Lauren Elizabeth Allen
Breaking Barriers to Long Acting Reversible Contraception: Preventing Rapid Repeat Pregnancy in Latina Teens
Advisor: Pat Mahaffee Gingrich, MSN, WHNP-BC
I decided that I wanted to become a nurse because I love science and I love helping others. I wanted a career that would be fulfilling and that would give me the opportunity to interact with people from many different backgrounds and perspectives. I enjoy being with people through difficult times in their lives and caring for those who need extra compassion and support.
Teen pregnancy and rapid repeat pregnancy in Latinas places a heavy burden on this population, which can lead to negative outcomes for the mother and her children. Long Acting Reversible Contraception (LARC) is highly effective for preventing pregnancy, yet is vastly underused by Latina teens. A literature review revealed that the cost of the devices, myths and misconceptions about LARC, and inadequate counseling prevent many teens from utilizing the most effective forms of contraception. Discussions with Latina patients about LARC should be informative and thorough, with an understanding that it is crucial to maintain deep respect and cultural sensitivity, to recognize distinctive values, and to understand the role of acculturation in a patient’s contraceptive decision. By compiling evidence-based practices for discussing LARC and maintaining culturally sensitive care for Latinas, a tool was created to facilitate communication between patients and providers. The patient handout was designed to initiate conversation with the provider about a patient’s background, her knowledge about contraceptive methods, and her goals for contraception. It also includes a list of common myths about LARC that are dispelled. This handout would ideally be given to the patient as she is in the waiting room before the appointment. Providers receive a handout with all the information given to the patient, tips for promoting LARC, and a guide to providing individualized care to Latina patients. Better communication between Latina teens and healthcare providers can facilitate selecting a method of contraception that best suits the patient’s needs.
Laura Elizabeth Britton
The Impact of Abortion Policy on Patient Safety: How Is It Measured?
Advisors: Beth P. Black, PhD, RN & Cheryl B. Jones, PhD, RN, FAAN
I chose to become a nurse after working in patient care and research at Planned Parenthood. I felt called to the role because as nurses we listen to our patients, honor their dignity, and help them to find their strength when they are suffering. We also see firsthand how policy affects health. With that insight from the bedside, we are well-positioned to be leaders that identify structural inequality and work for social justice. I decided to pursue nursing research as a Hillman Scholar in order to work for health equity. My research interests include health disparities among the LGBTQI population, end of life care, and reproductive justice, particularly issues revolving around breastfeeding, contraception, and abortion. My doctoral work will focus on public policy and abortion access.
In 1973, the Supreme Court decision Roe vs. Wade established the constitutional right to abortion, but since 2010, the number of abortion laws has increased significantly. The impact of those laws on society has been conceptualized and evaluated in a variety of ways, but their impact on patient health remains obscure. The purpose of this research is to examine measures that could be used to evaluate the impact of abortion policy on patient safety. The methodology used in this project was Bardach’s “eight-fold path” for conducting a policy analysis. A literature review was performed to identify measures from 20 studies evaluating the association between abortion policy and patient safety. Four common measures were identified: abortion fatality rate, abortion rate, unintended pregnancy/birth rate, and delay in abortion timing. Each measure was systemically evaluated based on two criteria: (1) relevance and validity as a measure of patient safety and (2) convenience. The most relevant and valid measure was delay in abortion timing. While collecting data about abortion timing is inconvenient and costly, it is worthwhile as long as the concept of “safety” is prominent in the political discourse around abortion and valid evidence for policy-making is desired. The first step toward evidence-based public policy is ensuring the use of valid, relevant measures.
A Transgender Individual’s Lived Experiences: Navigating Discrimination and Stigma in Healthcare
Advisors: Beth P. Black, PhD, RN & Beverly B. Foster, PhD, RN
Through my life I have enjoyed an enduring interest in healthcare. As an active child, I sustained various injuries that resulted in medical care. My curiosity about the human body grew with each health care visit. I was fascinated by the multi-disciplinary approach afforded to the patients and became aware that the compassion, respect, and empathy of the nurses was sometimes more therapeutic than any diagnosis delivered or medication prescribed. As an adult, I served as a firefighter and emergency medical technician. My most fulfilling moments in this position came while working directly with patients to set them at ease as they received treatment. I believe that my place in the health care field is working with patients during their time of need by being their nurse. The nursing profession provides me with a future filled with passion, purpose, and a commitment to the lives of others.
This paper explores the various types of marginalization transgender individuals experience on a daily basis and its direct impact on the aggregation of health disparities for this population. In addition, responses from the healthcare community to the documented injustices of transgender people are analyzed at a federal, systems, and academic level. Conceptual frameworks are also evaluated to further understand and care for transgender clients. Using a phenomenological approach, this research describes the lived experiences of a transgender individual with healthcare, specifically how they navigate discrimination and stigma with providers, nurses, administrative staff, and facilities. Analysis revealed four themes, both with navigating healthcare and social interactions that have influenced his sense of self and state of health. These themes are (a) calculating the disclosure of a transgender identity, (b) managing discomfort of self and others, (c) respect and validation from others, and (d) lack of healthcare access. Practical implications for healthcare providers are also investigated, including opportunities for furthering the advancement of the healthcare profession as it relates to caring for the transgender community.
