intervention and surveys completed by the study participants (N = 41) during the year of intervention. Overall statistical analysis did not support two research hypotheses that addressed the insurance expenditures in the four years prior to the study and in the year following the study. Mean expenditures for the non-participant group of employees continued to be significantly higher than for the study participants. An examination of employee satisfaction for the study participants revealed statistically significant support for the use of Healing Touch and guided imagery. Significant decreases in pain, stress and increase in emotional well-being (decreased anxiety and depression) were reported by the study participants following therapy. Findings in this study did not support the addition of CAM therapies to a health benefits package. However, the conclusions drawn do not (open full item for complete abstract)

Committee: Dr. Marilyn Sommers (Advisor) Subjects: Health Sciences, Nursing

PhD, University of Cincinnati, 2006, Nursing : Nursing, Doctoral Program

Adolescents constitute the largest group of rape victims. Physiologic theory suggests that injuries may be different in adolescents when compared to adults; however, little is known about genital injuries that adolescents sustain following rape. Previous investigators reported a racial difference in injury prevalence among adult rape victims, with higher injury prevalence among White victims as compared to Black victims. A possible racial difference has not been studied in an adolescent sample. The present study examined the associations among injuries, age, race/ethnicity, and skin color in two groups of female rape victims: adolescents and young adults. The study involved a retrospective review of 234 medical records of women aged 14-29 years old. Over half of the sample was White (56%) and 42.7% was Black. Demographic and injury data were retrieved from medical records and color was quantified through digital image analysis of photographs taken during the examinations. Overall injury prevalence was 62.8%. A series of nested logistic regression and zero-inflated Poisson regression models were conducted. Age was significantly associated with overall injury frequency (Z=6.19, p <.001) and frequency of injuries to the thighs (Z=-3.63, p<.001), labia minora (Z=3.68, p<.001), periurethral area (Z=2.70, p=.007), fossa navicularis (Z=-2.68, p=.008), and vagina (Z=3.20, p<.001). In these associations, younger participants sustained a higher frequency of injuries than older participants. Race/ethnicity was significantly associated with frequency of injuries to the thighs (Z=3.88, p<.001), periurethral area (Z=3.41, p=.001), and fossa navicularis (Z=3.15, p=.002), with White participants having a higher frequency of injuries than Black participants. Finally, skin and mucous membrane color was significantly associated with injury frequency to the labia minora (Z=3.02, p=.003), posterior fourchette (Z=2.75, p=.006), hymen (Z=3.38, p=.001), and cervix (Z=2.85, p=.004), with vi (open full item for complete abstract)

Committee: Dr. Marilyn Sommers (Advisor) Subjects: Health Sciences, Nursing

PhD, University of Cincinnati, 2005, Nursing : Nursing, Doctoral Program

The mission for faculty in university and college settings is generally three-part and encompasses teaching, research, and service. Nurse faculty have struggled to balance work and understand the changing views of scholarship. A number of factors affect faculty commitment to the academic organization, and can influence behavior and attitude in the workplace. No research was found that explored the effect of organizational climate, role ambiguity, role conflict, and nurse faculty work role balance on faculty organizational commitment and turnover intention. The purpose of this study was to examine how organizational commitment and turnover intention are influenced by organizational climate, role ambiguity, role conflict and nurse faculty work role balance in departments/colleges of nursing in Carnegie Doctoral/Research Universities – Extensive, public and private, not-for-profit institutions. The research was based on Meyer and Allen's Multidimensional Model of Organizational Commitment (Allen & Meyer, 1990). The sample was comprised of full-time tenure track, doctorally prepared nurse faculty. Forty-five schools of nursing and 316 full-time tenure track, doctorally prepared nurse faculty participated in the study. This non-experimental descriptive correlational study was conducted using an e-mailed approach. Zoomerang ™, a survey software package, was used for confidential and secure electronic data collection. Pearson correlation, analysis of variance, and logistical regression were computed to analyze the relationships and evaluate the predictive quality of organizational climate, nurse faculty work role balance, role ambiguity, role conflict, and organizational commitment on turnover intention. Path analysis was completed to test the fit of the correlation matrix against the causal model. Role ambiguity and role conflict scores were affected by low, moderate, and high levels of the research, teaching, and service components of work role balance. Significant negat (open full item for complete abstract)

