Using a cross-sectional, correlational design, a convenience sample of 95 African American women from the southeastern United States was obtained. Results confirmed a statistically significant 1) positive relationship between gender role beliefs and relationship power, (r = 0.354, p < .001); 2) negative relationship between gender ratio imbalance beliefs and relationship power, (r = -0.472, p < 0.001); 3) positive association between relationship power and avoidance of risky sexual behavior, (r = 0.340, p = 0.001); 4) negative correlation between gender ratio imbalance beliefs and risky sexual behaviors, (r = -0.235, p = 0.022); and 5) positive correlation between safer sexual behavior and peer perceptions of safer sex behaviors, (r = 0.475, p < 0.001). Results from a stepwise multiple regression indicated that relationship power (p = 0.001) and peer perception (p < 0.001) were significant predictors of sexual behavior, accounting for 31% (p < 0.001) of the variance.

A total of 23 women (mean age of 29.7, SD=3.9), 18 in SUGAR group and 5 in control group (CG) completed self-reported standardized questionnaires (Risk Perception Survey for Developing Diabetes adapted for women with GD; Self-Rated Abilities for Health Practices; Health Promotion Lifestyle Profile II; General Sleep Disturbance Scale; and Demographic Questionnaire) at baseline (third trimester) and post-test (postpartum 6-8 weeks). Intervention was given post the baseline data collection with a booster session at 2-4 weeks postpartum. The women in CG received attention control treatment.

Study participants were obese (BMI M=33.1, SD=7.7) and a majority had a family history of DM. Findings showed that self-efficacy was the single significant predictor and accounted for 22% of the variance of healthy lifestyle behaviors. Participants had a clinical significant sleep disturbance during both pregnancy and postpartum. At baseline, poor sleepers reported a lower self-efficacy. The intervention significantly increased DM knowledge for women in the SUGAR group; however, not for perceived risk, self-efficacy nor healthy lifestyle behaviors. There was no difference between groups for postpartum glucose screening rates with only 39% receiving recommended testing.

Future research needs to focus on prevention programs and center on self-efficacy, postpartum glucose screening, improve sleep, and adoption of healthy lifestyle behaviors. To ensure a better preventive care for GD women, education provided for both patients and health care provider is needed.

A correlational design was used. The design included three components: abstraction of patient data from the electronic medical record (EMR) (n=79 with VAP and n=79 without VAP), administration of surveys to ICU nurses (N =34), and vignettes related to SVs. Analyses included descriptive statistics, t-tests, correlations, and analyses of covariance.

Most nurses held a Bachelors degree (70.6%), had < 9 years of ICU experience (52.9%), worked in a medical ICU (47.1%), and reported high confidence in managing SVs (M =8.88, SD =1.25). The majority of patients (N =158) were Black (58.2%), males (56.3%), and on average middle-aged (M =61.5, SD =14.91), with a long ICU LOS (M =15.5, SD =11.84), extended duration of MV (M =9.5, SD =8.47), and high acuity (APACHE III) (M =70.2, SD =25.42).

The nurses’ education, advanced certification, and ICU experience were not associated with the appropriate implementation of SVs in the vignettes. On average nurses’ had low scores on the vignettes (M =6.97, SD =2.21; possible range =0-14). The adherence rate of nurses’ implementation of SVs, determined using EMR data, was also low (M =24%; SD =23%). There were higher rates of SV adherence in patients without VAP (p (p < .01), and a duration of MV < 6 days (p =.04).

These findings indicate that even with established protocols, nurses may not consistently implement the evidenced-based interventions that have been shown to prevent nosocomial infections. Future research is needed to improve nursing practice and the quality of care in this patient population.

This study used C57BL/6J mice with the R1648H missense mutation on the Scn1a gene (engineered in the Escayg lab) (Martin, M. S. et al., 2010). The three specific aims used separate groups of animals for experimentation, and all paradigms were performed under strict laboratory conditions.

Data were analyzed using either an independent t-tests, two-way ANOVA or repeated measures two-way ANOVA. Results showed that stress worsens seizure phenotype in both the Scn1a^R1648H (RH) mutants and wild-type (WT) group with the RH mutants more severely impacted. In addition, there was clear and consistent evidence for hyperactive locomotor behavior. Lastly, no evidence was found for use of docosahexaenoic acid (DHA, an omega 3 fatty acid) as a neuroprotectant for hyperactivity (DHA was given subcutaneously for two weeks starting at weaning).