Mary Grace Cromeens, JD
What Transitional Care Interventions Are Used in the Care of Burn Patients. An Integrative Review
Advisor: Cheryl B. Jones, PhD, RN, FAAN
I earned an undergraduate and master’s degree in history, and later attended law school to help the underserved better navigate the legal system. I was drawn to nursing to develop meaningful connections with patients, their families, and communitieis. Nursing offers challenging opportunities for learning and growth through a variety of exciting pathways. I chose to enter the Hillman Scholars Program in Nursing Innovation to be an advocate for my community and to improve health care by blending health, law, and nursing research.
Patients with burn wounds present complex and long-term challenges to healthcare providers. A recent study revealed burn patients experience 30-day readmission rates as high as 25% (Mandell, Pham, & Klein, 2013). Readmission rates represent a costly challenge. In the recent past, transitional care has been offered as a possible solution for high readmission rates, unexpected emergency visits, elevated mortality rates, and high costs. The purpose of this integrative literature review is to identify the potential need for transitional care in patients with burn injuries by pinpointing key elements of seminal works in transitional care and analyzing discharge planning in the burn patient population within this context. Cooper’s 5-stage method (1998) was used to systematically search the literature. Search terms included transitional care, discharge planning, home care planning and burn patients/wounds/injuries. After applying exclusion criteria, 10 articles covering 8 transitional care frameworks were selected, revealing 14 common transitional care interventions. Discharge and home care planning articles were also reviewed for studies predating the body of transitional care research. Six discharge/home care planning articles also met study criteria. These works, all descriptive in nature, shared 16 common interventions. The 6 home care and discharge planning articles for burn patients represent a lineage predating the transitional care frameworks currently used in healthcare. Burn units have a strong history of preparing for patient transitions from hospital care. However, the lack of current research examining the implementation of transitional care protocols in burn units combined with high readmission rates indicate a need for further development and investigation.
Emily E. Danforth
The Dear Baby Project: An Interactive Journaling Tool for Pregnancy Education
Advisor: Pat Mahaffee Gingrich, MSN, WHNP-BC
I was transitioning from a career in sociology, and I was ready to use my background in a more applied way. Nursing has allowed me to take my sociological perspective and use it as a tool for providing service to others while working to reduce health disparities. Previously, I did research and analyzed how different groups of individuals had different health outcomes. Now I have the chance to be out in the field and gain a broader idea of the context in which each person experiences “health.” It is immensely rewarding to feel like I am an agent of change and to have a direct impact on people’s lives and well-being. Beyond these reasons, I have found that nursing is personally empowering. I am able to be a better mother, wife, daughter, and friend.
A wide body of literature indicates that pregnancy and childbirth education is often inaccessible and that it inadequately addresses psychological aspects of pregnancy. This paper reviews the numerous barriers to providing useful prenatal education and outlines the ideal approach to prenatal teaching. The author presents the concept for a new tool for interactive pregnancy education, The Dear Baby Project. The Dear Baby Project is a self-contained kit that involves the cognitive, physical, and affective aspects of pregnancy and delivers health information while leading women to create a scrapbook and journal of their pregnancy. The Dear Baby Project capitalizes on the known benefits of reflection and journaling to provide a fun approach to pregnancy and parenting education. The exercises contained in the Dear Baby Project guide women through important learning topics and promote a feeling of mental and emotional readiness. The Dear Baby Project is meant to address six educational units and this paper presents the pilot materials for one of those units: emotions and emotional aspects of pregnancy and parenting. With careful attention to readability, appropriateness and suitability of materials, the author provides examples of educational, art and literary components from the kit. The flexibility of this design will allow clinicians to select relevant modules and distribute kits that are tailored to each patient’s individual risks, needs, interests and expectations. The final portion of this paper describes the next steps in the project’s design and implementation and proposes some innovative modifications for the project content.
Arthur John Gribensk II
The Use of Smartphone Apps as a Weight-Loss Intervention
Advisor: Jennifer Leeman, DrPH
Growing up in a rural town in North Carolina, along with teaching in a low-income inner-city school, I have realized that education and empowerment are key to improving all aspects of one’s life. These tools were given to me by others, and as a result I have dedicated my life to helping others develop them as well. I chose to go into nursing because the profession allows me to share with patients the knowledge and the resources necessary to take control of their health and lead better lives.
Today, over two-thirds of American adults are obese and this trend shows no signs of changing. Because older methods have been ineffective in decreasing this epidemic, this literature review was carried out to examine smartphone apps, a new technology that has recently become ubiquitous. Smartphone apps offer a novel approach to gather real-time patient health data and create personalized interventions to increase physical activity and maintain a healthy diet. In order to explore the evidence for apps as a weight-loss tool, a systematic search for studies that had smartphone apps as a patient intervention for weight loss was conducted on December 19th, 2013. The studies were reviewed for evidence of apps’ effectiveness, usability, and use of theory. Overall, there was a general lack of theory used in the creation of smartphone apps, and most studies had small sample sizes and lack of controls. The results of this review point toward smartphone apps being a usable, effective, and inexpensive intervention for patent weight loss. Because of the studies’ limitations, this conclusion must be qualified, and further research needs to be conducted in order to solidify these results.