Committee: Dr. Susan Kennerly (Advisor) Subjects: Health Sciences, Nursing

PhD, University of Cincinnati, 2005, Nursing : Nursing, Doctoral Program

The purpose of this study was to analyze the relationships among alcohol consumption and two psychological variables (depression, and conduct disorder) in women who are drinkers who had been involved in an alcohol-related motor vehicle crash (ARMVC). Wilsnack's theoretical model of causes and consequences of problem drinking among women was used to guide the analyses. The sample included 43 participants, 18 to 45 years old, with a mean age of 28.84 years (SD = 7.10). The sample was derived from a brief intervention study that was conducted to test the effect of brief intervention to reduce alcohol consumption. Data were collected using a Health Screening Survey, which included instruments to assess for conduct disorder before and after age 15 and depression both in the previous year and in over a life time. Alcohol consumption was calculated using the Timeline FollowBack method (TLFB). Multiple regression analyses were conducted to assess the relationship among the psychological factors of interest and the average number of drinks per drinking day. Results showed that the combination of conduct disorder before and after age 15, depression over a life time and in the last year, and age were significantly predicted almost 26% of the variance in the average number of drinks per drinking day, (F [5, 37] = 2.65, p < .05). Subsequent regression included three predictive variables at a time to find the best regression model. Results indicated that the best fit regression model that significantly explained approximately 25% of the variance in the average number of drinks per drinking day included depression over a life time, conduct disorder after age 15, and age. Depression over a life time significantly contributed the most to the variance to the average number of drinks per drinking day (37%) followed by age and conduct disorder after age 15. Younger women with a history of conduct disorder and depression consumed more alcohol than their older counterparts. Although more (open full item for complete abstract)

Committee: Marilyn Sommers (Advisor) Subjects: Health Sciences, Nursing

PhD, University of Cincinnati, 2005, Nursing : Nursing, Doctoral Program

Background: It China, more than 20 million people were diagnosed with diabetes in 2000 and it was estimated there would be 42.3 million people with diabetes by 2030 (Wild, Roglic, Green, Sicree, & King, 2004). Diabetes mellitus self-management (DMSM) is considered the cornerstone for controlling diabetes and preventing diabetic complications. To develop effective interventions to promote DMSM in China, it is critical to identify the factors influencing DMSM relevant to this population. The purposes of this study were to test a hypothesized model describing the effects of individual and environmental factors on DMSM in patients with type 2 diabetes in China, and to test if the estimated effects are the same between two subgroups, patients treated with insulin vs. patients treated without insulin. The individual factors included diabetes knowledge, beliefs of treatment effectiveness, and diabetes self-efficacy. Environmental factors included social support from family members and provider-patient communication. Methods: A cross-sectional survey research design was used in this study. The study was conducted at a major hospital in Beijing China. A convenience sample of 201 Chinese adult patients with type 2 diabetes mellitus who attended the outpatient department of the Endocrinology unit at the hospital from September 2004 to November 2004 was obtained for this study. Data were collected using a self-reported questionnaire. Structural equation modeling (SEM) analysis was conducted to test the hypothesized model, and examine and explore the relationships between and among the individual and environmental factors and DMSM. Findings: The initial hypothesized model did not fit the observed data. Based on statistical findings and theoretical soundness, the model was modified. The final model had a good fit to the data. The key findings were that belief in treatment effectiveness and diabetes self-efficacy were key proximal factors affecting DMSM. Knowledge and the environm (open full item for complete abstract)

Committee: Christine Savage (Advisor) Subjects: Health Sciences, Nursing

PhD, University of Cincinnati, 2004, Nursing : Nursing, Doctoral Program

Each year thousands of adolescents suffer burn injuries. Many bear permanent reminders of this trauma such as scars, amputations, and functional limitations. Developmental theories suggest that physical changes can profoundly affect an adolescent as they progress through the complex stage of adolescence. The purpose of this study was to gain an understanding of the experience of adolescents with burn injuries following hospitalization. The hermeneutic phenomenological research design of Max van Manen was chosen to explore this phenomenon. This design explores meanings of everyday experiences from the perspective of the individual. Several data sources were used to illuminate the meanings of this phenomenon: 1) personal experiences with the phenomenon, 2) experiential descriptions of those experiencing the phenomenon, 3) experiential descriptions of the phenomenon in literature, art, and other artistic forms, and 4) idiomatic phrases and etymological sources of words used to describe the phenomenon. Eight adolescents were interviewed however only six were fully analyzed, as two adolescents were unable to reveal the meanings of their experiences. Four common themes were uncovered from the interviews. The lived experience of adolescents with burn injuries is 1) an arduous journey of struggles as each individual freely chooses a unique path to a new way of being, 2) making difficult choices as cherished values are re-examined, 3) creating new images to transform the way of being normal, and 4) becoming empowered while rejoicing in accomplishments and abilities. Two participants contributed creative works which also reflected the themes identified in the interviews. Non-narrative data such as creative and literary works further illuminated the meaning of this phenomenon. A second review of the literature found the experiences of adolescents with chronic illness similar to the adolescents with burn injuries. The findings of this study were congruent with Rosemarie R. Pars (open full item for complete abstract)

