Natalie Neil Adamson
Exploring the Nursing Role During End-of-Life Care in Pediatric Oncology: The Family’s Perspective
Advisor: Beth Perry Black, PhD, RN, Assistant Professor
With a little real-world experience, I also spent a year just volunteering and doing service work with a non-profit. It was really that experience that propelled me. I realized that all the things I loved about my life at that time were brought about every day in this profession – and I knew I was going to be a nurse.
Few studies have been conducted on relationships that develop between nurses and parents of toddlers in end-of-life care. This paper examines nursing care relationships from the parents’ perspective near and at the end of their child’s life after cancer treatment. A single case ethnography was completed during which three interviews were performed, each approximately an hour and a half in length. The subjects were parents whose son passed away over two years earlier after relapse of Langerhans Cell Histiocytosis. An initial interview with both parents was recorded followed by individual interviews at a later date. These were all then transcribed. The data is organized along a timeline then presented in a two-by-two matrix distinguishing positive/negative and verbal/behavioral experiences the parents shared. One observation of the pattern of the family’s memories of this period of time is they are dominated by very brief interactions or experiences that carry residual importance long after the event. This family’s experience revealed personally significant moments in the care of their son, not only reflecting positive connections they had with nurses, but also challenges and areas of communication breakdown they encountered. Challenges presented by this work include questions of how to improve the experience when patients receive treatment outside of their primary care team. Over all this family reported benefits from their relationships with the nursing staff before and after the death of their child. These benefits continue today. The therapeutic potential of these relationships for both staff and patient families warrant further investigation.
Lianne Biemer Cole
Bridging the Gap: Addressing the Needs of Parents Who Receive A Prenatal Diagnosis of Down Syndrome
Advisor: Marcia Van Riper, PhD, RN, Associate Professor
During my birthing experience with my son, I had amazing nurses who cared for me in the maternity unit. From this experience, I realized that the aspects I enjoyed about patient care correlated more with the nursing profession than the medical profession. From that point forward, I decided to pursue a career in nursing, and I have never regretted it.
Having a child diagnosed with Down syndrome is one of the most stressful and life-changing events parents will go through. When the diagnosis is made prenatally, the idea of a “perfect pregnancy” is often replaced by feelings of grief and loss; however, parents who learn of their child’s diagnosis prenatally are in a unique position to adjust and prepare for their child’s birth. Nurses and other health care professionals are in a unique position to assist parents in adjusting to the news of having a child with special needs. Yet, much of the research suggests this is often not done effectively. The purpose of this project was to examine the specific ways in which nurses and other care providers can help families who receive a prenatal diagnosis of Down syndrome adapt to the news and prepare for the birth of their child. An education booklet for health professionals was also created with proposed adaptation in prenatal settings.
Kristina Elisabeth Karl
Head-to-Toe Assessment: Would You Recognize a Zoonotic Disease
Advisor: Janna Dieckmann, PhD, RN, Assistant Professor
I chose to go into nursing because of the diversity of the field and the opportunities for growth and development. In this field I will be able to provide care and support to families during a time of need.
The purpose of this project is to provide a general introduction to zoonotic diseases and tick-borne diseases by focusing on the most prevalent zoonotic diseases in North Carolina. Increasing contact between humans and animals, transport across the globe, increasing populations of immunocompromised individuals, and biological and evolutionary changes are contributing to the reemergence and new emergence of zoonotic diseases. Diseases naturally transmitted from animals to humans are often misdiagnosed or underdiagnosed. Lack of patient and provider awareness, fragmented and difficult to find information, and lack of definitive testing are factors contributing to misdiagnosis. Failure to promptly diagnosis these illnesses can lead to severe illness, long term health problems, and even death. This project emphasizes the importance of performing a thorough visual head to toe assessment and asking patients the right questions. The recognition of signs and symptoms leading to the diagnosis of zoonotic disease is most often secured through visual head to toe assessments due to unavailability of definitive testing. Incomplete assessments can lead to misdiagnosis resulting in increased risk of serious illness or mortality, but appropriate assessments will facilitate faster diagnosis and increased quality of life for patients. Nurses must recognize that performing thorough visual head to toe assessments will help them gather the necessary information to contribute to diagnosing patients, even when they are confronted with unfamiliar symptoms and diseases.