Caring Across Barriers: A Review of Literature Concerning Hispanic Women with Breast Cancer
Advisor: Sara L. Hubbell, APRN, MSN, NP-C, FCN
I chose to go into nursing because it combines my passion for physiology while providing care to those in need. What excites me the most is the relationships that I form with my patients. As a nurse, I have the opportunity to be my patients’ primary care giver and advocate. I am eager to be a part of a field that piques my interest, is constantly evolving, and also allows me to foster rewarding relationships with others.
Hispanics are the fastest growing minority in the United States, and breast cancer is the most common type of cancer in Latina women (Lopez-Class, M. 2011). A review of literature and an interview with a bilingual nurse who regularly converses with Hispanic patients were done to look deeper into this multi-faceted problem. This review and interview were conducted because of the negative effects that cross-lingual and cross-cultural care has on patient satisfaction and outcomes. Additionally, multiple interventions were suggested in order to determine successful methods for overcoming linguistic and cultural differences that affect the care of Latina women with breast cancer. From the literature review, it was concluded that more research needs to be done. Future intervention studies can be conducted, including one in which interpreters are permanent members of the healthcare team. Furthermore, the means of evaluation should be focused on increasing patient satisfaction rates and decreasing medical errors.
Warfarin and Dietary Vitamin K: A Multidisciplinary Patient Tool to Improve INR Maintenance
Advisor: Christina Leonard, MSN, RN, FNP, CNL
After spending 15 years as a high school science teacher, I realized that teaching science was not really my passion, and I needed to change careers. I chose nursing because I knew it would allow me to continue to develop my love of biology and anatomy while continuing to share my compassion for those who are less fortunate. I feel that with a BSN many more doors will be open to me for career advancement. It’s ironic that I am a Carolina Nurse because when I was selecting a college for the first time, I really wanted to attend UNCChapel Hill. As an out-of-state resident though, I knew I did not have the grades. So now, after all these years, I am finally a Tar Heel!
Warfarin is a vitamin K antagonist that is the most commonly prescribed anticoagulant and continued use is expected. It is well known that warfarin has a narrow therapeutic range, potential life-threatening side effects and is known for multiple types of interactions. Despite this, there is little consistency regarding holistic patient education, which is critical to any high-risk medication. Drug-food interactions have the potential to be controlled by the patient if they have received adequate education enabling the patient to maintain a consistent daily vitamin K intake and aiding in his/her ability to maintain a therapeutic INR. Since nurses are frequently in the position to offer formal and informal patient education, it is important that they possess essential knowledge about high-risk medications. A review of the nursing literature from the last ten years has revealed an extreme deficit of information regarding specific vitamin K content of food items. Some highly detailed information about food items and vitamin K content is available online, but in the form of long, cumbersome lists. In response, a patient tool has been created that sorts foods into categories of low, moderate, high, and extremely high and also groups some food items for simplicity. It is the objective of this tool to improve patient and nursing education as well as increase patient diet choices regarding vitamin K content of foods which should lead to improvement in maintenance of therapeutic INR.
Nous Sommes Ensemble: We are Together—A Narrative Exposition on Cross-Cultural Nursing That Weaves Personal Experiences With Research and Practical Guidelines.
Advisor: Christina Harlan, MA, BSN, RN
While I have always been fascinated with healthcare, nursing specifically appealed to me because of the focus on evidenced-based practice, the deep level of involvement in patient care, and the ability to care for vulnerable populations. I grew up with a strong interest in healthcare and learning about health and disease. When I came to UNC, I decided to pursue nursing to follow that passion. I love nursing because I am able to build rapport with patients while caring for them. I chose nursing because it gives me tangible and useful skills for working with underserved populations.
Nous sommes Ensemble is a resource for preparing nurses to work in cross-cultural settings. In this context, the term ‘cultural setting’ refers to a broad range of situations in which nurses provide care to people whose background or life experience may be different from their own. Personal experiences and examples from the literature are woven together to illuminate practical approaches to enhancing cross-cultural skills in health care environments. Based on Campinha-Bacote’s theoretical model of developing cultural competence, the author offers three themes which inform nursing practice in cross-cultural healthcare settings. The first is reflection—considering your own personal values, cultural background and biases that affect healthcare delivery, relationships, patient care and healthcare compliance. The second is exploration—learning about the values, customs and assumptions of the other culture or subgroup that you are working with in order to better understand healthcare from their cultural perspective. The third theme is communication—developing relationships and seeking advice from people who either represent the cultural group, or who have extensive experience with the cultural group, who can aid in building trust and providing insight into it. An understanding of these guidelines will enhance nursing practice to promote health among diverse populations.
JESSICA SOPHIA MURRAY
Transitioning to a Computer-Based Intervention for Women with Gestational Diabetes Mellitus
Advisor: Diane Berry, PhD, ANP-BC, FAANP
I have always wanted to be a part of the health care atmosphere, but I didn’t know I wanted to go into nursing until my sophomore year of college. I applied for a job to be a research assistant at UNC’s School of Nursing and Dr. Diane Berry exposed me to all of the amazing ways nursing can change and grow. I was exposed to community health nursing and inpatient nursing, and I decided that nursing would be the best path for me. I am so excited that I chose nursing, and I cannot wait to start my career as a nurse.