Committee: Dr. Margaret Miller (Advisor) Subjects: Health Sciences, Nursing

PhD, University of Cincinnati, 2004, Nursing : Doctoral Program in Nursing

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, occupatio (open full item for complete abstract)

Committee: Dr. Donna Gates (Advisor) Subjects: Health Sciences, Nursing

PhD, University of Cincinnati, 2004, Nursing : Nursing, Doctoral Program

The care of frail, elderly parents is becoming an issue of rising concern as the number of aged people in the population increases. It is estimated that over 22 million people currently provide support to elderly family and friends in this country. Caregivers often provide services at great physical, emotional, and financial cost to themselves. Evidence indicates that the majority of informal caregivers are daughters caring for their parents. Abundant research is available on family caregiving, however, the greatest focus has been on the concepts of caregiver burden and strain. Little investigation into the needs of daughters as a specific group has been conducted. The purpose of this study was to examine the lived experience of daughters who care for their frail, elderly parents in the parents' home. The philosophical underpinnings and nature of phenomenological research were examined as the context for application of van Manen's design. Data were collected from interviews with seven daughters who were currently in the caregiving role. Support for the themes was gleaned from artistic sources. Ten essential themes were elicited. These themes were that caring for frail, elderly parents in the parents' home is: (1) being torn between worlds; (2) embracing the wholeness of commitment; (3) a crucible of individual human effort; (4) a means of self-discovery; (5) a thread that can weave a family together or cause it to pull apart; (6) an experience of reciprocity; (7) a doorway to intimacy; (8) the attempt to maintain the autonomy of the parent; (9) grieving the decline of the parent; and (10) making the best use of the time left with a parent. The ten themes were used to compose a narrative of the daughters' experiences of caring for their frail, elderly parent in the parent's home. The findings were examined in light of Bowlby's Attachment Theory and Kristen Swanson's Theory of Caring. Congruence of the findings with Attachment Theory and partial congruence with the Th (open full item for complete abstract)

Committee: Dr. Margaret Miller (Advisor) Subjects: Health Sciences, Nursing

PhD, University of Cincinnati, 2002, Nursing : Doctoral Program in Nursing

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 (open full item for complete abstract)

Committee: Dr. L. Davis (Advisor) Subjects: Health Sciences, Nursing

PhD, University of Cincinnati, 2001, Nursing : Doctoral Program in Nursing

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.

Committee: Dr. Elizabeth Betemps (Advisor) Subjects: Health Sciences, Nursing

PhD, University of Cincinnati, 2001, Nursing : Doctoral Program in Nursing

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 f (open full item for complete abstract)

Committee: Dr. Margaret Miller (Advisor) Subjects: Health Sciences, Nursing

Doctor of Philosophy, The Ohio State University, 2007, Nursing

Good oral health is vital to the health of women of childbearing age due to the connection of oral disease with poor birth outcomes, preeclampsia, and effects on dental health of her child/children. This secondary analysis of two existing datasets (the Ohio Family Health Survey and the National Health and Nutrition Examination Survey) examined factors related to dental service use and dental insurance for women of childbearing age at varying levels of income, socioeconomic status (SES), and dental insurance coverage. Andersen's Behavioral Model of Health Services Use guided this study. The results showed that for women with low income, dental use was similar for those with Medicaid and private dental insurance, that provider availability influenced utilization, and the factors influencing use were similar at the state (Ohio) and national level. Dental utilization varied significantly by SES. Perceived unmet dental need and dental insurance were significant predictors of use for women across SES groups, but age was a significant predictor for mid and higher SES groups. Race was a significant predictor of dental utilization in the mid SES group. Women of childbearing age with low income (<200% of the 2004 Federal Poverty Level), less than a high school education, and who were unmarried were less likely to have dental insurance. For uninsured women of childbearing age, being a minority and having less than a high school education was associated with dental service use. This study showed that low income women of childbearing age who received Medicaid insurance had similar utilization levels as privately insured. Significant disparities existed with concerns to dental need and dental service use by socioeconomic status. Therefore further work is needed to reach the goals of increasing access to dental care in Ohio and nationally in order to meet Healthy People 2010 objectives. Public health nurses and nursing organizations need to promote oral health in all women of chil (open full item for complete abstract)