Outcomes from this study implicate that stress worsens the seizure phenotype in animals with Scn1a^R1648H. This study is also the first to report hyperactive locomotor behavior in animals with Scn1a^R1648H. Results from this study may broaden beyond GEFS+ in that we may also be able to apply the findings to other disorders with SCN1A dysfunction. In addition, it may be that genetic variants affecting SCN1A, but not necessarily in epilepsy, may contribute to hyperactivity. This could mean that SCN1A is a candidate gene for hyperactivity. The main goal of nursing care is to reduce and prevent disease morbidity, and knowledge gained from the current study will guide clinical nursing practice, such as targeted behavioral assessment and education, as well as nursing research focusing on children with this genetic disorder.

THE EXAMINATION OF FACTORS THAT INFLUENCE TREATMENT SEEKING

DELAY AMONG OLDER ADULTS DIAGNOSED WITH

ACUTE MYOCARDIAL INFARCTION

By

Deonna S. Tanner

Early diagnosis and treatment of acute myocardial infarction (AMI) can greatly reduce the morbidity and mortality associated with this condition. However, individuals, particularly older adults, delay seeking treatment for AMI symptoms. The purpose of this study was to examine the relationship of factors that influence pre-hospital delay in seeking treatment among older adults diagnosed with AMI.

A descriptive, cross-sectional, comparative study design with a correlational component was used. Data were collected from 82 hospitalized older adults (60-80 years of age). For statistical analyses, older adults were divided into two groups. The shorter delay group delayed ≤ 120 minutes from the onset of symptoms (OS) and the longer delay group delayed > 120 minutes. Using the Common Sense Model as a guide, groups were compared on the following variables: internal influences (age, gender, race, history of AMI) and external influences (personal and professional support), cognitive representations of symptoms (symptom interpretation, perceived level of control, seriousness), and emotional representations of symptoms (anxiety and uncertainty).

The majority of participants were retired/unemployed (64.6%) White men (82.9%) who were married (73.2%) with a mean age of 69.04 (± 5.82) years. The median delay time was 2.6 hours (range 0.5 - 432 hours). Participants experienced on average eight (± 3.86) symptoms (typical and atypical) with high levels of pain (M= 7.1 ± 3.4) and high state anxiety (M = 56.47 ± 10.37) at the time of the AMI.

Findings show the only significant independent predictor of delay time was personal support. Being more certain that symptoms were heart related or having a previous AMI resulted in significantly shorter delay time (p <.05). Contacting a healthcare provider was not helpful for these older adults. Findings show factors influencing delay are challenging and complex, yet laypersons play an important role in the decision to seek treatment. Future research should include community-based educational programs focusing on atypical AMI symptoms and ways to increase the activation of emergency medical services soon after the OS.

A cross-sectional, correlational study was conducted with a non-randomized sample of 216 HIV positive MSM. Participants were predominantly Black/African American (85.6%). The mean age of the sample was 43.02 years (SD = 9.74) and ages ranged from 19 to 66. More than 90% reported a high school educational level or greater; and nearly half (47.2%) had been diagnosed with HIV for more than 10 years.

The overall model predicted that participants who had perceived less severity of living with HIV and who had a positive attitude toward condom use were more likely to practice safer sex, accounting for 24% of the variance in sexual behavior (p < .001). When controlling for demographic characteristics (age, number of years diagnosed as HIV positive, number of recent sexual partners, and current antiretroviral medication use), the overall model accounted for 41% of the variance (p < .001). Participants who had a fewer number of recent sex partners and who had a positive attitude toward condom use were more likely to practice safer sex. Additionally, those who practiced safer sex (n = 58, 27%) reported significantly higher levels of perceived severity of living with HIV (p = .037), perceived benefits of safe sex (p = .018), perceived barriers to safe sex (p < .001), and self-efficacy for negotiating safe sex (p = .013) compared to those who did not practice safer sex (n = 157, 73%).

Results from the study indicated there was a high prevalence of unsafe sexual practices among the participants. These findings support the need for additional research to explore factors that influence sexual behavior among HIV positive MSM with an emphasis on testing interventions that support safe sex practices.

Interpretive phenomenology was used to describe and interpret the experiences of 11 medical-surgical nurses who cared for patients who were homeless and reported their attitudes toward this marginalized population had transformed. Nurses’ clinical experiences ranged from 3 to 40 years. Audiotaped semi-structured interviews were conducted. Data analysis was ongoing throughout data collection as delineated by Diekelmann and Allen (1989) and expanded by Minick (1992). Five themes were revealed through interpretation of the rich data. The themes were ‘Discovering homelessness,’ ‘Finding common ground,’ ‘Piecing it together,’ ‘A daily struggle,’ and ‘Relationships based on distrust.’