Health promotion remains important for all individuals, especially for those at risk for developing chronic disease. Many women are diagnosed with gestational diabetes mellitus while in their second trimester of pregnancy, and this puts them at risk for developing type 2 diabetes mellitus later in on in life. Optimizing Outcomes in Women with Gestational Diabetes and their Infants is a randomized controlled two group repeated measures design that offers a nutrition and exercise education and coping skills training intervention to help women to improve eating and exercise behaviors and lose weight postpartum. The ultimate goal for this study is to reduce the risk of women diagnosed with gestational diabetes mellitus from developing type 2 diabetes mellitus later in life. Although enrollment was successful, it was difficult and took slightly longer than projected. In addition, many women returned to work 6 weeks postpartum due to financial necessity. Therefore, a new way to deliver the intervention was needed for future studies. A review was conducted examining other forms of intervention delivery and a decision was made by the research team to make the following changes. An online interactive educational program was designed to guide future participants through information on general health, nutrition and exercise education and coping skills training, and an at-home tabletop easel was created with the same information for home use. The tabletop easel was designed to allow mothers to teach their families about the importance of exercise and nutrition. These two changes will be tested in future studies.
LEANNA DAWN PHIFER
Daily Checklist: A Visual Aid to Increase Self-Efficacy in Congestive Heart Failure Patients
Advisor: Julianne B. Page, RN, MSN
When I was a child, I remember seeing my mother give my grandfather his insulin injections. He also suffered from congestive heart failure and spent many nights in the hospital. The thing I remember most about my grandfather was how he would talk about his nurses. He would praise nurses who showed him they truly cared about him and his recovery. It was extremely hard for my family and me when my grandfather passed away from a heart attack. Because of him, I chose to become a nurse. I want to be the type of nurse my grandfather would praise, one who makes a difference in my patients’ and their families lives. I will always treat my patients with respect and unconditional positive regard because ultimately, these things are what patients remember at the end of their hospital stay.
Congestive heart failure (CHF) is a chronic condition that requires daily management by those affected. Readmission and mortality rates are high for congestive heart failure patients (Yancy et al., 2013). Additionally, CHF affects the health related quality of life (HRQOL) experienced by those impacted (Yancy et al., 2013). The health care costs for treatment, hospital readmissions, and management of CHF are very expensive and they are a burden to the health care system (Yancy et al., 2013). Current strategies to increase patient self-management of CHF have not proven sufficient to lower the rate of readmissions and the associated costs (Bradley et al., 2012). In addition to the current methods used to decrease readmission rates, the Daily Checklist should be given to patients upon diagnosis of CHF or before discharge from the hospital. The Daily Checklist which includes medications, exercise, daily weight, and sodium (salt) will help patients remember what steps they must take each day to control their CHF, reduce their symptoms, and prevent readmissions for exacerbations. This will increase the patient’s self-efficacy (confidence) in their ability to manage their CHF on their own and activate their motivation to perform self-care behaviors (Shively et al., 2013). The expected outcome of the Daily Checklist is increased self-efficacy and self-management of CHF, decreased hospital readmissions and early mortality, and reduced health care costs associated with managing CHF patients.
NABILA SIRAJ RATTANI
Deconstructing Breast Cancer Heterogeneity: Clinical Implications for Women with Basal-like Tumors
Advisor: Theresa Swift-Scanlan, PhD, RN
I have always had a great interest in medicine and a genuine desire to help others. In middle and high school, I volunteered in special education classrooms and spent over 400 hours immersing myself in the hospital environment through volunteering. After coming to UNC, I continued volunteering at UNC Hospital through Carolina Pediatric Attention, Love, and Support (CPALS). I gained invaluable experience interacting with patients and families from diverse backgrounds. It was there that I met a remarkable young girl who had acute lymphoblastic leukemia and embarked with her and her family on their journey. This experience opened my eyes to the pivotal role that nurses play from diagnosis through treatment and follow-up care. I can think of no career more fulfilling than one that allows me to make a difference in people’s lives and provide exceptional care for them during some of their most vulnerable times.
Breast cancer is a heterogeneous disease comprising five major subtypes including luminal A, luminal B, HER2, basal-like, and normal breast-like tumors. Of the five subtypes of breast cancer, the basal-like subtype has the shortest survival and poorest prognosis. This subtype accounts for 10-20% of all breast cancers and is particularly problematic due to its aggressive nature. Moreover, these tumors currently have limited treatment options, due in part to the absence of growth factor receptors ER, PR, and HER2, which are often used as clinical targets in breast cancer therapies. A review of the literature was conducted using multiple databases, journal publications, and citation indices to comprehensively understand the genetic, epigenetic, and environmental factors contributing to the basal-like subtype. Beginning with a diagnosis of basal-like breast cancer, through aggressive treatment and post-treatment follow-up, oncology nurses play a pivotal role in providing holistic care and support for these patients. Therefore, it is imperative that they understand the complexity of the clinical presentation, as well as the current therapies and the underlying biology of this cancer subtype.
