December 2012 Honors Graduates

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Joseph M. Biddix

Comfort Levels of Active Duty Gay/Bisexual Male Service Members in the Military Healthcare System

Advisors: Catherine I. Fogel, PhD, WHCNP, FAAN and Beth Black, PhD, RN

Statement

After working for four years in the entertainment business in Los Angeles, I realized I was not living up to my potential. I knew I had the capacity to do more with my life than simply network in the entertainment world for career gains. In nursing, I found a profession that challenged me to think critically, perform thoughtful decisionmaking, and continuously add to my knowledge base for the purpose of improving my practice and providing the best care possible to my patients. It also helped having my mom, a nurse of nearly 40 years, coaching me along the way.

Abstract

Prior to a revision of the “Don’t Ask, Don’t Tell” (DADT) policy in 2010, the sexual behaviors that lesbian, gay, and bisexual (LGB) service members disclosed to military healthcare providers (MHCPs) could be used against them in discharge proceedings. However, after the 2010 revision reversed this clause in the policy, service members either did not know about the revision, or were still uncomfortable approaching MHCPs regarding issues of sexuality/sexual health (Katz, 2010). The purpose of this study was to examine the attitudes and comfort levels of active duty gay/bisexual males in approaching MHCPs about sexuality/sexual health concerns. Utilizing a quantitative descriptive approach, we developed a 31-item survey that provided initial research data to inform future studies on this topic. Analyzing responses from 30 participants, we found differences in the comfort levels among age groups in disclosing their sexual orientation, in addition to differences between officers and enlisted men concerning the cost of seeing a non-military healthcare provider. We also found trends suggesting distrust between respondents and the military healthcare system. Nurses should understand that some patients may be hesitant to disclose their sexual orientation, and therefore may want to see a non-military HCP for sexual health reasons. Because costs can be a concern, nurses should be knowledgeable of the availability of resources for persons with low incomes.

Mary Kathleen Goodwin

A Comparative Analysis of Nurse Practitioner Scope of Practice Laws and Regulations

Advisor: Cheryl B Jones, PhD, RN, FAAN

Statement

I chose to go into nursing because I was interested in the healthcare field and attracted to nursing’s emphasis on promoting wellness and health. I also value the many different directions that a nursing career can take me.

Abstract

The IOM’s Future of Nursing Report has called for utilizing nurses – including nurse practitioners – to the fullest extent of their education, and for removing unnecessary barriers that prevent them from doing so. The objective of this study was to examine state-level nurse practitioner (NP) scope of practice (SOP) regulations and to compare regulations across states. By determining differences in SOP regulations among these states, it is possible to identify areas for improvement and specific factors that may impact NP SOP rules and regulations.

The sample of states used in this analysis was drawn from the 2012 Pearson Report, an annual report of NP rules and regulations by state that grades states on how well they promote the ability of patients to choose their own providers and the restrictions that NPs face in their ability to practice. NP SOP regulations were examined from ten states, selected from three US regions: the Southeast, Middle Atlantic, and Northeast. States from the three regions were categorized based on their Pearson Report grades and then, within each grade, states with the highest and lowest GDP were selected. SOP was defined by NPs’ ability to treat and diagnose disease, prescribe medications (including controlled substances), and the overall level of physician supervision required.

The laws and regulations affecting NP SOP varied between states included in the sample. Maine and Maryland offer ideas that may be considered by other states as they look to change NP SOP regulations in order to improve the health of Americans.

Jacob R. Haskins

Case Study: Social Isolation in Cystic Fibrosis and the Promise of Social Media

Advisor: Diane Yorke, PhD, MSN, MBA, RN, CPNP

Statement

Two of my grandparents died of cancer. The nursing care that they received while in the hospital inspired me to want to become a nurse and help other families through the tough times that hospitalizations can bring.

Abstract

Cystic Fibrosis is a genetic condition which causes thick sticky mucous to build up in the lungs, digestive tract, and other areas of the body. The mucous can become stagnant because of the inability to clear it, leading to bacterial growth and infections (Wilson, 2011). In addition, since people with CF can easily spread germs they have in their lungs to one another, they are not permitted to be in immediate contact with each other and when hospitalized they are placed in isolation. This infection control practice can be difficult for patients psychosocially; especially adolescents who are striving to have meaningful personal relationships with their peers (Cystic Fibrosis Foundation, 2009). Nurses need to find new and improved ways to promote the psychosocial well being of these patients when they are hospitalized while still adhering to the isolation protocols (Berk, 2010). One way to do this is to use the recent technology of social media. Social media enables people to have social relationships without being face to face. This study examines in depth the case of a hospitalized teenage female with cystic fibrosis. The case study analyzes her feelings about being under isolation and her opinions about the potential of social media for hospitalized adolescents with Cystic Fibrosis. Clearly more needs to be done for these patients and social media could be useful in combating the negative effects that isolation can bring to adolescents with Cystic Fibrosis.

Megan Danielle Lucovsky

Pediatric Oncology Nurses’ Perceived Patient Support Needs

Advisor: Diane Yorke, PhD, MSN, MBA, RN, CPNP

Statement

I have a passion for both working with children and providing care for others, and I realized that by becoming a nurse, I could combine these passions into a meaningful career! Nursing is my second degree, and I am so happy that I made the choice to return to school because I have definitely found the job for which I was meant.