Nurses’ attitudes were in constant development and transformation. Nurses’ life and clinical experiences created opportunities for attitude transformations. Experiences associated with attitude transformation were identified. Nurses’ experiences revealed how nurses enter practice with an established attitude toward this marginalized population. As nurses came to realize that homelessness was no longer an abstract, intangible concept rather homelessness existed and was present in their day-to-day nursing practices their attitudes began to transform. Nurses sought common experiences with patients who were homeless to create a sense of connectedness in nurse-patient relationships. Nurses described a daily struggle of maintaining positive, non-judgmental attitudes. Nurses shared how early experiences of negative encounters with patients who were homeless created feelings of distrust thus altering nurse-patient relationships with future patients who were homeless. This study contributes to nursing knowledge by revealing how medical-surgical nurses’ attitudes develop and transform and how experiences are associated with attitude change. Recommendations for nursing practice, education, research are identified.

Methods: Secondary analysis of baseline and 12-month data collected from women presenting for CPP treatment (n = 673) at a tertiary referral center was performed. Questionnaires assessed medical symptoms, physical and mental health, abuse, trauma, catastrophizing and the main outcome measures of pain reports (McGill Pain Questionnaire) and QOL scores (adapted version of the Irritable Bowel Syndrome QOL Questionnaire).

Results: Of the 673 enrolled, 401 completed baseline questionnaires. These women were predominantly middle aged (M = 35.68, SD = 9.87), married (66%), Caucasian (78%), and educated (M = 14.83, SD = 2.55). Two hundred seventy-two women completed questionnaires at baseline and 12 months and were similar in most characteristics but reported fewer incidents of trauma and abuse, improved physical health and fewer medical symptoms. Women experienced a significant reduction in pain (t (261) = 11.23, p < .001) and improved QOL (t (257) = 6.78, p< .001). Baseline catastrophizing was a predictor of baseline pain (R² = .42, pβ = .46, p < .001) and baseline QOL (R² = .79, p< .001; β = .71 p < .001) with similar results at 12-month follow-up. While baseline catastrophizing contributed only 3% of the variance it remained a significant predictor of 12-month pain (R² = .39, p < .001; β = .18, p = .003). Unexpectedly, abuse and trauma histories were not significant predictors of pain or QOL.

Conclusions: These findings contribute to the existing body of literature by confirming the complex nature of CPP and suggest that psychological processes such as catastrophizing play a vital role in CPP. Future research in CPP will benefit from the exploration of the contribution of psychological processes to CPP and the application of research from other pain conditions to gynecologic pain disorders.

Descriptive correlational analyses were performed using retrospective triage data from electronic medical records. The sample of 286 patients with symptoms suggestive of AMI comprised primarily Caucasian, married, non-smokers, of mean age of 61 with no prior history of heart disease. The sample of triage nurses primarily comprised Caucasian females of mean age of 45 years with an associate’s degree in nursing and 11 years’ experience in the ED.

RNs in the study had an accuracy rate of 54% in triage of patients with symptoms suggestive of AMI. The older RN was more accurate in triage level designation. Accuracy in triage level designations was significantly related to patient race/ethnicity. Logistic regression results suggested that accuracy of triage level designation was twice as likely (OR 2.07) to be accurate when the patient was non-Caucasian. The patient with chest pain reported at triage was also twice as likely (OR 2.55) to have an accurate triage than the patient with no chest pain reported at triage. Electrocardiogram (ECG) delay was significantly greater in the patient without chest pain and when the RN had more experience in ED nursing. Triage delay was significantly related to patient gender and race/ethnicity, with female patients and non-Caucasian patients experiencing greater delay. An increase in RN years of experience predicted greater delay in triage. Further studies are necessary to understand decisions at triage, expedite care, improve outcomes, and decrease deaths from AMI.

A total of 45 Latino (mean age 45 + 9) MSFWs receiving HTN treatment participated in this study. Spanish and English questionnaires were available for participants to measure adherence to HTN treatment and the five independent variables. Analysis included correlations, t-tests, hierarchical multiple regression, and hierarchical logistic regression.