Sarah Emily Rich
Reducing the Risk of Diabetes: The Role of Self-Efficacy in a Mindfulness-Based Intervention
Advisor: Cheryl Woods Giscombé, PhD, PMHNP-BC
While completing my bachelor’s degree in psychology, I volunteered as a child advocate for the Guardian ad Litem program. I was deeply affected by the vulnerability of the families, and I felt empowered in my ability to incite change in the lives of others. My service as a Guardian ad Litem compelled me to pursue nursing because it allows me to continue to be an advocate for vulnerable individuals. I also aspired to utilize my background in psychology to provide holistic care that addressees both physical and mental health. I am excited to embark on a career that will be personally and professionally rewarding.
Diabetes has reached epidemic proportions in the United States. Pre-diabetes, blood glucose levels higher than normal but less than diagnostic for diabetes, is also increasing. African Americans are disproportionately impacted by diabetes, pre-diabetes, and disease complications. Lifestyle modifications can reduce the risk or delay the onset of diabetes; however, behavior change is a complex and stressful process. The current study examines the impact of mindfulness on self-efficacy and health behavior changes related to diabetes risk reduction. Pre-diabetic African Americans, 25-65 years old, and experiencing significant stress were randomized into either a conventional diabetes prevention education program (CDPEP) group or a mindfulness-based diabetes prevention education program (MPDEP) group. Meetings occurred weekly for eight weeks, then monthly for six months. At weeks one and eight, participants ranked their self-efficacy regarding behavior change to reduce the risk of diabetes. We hypothesized that mindfulness group assignment predicts greater self-efficacy, and that baseline self-efficacy predicts eating habits and physical activity (EHPA) outcomes. Findings reveal no significant difference in self-efficacy between groups, and self-efficacy was not a statistically significant predictor of EHPA outcomes. However, there were trends in the MDPEP group regarding self-efficacy and body mass index (BMI), overeating less often, and eating fatty foods less often. The study is limited by a small sample size and attrition. Future research should further investigate the impact of mindfulness on self-efficacy with attention to the following outcome variables: BMI, overeating, and eating fatty foods less often.
Erin C. Richardson
The Experience of Pregnancy for Women with Bipolar Disorder: An Exploratory Study
Advisor: Catherine Ingram Fogel, PhD, WCHNP, FAAN
I love helping people during exciting and challenging moments of change that occur every day in a hospital, along the spectrum from birth to death and illness to wellness. As nurses, we care for our patients and walk alongside them during these moments, and that is an incredible privilege. I realized that I loved working with people during my work in psychiatric research prior to nursing school. I chose nursing because I also wanted concrete skills with which to help them. I look forward to a career that provides opportunities for caring for people, learning, and doing good each day.
Bipolar disorder often emerges in an individual’s late teens and early twenties. As a result, women with the disorder are impacted for the majority of their childbearing years. Pregnancy brings a unique set of challenges to this population, including risk of relapse, teratogenicity of medications, and increased risk of postpartum psychosis. This study utilized semi-structured telephone interviews to gather qualitative data on the experience of pregnancy for women with bipolar disorder with the long-term goal of developing patient education materials and improving nursing interventions to help manage illness during pregnancy and the postpartum period. A sample of three English-speaking women, aged 29-39, with a confirmed diagnosis of bipolar I or II and who have given birth within the last eighteen months, were recruited. Interviews were audiotaped, transcribed, and coded using a grounded theory approach, in consultation with the faculty advisor. Women with bipolar disorder described a unique pregnancy experience, influenced by the intersection of mental illness, pregnancy and pharmacotherapy. Recurrent themes included hopefulness, patient and provider as advocates, education, community support and the mixed impact of medication. This research will contribute to initiatives designed to improve healthcare for pregnant women with bipolar disorder and augment patient education materials. Existing empirical research findings become even more valuable tools for improving patient care when paired with the voices of patients themselves. As pregnant women are a historically under-studied population, this study also contributes to the larger body of scientific research on this population.
Meeting the Needs of Mothers in Prison: An Investigation of North Carolina’s Policies and Procedures and the Nurse’s Role
Advisor: Catherine Ingram Fogel, PhD, WCHNP, FAAN
I chose to pursue a career in nursing because I am drawn to the intimate and holistic approach of nursing care. When I made this decision, I was working exclusively in research and knew I wanted to change my career to something with more patient contact. Nursing provides that contact and allows me to develop relationships with both patients and families in a healing environment.
Women make up a larger portion of the incarcerated population in North Carolina than ever before. Nearly two-thirds of women in prison are mothers. Unsurprisingly, the policies and procedures that govern the care of the general prison population are often insufficient to provide adequate care for the incarcerated mother. This paper explores the current policies and procedures that currently govern the care of incarcerated mothers and and makes recommendations to address deficiencies in these standards. Improvements in prenatal care, shackling policies, and family based treatment programs could all enhance health outcomes for incarcerated mothers. In addition, this paper identifies gaps in the data and recommends additional reporting requirements to augment the state’s ability to measure progress. Finally, this paper outlines the role of the registered nurse in caring for mothers while they are incarcerated and highlights the unique health needs of this vulnerable population.