Committee: Barbara Polivka (Advisor) Subjects: Health Sciences, Nursing

Doctor of Philosophy, The Ohio State University, 2007, Nursing

Lung cancer is the leading cause of cancer death in the United States. Despite known benefits of quitting smoking after a diagnosis of lung cancer, 13-20% of patients still do not quit. The variables and relationships that influence smoking behavior among lung cancer patients are poorly understood. The Self-Regulation Model of Illness (SRMI) provides a framework for furthering an understanding of why individuals diagnosed with lung cancer continue to smoke. The purpose of this study was to examine sociodemographic (age, education, income) and biobehavioral (nicotine dependence, social support) characteristics, patient perception of illness (illness representation), and quality of life after a recent diagnosis of lung cancer at baseline and 6 months to further describe smoking behavior. This study had a prospective, one-group longitudinal design and included patients who were 18 years or older, had a confirmed diagnosis of lung cancer within the past 60 days, and self-reported current smoking within the past 7 days. After obtaining informed consent, patients produced a 1mL saliva sample for cotinine analysis and completed a series of questionnaires at baseline and 6 months. Patients who self-reported abstinence from smoking at 6 months provided a saliva cotinine sample for biochemical verification. Descriptive statistics were calculated on sociodemographic, medical history, tobacco use, illness representation, and quality of life data. Differences between mean scores for each illness representation attribute over time were calculated. Fifty-three patients enrolled and only 27 (50.9%) reached the 6 month study endpoint. At 6 months, five (18.5%) patients were biochemically confirmed to be abstinent by saliva cotinine. Due to the small sample size at 6 months, statistical comparison between smokers and quitters was not conducted. Importantly, most patients (78.1%) made at least one attempt to quit smoking in the previous 6 months. Significant differences over time were (open full item for complete abstract)

Committee: Mary Ellen Wewers (Advisor) Subjects: Health Sciences, Nursing

Doctor of Philosophy, The Ohio State University, 2007, Nursing

Physiological events in the initial, essential inflammatory stage of wound healing influence subsequent overlapping stages. Proinflammatory cytokines coordinate molecular and cellular processes during the inflammatory stage. Polyunsaturated fatty acids alter proinflammatory cytokine production, but how this phenomenon influences wound healing is not clearly understood. We examined effects of marine-derived omega-3 eicosapentaenoic and docosahexaenoic polyunsaturated fatty acids on proinflammatory cytokines in wound serum and time to complete healing in healthy, human skin. This randomized, experimental study of two groups, (N=30), compared plasma fatty acid levels at baseline and after four weeks of omega-3 supplements or placebo. Eight small blisters were created on all participants. Proinflammatory cytokines IL-1beta, IL-6, and TNF-alpha were measured in blister fluid at 5 and 24 hours after creation. Wound area was calculated daily until 100% closure. We found that eicosapentaenoic and docosahexaenoic plasma fatty acid levels were significantly greater in participants who received the supplement for 4 weeks than the control group. Additionally, there were significantly higher levels of IL-1beta in blister fluid in participants consuming the supplements and time to complete wound closure was no significantly longer. These results suggest that omega-3 eicosapentaenoic and docosahexaenoic polyunsaturated fatty acids increase proinflammatory cytokine production at wound sites and thus, depending on the clinical context, have noninvasive, therapeutic potential to affect skin wound healing .

Committee: Karen Ahijevych (Advisor) Subjects: Health Sciences, Nursing

Doctor of Philosophy, The Ohio State University, 2007, Nursing

Type 2 diabetes is a growing threat to the health and well-being of Americans. Mid-life women are especially vulnerable to the devastating complications associated with diabetes. Health care professionals must facilitate effective diabetes self-management to minimize the negative consequences of the disease. Self-regulation theory provided a framework for nursing research, “Illness Representation and Glycemic Control in Women with Type 2 Diabetes” (IRT2DM). Illness representation theory proposes that a health threat is processed on cognitive and emotional levels. Emerging from this is a schema termed “illness representation”. The content of illness representation then shapes the choice of coping procedures to the threat. Using a descriptive, exploratory, cross-sectional design, the following research questions were posed: 1. What are the illness representations of a group of women with Type 2 diabetes? 2. What psycho-social factors are associated with illness representation? 3. What is the relationship between illness representation and diabetes self-management? 4. What diabetes self-management practices are associated with glycemic control? Illness representation was measured using the Illness Perception Questionnaire-Revised (IPQ-R). Diabetes knowledge was tested using the University of Michigan Diabetes Knowledge Test (DKT). Demographic and medical history data were gathered. Self-monitoring of blood glucose (SMBG) was chosen to represent effective coping procedures. Level of glycemic control was measured using HgbA1C. The average age was 57 years. The majority was White (65%) and well educated. The majority of the women (75%) reported having 2 or more co-morbidities. Only 40% reported performing SMBG daily. The average HgbA1C was 8.2% at baseline. Diabetes knowledge was high, although there was lack of knowledge about goals for blood glucose testing. Higher scores on two of the constructs in illness representation, cure/control and emotional representation, were (open full item for complete abstract)

Committee: Nancy Reynolds (Advisor) Subjects: Health Sciences, Nursing