The majority of MSFWs were from Mexico, female (55.6%), had less than a 6^th grade education. Most (82%) of the MSFWs had uncontrolled BP, and were not adherent to medications (42%), even with high BP knowledge scores (M = 6.5 ±1.3). MSFWs perceived a high level of stress (M = 16 + 6.9), low acculturation level (Anglo orientation: M = 2.9 + 0.9), and no employer-provided health insurance for personal illnesses or injuries (93%). Blood pressure knowledge, perceived stress, acculturation, health literacy, and HCA accounted for 49% of the variance in the BP self-care; however, only higher BP knowledge was a significant predictor of better BP self-care (p < .001). Furthermore, acculturation was a significant predictor of BP control (p < .01).

This study explored select determinants of adherence to HTN treatment in Latino MSFWs in a culturally informed way. Although BP self-care behaviors appeared to be a consequence of BP knowledge, this study found low medication adherence in Latino MSFWs and uncontrolled BP explained by the two predictors, acculturation and health literacy. Perceived stress and health care access did not influence the adherence to HTN treatment. MSFWs had poor BP control and HTN treatment adherence. A culturally appropriate educational program is needed to help the MSFWs adherence to HTN treatment.

A secondary data analysis using baseline data from a larger study of mind-body interactions in caregivers of family members with PMBTs was used. Caregiver data included standardized questionnaires, serum blood draw, and three-day sleep-wake activity data from an accelerometer. Analyses included descriptive statistics, correlations, t-tests, and hierarchical regression models.

Caregivers (N = 133) were White (94%), female (69.2%) spouses (75.2) and on average 52 years old (SD = 11.8). Care recipients were mainly White males of similar age

with a highly malignant glioma (57.4%). Sleep latency was longer (35 min, SD = 34.5), with shorter total sleep time (TST) (357 min, SD = 84.6) and more frequent wake after sleep onset (WASO; 15.1%, SD = 9.2) than in the general population. Caregivers reported high anxiety (59.4%). Caregiver comorbidities and care recipient functioning explained higher perceptions of health (R² = 26, F(2, 84) = 14.94, p < .001). Whereas, longer TST, more WASO and poorer sleep quality explained poorer quality of life (R² = .27, F(4, 66) = 6.19, p < .001). Sleep loss variables explained little variance in physical health status, interleukin-1ra and interleukin-6 levels, fatigue, depressive symptoms, spiritual health, social support, and work limitations.

Nurses need to assist caregivers with anxiety management and ways to improve sleep at time of PMBT diagnosis. Sleep impairments place these caregivers at risk for physical and mental health problems, and compromise their ability to continue in the role.

Using a cross-sectional correlational design, associations between disaster exposure, problem focused coping (PFC), emotion-focused coping (EFC) and PTSD symptoms (Impact of Events Scale-Revised (IES-R) scale) were explored. A random sample (n= 995) was drawn from a list of nurses from the New Orleans region. Each nurse was mailed an invitation to participate in an online survey. Three post-card reminders were sent.

The sample was divided into nurses who participated in disaster activities (n=76) and those who did not (n=32). Prevalence of PTSD in the PIDA nurses was 13.2%. Almost half the PIDA nurses (48.7%) reported symptoms of PTSD, and increased use of substances to cope (31.5%). Only 9.2% sought psychological care post-event. Regression analyses, controlling for history of trauma, marital status, and gender found EFC accounted for a significant amount of the variance of symptoms of PTSD (R² = 0.32, F (1, 67) = 25.09, p < 0.001) (B=0.4, SE=0.01, p

Prevalence of PTSD among PIDA nurses was lower than other groups of professional responders (17.4% in firefighters), but greater than the general public (6.8%). Presence of PTSD in PIDA nurses five years after Hurricane Katrina is associated with the increased use of EFC and substances.

A cross-sectional, correlational design was used. Data were collected from female caregivers of preschoolers. Reliable and valid instruments measured family factors, demographic characteristics, comfort in parenting, appraisal of behaviors, daily stress, parenting stress, depressive symptoms, social support, ratings of children’s behaviors, and distortion in the ratings. Analyses included ANOVA, ANCOVA, Chi-square, simultaneous and hierarchical linear regressions.

Results indicated that family typology was not associated with the female caregivers’ appraisals of children’s behaviors or distortion of caregivers’ ratings of behaviors; however, it was associated with risk of having children with behavioral problems. In the simultaneous regressions models, greater discomfort with parenting and greater perceived daily stress were associated with more negative appraisals of children’s behaviors by the female caregivers and Caucasian race and higher distortion in behavioral ratings were associated with higher risk of behavioral problems in children. Social support did not buffer the effects of caregiver depression on appraisals of children’s behaviors or level of risk of children having behavioral problems.