Kangaroo Care: Creating a Video Teaching Tool for Parents and Neonatal Nurses
Advisor: Rhonda K. Lanning, MSN, RN, CNM, IBCLC
I have always been interested in the health care field, and nursing care has been an active part of my life for many years. As a patient at UNC Hospitals, my UNC nurse practitioner and I cultivated a strong, trusting relationship. She provided compassionate, patient-centered care, and her positive outlook and passion for nursing inspired me to be a nurse. I am eager to deliver this same standard of care to my future patients and build my own personal relationships with patients and families.
Kangaroo Care (KC) is the process of holding an infant skin-to-skin, a timeless technique with scientific benefits revealed in the 1970’s (Johnson, 2013). With a thorough literature review, many benefits of KC were discovered for infants, parents, and nurses. Many professional health care organizations support the implementation of KC early in the infant’s life, as neonates are better regulated by their mothers as compared to hospital incubators (Mori, Khanna, Pledge & Nakayama, 2010). A survey of nurses (n=70) was conducted at a Neonatal Intensive Care Unit to identify a possible need for increased KC education, evaluate the nurses’ perceptions of KC, and establish a preference for a teaching tool. The majority of those surveyed (64%) agreed a video would be the most effective medium to educate both parents and nurses on KC. In addition, research has shown that videos serve as an effective tool to educate patients in a cost-effective manner (Shah, Swanson, Nobay, Peterson, Caprio & Karuza, 2012). A DVD explaining the benefits of KC was created, and the proper transfer technique for KC was demonstrated. This teaching tool is intended to be used in the NCCC to educate parents and nurses on the benefits of KC for infants, and to increase implementation of KC.
Exercise as a Fatigue Intervention for Breast Cancer Patients Receiving Treatment
Advisor: Deborah K. Mayer, PhD, RN, AOCN, FAAN
I have always had a passion for helping people and for science. These passions led me to choose nursing due to its vast areas of interest, direct hands-on patient care, and its holistic view of health. I am drawn to nursing because it is a service-oriented field and allows me to make a difference on a personal level.
Cancer-related fatigue (CRF) is the most common side effect reported by cancer patients. Because of its impact on the daily lives of patients, its management and assessment are important to include in the plan of care. The purpose of this literature review is to examine the effects of exercise and its characteristics on CRF in breast cancer patients currently receiving treatment. A systematic search of the literature using exercise as an intervention was conducted in the fall of 2013. Databases searched were PubMed, CINAHL, PSYCHINFO, Web of Science, Journal of Cancer Nursing, and ScienceDirect. The exercise interventions were evaluated according to the length of session, length of the intervention, type of exercise, intensity of exercise, frequency per week, and location of exercise. Fourteen studies were included in this literature review, 11 of which found a significant reduction in fatigue in the exercise group when compared to the control group. Aerobic exercise was used in 12 of the studies either alone or in combination with resistance exercise. The studies included home-based and/or supervised exercise. On average, the studies reported an exercise session of 31.5 minutes 3.8 times per week at various intensity levels. This review concluded that aerobic exercise, with or without resistance training, is a common characteristic of studies that found a significant reduction in fatigue following exercise in women being treated for breast cancer. Exercise can be a safe and cost-effective non-pharmacologic therapy to manage cancer-related fatigue in breast cancer patients receiving treatment.
Pressure Ulcer Healing and the Impact of Nutritional Intervention
Advisor: Julianne B. Page, RN, MSN
I view nursing as a calling more than a career choice. I cannot imagine myself doing anything else! Growing up with both parents working in health care and a grandfather who was a victim of a debilitating stroke, I was constantly surrounded by all things medicine! While visiting my grandfather, I watched his nurses transform both our family and his health. They made a difference. I realized I wanted to continue to create meaningful impact in others’ lives, just as my grandfather’s nurses had done for my family. I have grown to love nursing because at its core, it encompasses the complexities of human nature: people at their worst, at their best, and everywhere in between. Nursing is a profession that fulfills both my personal and professional needs. It is a career that is selfless yet endlessly rewarding because nurses are constantly making a difference in the pivotal moments of others’ lives.
Pressure ulcers are a condition creating an epidemic of sorts within the healthcare system, both within the United States and Internationally (Doley, 2010). While there is a variety of research on mechanisms to prevent pressure ulcers, current pressure ulcer prevention strategies have proven insufficient, as pressure ulcers continue to lengthen patient hospital stays, complicate their health status, and cost the health-care industry copious amounts of money (Joseph & Davies, 2013). If pressure ulcers cannot be eradicated completely, it is imperative to find a way to lessen the severity of pressure ulcers and increase their healing times, thus creating fewer health-related complications and placing less of a burden on the health-care system. One way to do this is through the use of supplemental nutrition, a practice that has been seemingly neglected in regard to its’ effect on the healing of decubitus ulcers. Research indicates that certain nutrients, such as Vitamin A, Vitamin C, Zinc, Glutamine, and Arginine have proven beneficial in increasing the healing times of pressure ulcers. Such nutrients have the potential to create a profound impact on the physiological process of healing wounds. Thus, a visual aide known as the “Pressure Ulcer Tray for Healing” was created to guide patients, nurses, dieticians, and all health-care personnel in facilitating adequate intake of essential nutrients that will promote healing of ulcers. In theory, a poster of the tray would be displayed in every patient room, in order to assist patients in ordering foods conducive to expediting the healing process.