Abstract

Pediatric oncology nursing has many components. While medical treatment is very important for pediatric oncology patients, it is equally important to focus on these patients’ psychosocial needs. The aim of this study was to describe pediatric oncology nurses’ perceived patient support needs and explore ways to provide holistic care within this patient population. Nurses (n=20) working in pediatric oncology participated by completing anonymous web-based surveys. The data was analyzed by means of content analysis, and common themes were identified: family involvement as an important means of providing support, age, psychological factors, and availability of resources as barriers to participation in support methods, and the importance of individualizing care and support methods to the specific patient and family. Overall, nurses that serve the pediatric oncology patient population seem to have a deep realization for and understanding of the psychosocial support that is required by patients and their families, and the themes identified in this study should be considered when building a supportive nursing care plan.

Lauren Leigh Sauve

Internet Cognitive Behavior Therapy for Patients with Chronic Physical Illness

Advisor: Theresa Raphael-Grimm, PhD, CNS

Statement

Nursing represents a combination of my love of learning with my desire to help people at the times when they are unable to care for themselves. The nurses who had been present in my life were amazing in their care and compassion for others—I wanted to be even a fraction of that in someone else’s life.

Abstract

With advances in medical care, people with chronic illness are living longer. People live with conditions such as heart disease, diabetes, and COPD, for an extended time prior to their death (Laidlaw & Pachana, 2011). Despite this increased lifespan, without effective self-management of the disease those afflicted can experience a diminished quality of life. To maximize their quality of life, patients must have the wherewithal to consistently learn, adapt and manage complex self-care routines. Patients frequently feel overwhelmed by the emotional burden of the chronic illness as well as the commitment that self-management requires. This burden often manifests itself as anxiety and depression. Chronic physical conditions are positively correlated to anxiety and depression, with “comorbidity [being] the rule rather than the exception” (Teesson, 2011).

As a result of this comorbidity, providing appropriate resources for treating patients’ anxiety and/or depression is the vital for empowering patients to manage their chronic illness. Cognitive Behavioral Therapy (CBT) is a widely used, evidence-based method for treating anxiety and depression. However, CBT is frequently not covered by insurance, not regionally available, or carries a considerable stigma – all of which serve as obstructions to access. With the advent of internet-based CBT, the therapy is now accessible to previously underserved patients in need of mental health care. The purpose of this paper is to examine the professional literature on and assess the value of Internet Cognitive Behavior Therapy as a viable and effective option for patients with chronic physical conditions and to provide implications for nursing practice.

Courtney Anne Sorensen

Exploring the Relationship of Parenting Techniques, Compliance in Children with Cystic Fibrosis, and Parental Mental Health: A Comprehensive Literature Review

Advisor: Lisa Woodley, MSN, RN

Statement

When my mother was diagnosed with breast cancer during my senior year of high school, I became aware of how her trust in her health care professional positively affected her attitude and recovery. This observation led to my first degrees in Psychology and Spanish with the desire to intimately interact with and help individuals. During my first few years at UNC completing these degrees, I discovered the beauty of nursing and how the hands-on, compassionate nature of this profession allows me to be the most effective vehicle to positively impact people in need.

Abstract

Poor compliance with treatment regimens in children with chronic illnesses is linked with decreased parental mental health. Additionally, increased parental stress, anxiety, and depression seems to contribute to increased reporting of children’s problem behavior. This comprehensive literature review examined existing research on effective parenting styles, increased stress for parents of children with chronic illnesses, and how these two factors relate to pediatric compliance with treatment, specifically for preadolescent school-aged children with cystic fibrosis between the ages of five and twelve years. The findings of the examined studies show the need for more research to consider effective parenting methods to increase compliance in children with cystic fibrosis, and how, in turn, this affects parental mental health.

Scott Taylor

The Efficacy of Nurses Using Wireless Phones for Communication in an Intensive Care Setting

Advisor: Diane Yorke, PhD, MSN, MBA, RN, CPNP

Statement

I chose to be a nurse because at the end of my working life I want to be able to look back with the satisfaction that I did what I could to make a positive impact on the lives of others by helping them regain and maintain their health. The care process in nursing met what I wanted in a profession. I hope to work with critically ill patients after graduation and return to school for an advanced degree in nursing.

Abstract

Bedside nurses use various forms of communication such as wireless phones to exchange information within and outside the healthcare institution, allowing them to receive and make phones calls without the need to locate a land line. Concerns exist about how this type of communication is perceived by nurses, patients, and family members in intensive care unit (ICU) settings. A literature review revealed that there is currently no research available pertaining to perceptions of nurses, patients, and family members related to phones. Due to this gap in research a survey was developed to capture data related to intensive care unit nurses’ perceptions regarding the use of wireless phones as a communication tool. Survey results indicated that the majority of the nurses have experienced an interruption in care due to the use of wireless phones however no near misses or medication errors were reported. The majority of nurses reported receiving their heaviest call volume during the first four hours of their shift, and many of the calls were family members in need of a patient status update. Recommendations to improve care include having a call answering service during the first four hours of shifts, implementation of a hands-free phone system with call block, and a no call policy while in patients’ rooms giving care. Further research is needed to understand call volumes and interruptions specific to various shifts. Improving the communication process can increase nurse and patient satisfaction, improve patient safety, and decrease or prevent errors in the care process.