Methods: This study used a descriptive, correlational design. A convenience sample (N = 220) included female registered nurses (RNs), 23-66 years old (M = 48; SD = 9.7), mostly white (N = 143; 65%), who had worked in nursing an average of 21 years (SD = 11.3) and reported their job as stressful/very stressful (N = 129; 59%). Nurses were recruited from five acute care hospital systems in a large southeastern city. Data were collected using standard questionnaires that measured perceived CVD severity and susceptibility, social support, depression, stress, exercise and nutrition. Participants completed data collection via an online survey method.

Results: Data were analyzed using MANCOVA. For every standardized unit increase in perceived severity of CVD, participants had a 1.26 (95% CI: 0.02, 2.50) unit reduction in their healthy food choice score (lower scores = healthier food choices), and a 0.12 increase in their physical activity score (higher scores = more physical activity) (90% CI: 0.01, 0.23) unit. For every standardized unit increase in perceived CVD susceptibility there was an increase in the healthy food choice score by 2.37 (95% CI: 1.09, 3.65) units, and a reduction in the physical activity score by 0.27 (95% CI: 0.12, 0.41) unit. Greater age (p = 0.01) and greater depression (p = 0.001) were statistically significant predictors of lower physical activity. CVD susceptibility did not moderate the effect of CVD severity on nutrition or physical activity.

Conclusions: Higher perceived CVD severity was associated with increased likelihood for healthy food choices and physical activity. In contrast, higher perceived CVD susceptibility was associated with decreased likelihood for healthy food choices and physical activity. More research is needed to understand how susceptibility beliefs around CVD are formed in women and how to better engage women in risk reduction behavior.

Interpretive phenomenology, based on the work of Maxx van Manen, was used to describe and interpret the healthcare experiences of 15 obese AAW living in communities in Georgia. The women ranged in age from 23 to 62, with body mass index ranging from 35-55. The majority of the sample (83%) had adequate health insurance. This was a well educated sample with 87% having college degrees or some college education. Individual, audio-taped interviews were used to collect data.

Data were analyzed using interpretive phenomenological methods, with analysis and collection occurring concurrently. Data were analyzed as a whole then line by line to identify themes across transcripts. Two patterns and five themes were identified. Patterns were: They're not listening and Good or bad, it's my decision. Themes were: Attributing all problems to weight; They say lose weight but give us no tools; Stigmatization; Cancel my appointment please: I won't be back, and Empowerment.

The women recalled a pleothra of negative encounters with providers that they termed "demeaning" and "nastiness for no reason." Many women reacted by delaying or avoiding healthcare, some not returning for preventive health screens for many years. The significant association between obesity and mortality from cervical and breast cancers necessitates timely preventive screens by obese women. The results of this study can help to inform practice, education, and research. Recommendations for all three areas were deleneated in the study.

Methods: A descriptive correlational analysis was performed using baseline data from the National Health and Nutrition Examination Survey (NHANES) [2007-2008]. Constructs from the Health Promotion Model were used to predict health-promoting behaviors and health outcomes in diabetes self-management. The 713 participants with diabetes were primarily Black or Hispanic (57.5%), older ( M 62.2 years, SD 12.9), and married or living with a partner (56.2%). Approximately half of the participants were female (50.8%); 59% were obese.

Results: The longer the time since diagnosis and the more barrier days experienced per month, the more frequently blood glucose monitoring was performed (R2 = .076, R2adj = .060, F (6, 363) = 4.875, p < .001). The greater the body weight, the more likely participants were to implement diet management behaviors (R2 = .097, R2adj = .081, F (7, 413) = 6.209, p < .001). The younger the age and the higher perceived health status, the more minutes per week were spent in exercise (R2 = .054, R2adj = .038, F (7, 412) = 3.307, p < .01). The older the age and the shorter time since diagnosis, the lower the A1c levels (R2 = .054, R2adj = .044, F (6, 568) = 5.391, p < .001). The younger the age, the more barrier days per month and the more diet management behaviors reported, the higher the BMI (R2 = .149, R2adj = .140, F (6, 581) = 16.764, p < .001). Findings indicate that treatment measures, not preventative, are being practiced, and that predictors of behaviors and outcomes are multifaceted and require further investigation.