Prevalence, Incidence and Impact of Sexual and Gender-Based Violence in Areas of Humanitarian Conflict: A Systematic Review
Advisor: Gwen Sherwood, PhD, RN, FAAN
Human suffering infuriates me and is the core of one constant in my life: my desire to help others. Until a few years ago, I was completely irresolute of how to utilize the composite of my skills and interests to serve others. Over the last three years, I concluded that nursing is the ultimate response to my deeply rooted career aspiration of serving those in need. Nursing coalesces my natural organizational abilities with my gift for comforting and caring for others while allowing me to serve those in need. Nursing school opened my eyes to the countless opportunities as a nurse. Thus, as I look to my future, the decision to dedicate my life to nursing has been confirmed because I know that my career can evolve alongside my interest in serving others.
Women and children are disproportionately targeted for violence in conflict and require higher levels of protection (Ward & Marsh, 2006). The United Nations estimates that 35% of women and girls experience sexual and gender-based violence (SGBV) in their lifetime (World Health Organization, 2013). PubMed/Medline, CINHAL, Google Scholar and Cochrane Database of Systemic Reviews journals and grey literature was searched looking for incidence, prevalence and impacts of SGBV in conflict-affected countries. Out of the 3,551 returned studies, 89 studies were assessed for eligibility. Of the 10 studies that met the inclusion and exclusion criteria, one was a randomized cohort study, four were non-randomized cohort studies, three were retrospective cohort analyses and two were cross-sectional surveys. Studies occurred in the Democratic Republic of Congo (DRC), East Timor, Uganda and mixed (Burundi, DRC, Rwanda, Sierra Leone, Somalia, southern Sudan, Uganda). All focused on examining incidence, prevalence and impacts of SGBV in conflict. Although limited, these studies demonstrate the increased incidence and prevalence of SGBV in conflict. Girls are disproportionality, more intensely impacted. Impacts for women and girls affected by SGBV range from intense psychosocial impacts and physical symptoms ranging from traumatic fistulas, pregnancy, abdominal pain, chronic pain, urinary incontinence, generalized malaise and symptoms of sexually transmitted infections.
Jaime Michelle Stanton
Management Strategies During Pregnancy to Prevent Neonatal Herpes: An Educational Intervention for Health Care Providers
Advisor: Janna Dieckmann, PhD, RN
I chose nursing because of the profession’s founding principle – caring. There are many benefits that come with being a nurse, including the ultimate reward of bettering the lives of individuals and families. Not only do I desire to improve the health of others, but I also want a career where I am able to spend time with patients and develop a relationship with them. Nursing is truly my calling.
Neonatal herpes is a significant yet preventable outcome of genital herpes exposure. Approximately 1,500-2,000 new cases of neonatal herpes infection are diagnosed annually (Ural & Cheng Peng, 2013). The purpose of this project is to increase the knowledge of health care professionals about genital herpes and its prevention, so that the general public can become better informed. Ultimately, the hope is that by increasing the general public’s awareness about genital herpes and its prevention, genital herpes acquisition in pregnancy will be decreased, thus reducing cases of neonatal herpes. The educational intervention Neonatal Herpes Prevention: Management Strategies During Pregnancy combines lecture and interactive formats and is intended for use during an educational meeting. The envisioned use for the educational intervention is a continuing education course, specifically among health care professionals caring for pregnant women or women of childbearing age. The literature suggests that in-person educational meetings, web-based educational modules, and printed educational materials are all effective at improving professional practice among health care providers. Thus, the educational content is designed for adaptation to various educational methods in order to meet the diverse educational needs and learning style preferences of health care providers. The anticipated outcome is a reduction in occurrences of neonatal herpes as a result of increased awareness among providers, patients and the general public, behavioral changes regarding sex practices, and improved management of genital herpes.
A Nursing Tool to Promote Patient- and Family-Centered Care in Adult Critical Care: The Family Care Assessment
Advisor: Christina Leonard, MSN, RN, FNP-BC, CNL
My primary motivation for choosing a career in nursing is a desire to pursue meaningful work that will help others. The amount of time nurses spend with their patients allows them to have valuable insight about patients’ health. I am excited that I will have the opportunity to serve and advocate for my patients by recognizing their unique needs and playing an active role in identifying solutions to their challenges.
Families of critical care patients experience stress that negatively impacts the family’s well-being and impedes the family’s ability to support the patient (Horn & Tesh, 2000). The patient- and family-centered care (PFCC) model emphasizes the importance of mutually beneficial partnerships among health care providers, patients and families, and one of the core components of PFCC is family participation (Institute for Patient and Family-Centered Care, 2010). Research indicates that involving families in providing care to critically ill patients is an effective way to meet family needs and reduce stress (Al Mutair, Plummer, O’Brien, & Clerehan, 2013). Additionally, evidence suggests that critical care nurses, families of critical care patients, and critical care patients themselves all support family participation in patient care (Garrouste-Orgeas et al, 2010). Critical care nurses are in a unique position to lead interventions to meet family needs by promoting family involvement in care. The Family Care Assessment is a tool that critical care nurses can use to assess the family’s desire to become active participants in patient care. I created this tool after conducting a review of the literature on nursing care of families of critical care patients which revealed a need for specific interventions to facilitate nurses in caring for families. The purpose of the Family Care Assessment is to facilitate a positive and productive relationship between the nurse and family, with the ultimate goal of supporting the family and improving patient care.
Carra Lee Wainwright
Female Genital Cutting: A Maternity Nurse’s Guide to Providing Culturally Competent Care
Advisor: Rhonda K. Lanning, RN, MSN, CNM, IBCLC
Since I was young, I have wanted to make a difference in the lives of others. A career in nursing will allow my dreams to come true. My aspiration for nursing was sparked by my personal experience as a patient. The care and compassion a nurse showed me while I was hospitalized influenced me and led me to pursue a career in nursing. I desire to make a positive impact in the lives of my patients, just as one nurse impacted me.
As a result of immigration trends, maternity nurses in the United States are likely to encounter women who have undergone female genital cutting. There is a lack of knowledge and awareness about female genital cutting among nurses. Chalmers and Hashi (2000) found that women who had undergone female genital cutting at a younger age and gave birth in Canadian hospitals perceived their nurses to be insensitive to their needs. In addition, one study of the birth experiences of Somali immigrant women found that healthcare providers in the United States rarely discussed female genital cutting or how it could affect the women’s birth experiences (Ameresekere, Borg, Frederick, Vragovic, Saia, & Raj, 2011). An extensive literature search was performed utilizing CINAHL, PubMed, and Google Scholar. The objectives of this literature review are to inform maternity nurses of the following: 1) the prevalence of female genital cutting and regions where it is commonly practiced, 2) the reasons why female genital cutting is practiced, 3) the complications of female genital cutting, and 4) the nursing care needs of women who have undergone female genital cutting. This review of literature elucidates that: female genital cutting rates are high in Africa and the Middle East, maternity nurses in United States hospitals will increasingly care for women who have undergone female genital cutting, there are serious complications related to female genital cutting, and there is a need for culturally competent maternity nurses to care for women who have undergone female genital cutting.
Laura Katherine Wert
An Analysis of Communication Between Nurses and Physicians: Evidence from the Literature
Advisor: Shielda Rodgers, PhD, RN
I have always known that I wanted to do something in the health care field, even on my first day in kindergarten when I dressed up as a doctor in my father’s scrubs. As I grew up though, I realized it was my mom’s profession that better aligned with how I wanted to dedicate my life to helping and caring for people. Interacting with patients is my favorite part of nursing, but caring for patients at some of their best and worst moments of life keeps me passionate for this profession. It was not until nursing school that I truly understood the value of caring and realized that it is what drove me to go into nursing.
Communication has been identified by many governing bodies to be important for the safety and well-being of patients. This study is an analysis of communication between nurses and physicians using evidence from literature. The ways that nurses and physicians communicate, the perceptions of nurses and physicians surrounding communication, the participation of nurses in physician rounding, the barriers to effective communication, and interventions to improve communication are presented and analyzed. Following this analysis, a research project is proposed for a manager of a floor to investigate the communication patterns between nurses and physicians on his or her floor. Tools are also provided for this research project. Using this research and the proposed research project, it is hoped that the outlined evidence-based interventions can be utilized by a nurse manager to improve communication between nurses and physicians, which in turn will lead to decreased costs, greater patient safety, and better patient outcomes.
Brittany Lynn White
Perceived and Actual Noise Levels in Critical Care Units
Advisor: Meg Zomorodi, PhD, CNL, RN
I chose to pursue nursing because it seemed to be the nucleus of the health care team. In addition to constant critical thinking and problem-solving, nurses must have compassion and sympathy for the sick and the suffering. As a nurse, I will advocate for my patients while upholding their dignity through their most intimate and vulnerable circumstances. I feel fortunate to enter such a noble profession!
Deep, restorative sleep is needed for Intensive Care Unit patients to help with healing and recovery. Although many studies have acknowledged that the Intensive Care Unit (ICU) is noisy, few studies have compared the nurses’ perception of noise to actual noise levels. The purpose of this study was to compare actual noise levels to perceived noise by nursing staff in the ICU. Actual sound levels were compared with nurses’ perception of noise in 7 Intensive Care Units. Actual sound was measured using the Decibel 10th Iphone application by SkyPaw Co. Ltd, and perceived sound was measured using a Familiar Noise Survey developed by the researcher. A random sample of nurses were surveyed twice in a 3-day period (n = 18) to measure their perception of sound on the unit. Sound pressure levels and nurse perception were compared using descriptive statistics. Critical care nurses perceived the ICUs to be noisier than the actual values. There did not appear to be a substantial difference in noise during the morning, evening, or weekend shifts. The ICU was quieter than the actual noise of the lobby or cafeteria, but louder than the recommended noise level for resotrative sleep. Nurses perceive the ICU to be the loudest area of the hospital. This finding raises the question of how we can assist nurses to reduce what they perceive to be a loud environment. Future work is needed to develop interventions specifically for nurses to assist in reducing noise in the ICU.