A Comparison of Women’s Responses to Pregnancy Loss and Neonatal Death: A Cross-Cultural Analysis of the United States, India, and Tanzania
Advisor: Beth Pack, BSN, BA, MPH, RN
Interest and research related to the unique experience of perinatal loss has increased in response to bereavement reform that began in the 1970s following the release of Elizabeth Kübler-Ross’s book On Death and Dying. Women’s experiences in the United States and other industrialized countries have been the center of research. Little focus has been given to women in the third world where a majority of the world’s pregnancy losses occur. Women’s agency, access to technology, social constructs, available support network, and religious beliefs have profound impacts on the way in which each individual woman conceptualizes pregnancy loss and experiences grief surrounding the event. Women’s responses to perinatal loss in the third world are different from women’s experiences in the first world, yet no less significant. Further research is needed to better understand the grief response of women in the third world regarding perinatal loss in an effort to target interventions that address their emotional needs.
Jessica Shan Perz
Availability of Culturally Appropriate Health Care Services for Latino Children: A Pilot Study
Advisor: Carolyn McKenzie, RN, PhD, Clinical Assistant Professor
Throughout my life, I have witnessed how people’s lives are affected by their career choices. I have been so moved by the ability of nursing to consistently go beyond being only a career for people, but also a passion. I have seen how people’s lives have been enriched at times when they are feeling most vulnerable as patients by the work of nurses. It is this unique interplay, combined with my love of science, fascination with the human body, and the appreciation of strong, meaningful relationships that drew me to the field.
The Latino population of North Carolina is growing at a rate of 54.9% (from 2000-2006), indicating there will be increasing numbers of Latino children seen in health care facilities across the state. Access to and quality of health care for Latino children currently includes many barriers and deficiencies. Provision of culturally competent care for this population is becoming increasingly important, and requires an understanding of this group’s health care access and utilization. This descriptive pilot study examined how health care facilities in central North Carolina provide culturally competent care to pediatric Latinos. The study also examined how survey responses are affected by electronic administration. A convenience sample of five nurse managers and school nurses from health care facilities across central North Carolina completed a 16-question electronic survey regarding culturally appropriate services at their respective workplaces. All respondents answered affirmatively to offering Spanish informational pamphlets and interpretive services. All respondents also identified difficulties in using interpretive services including cost, availability, literacy issues with patients, and immigration issues. The results demonstrate there are several services being provided consistently across facilities, whereas others are inconsistent. This pilot study suggests the need for a larger study to further examine the quality of culturally competent services available to Latino children in central North Carolina.
Allison Joy Silsbee
Early Identification and Nursing Management of Infants with Necrotizing Enterocolitis: A Service Learning Project
Advisor: Kathryn R. Alden, EdD, MSN, RN, IBCLC, Clinical Associate Professor
With a childhood love for medicine driving my ambitions, I desired a profession that allowed me to have a significant impact upon the health and well-being of those who are attempting to piece their illness-shattered lives back together. When I started volunteering at Rex Hospital at the age of 15, I quickly realized that nurses fulfilled not only this, but a multitude of vital roles. Nursing rapidly became something so much more than simply providing the care ordered by the physicians. In fact, I discovered that the care that nurses provide is multidimensional, multifaceted and, all around, a world apart. From that point forward, I developed a passion to be a part of such a profound impact, as well as the unforgettable connections made between a nurse, a patient and a patient’s family. Nursing became,
and still is, my destiny and purpose.
Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency in infants who are hospitalized in neonatal intensive care units (NICU). Despite advances in treatment, NEC remains the primary cause of morbidity and mortality in preterm infants (Hunter et al, 2008). With the exact etiological factors and disease pathophysiology of NEC largely unknown, it can make prevention, recognition and management difficult. Presently, the only treatment option is disease management. Without a cure, NEC management leads to an increased length of hospitalization and myriad of long-term health problems, including short gut syndrome, liver failure, nutritional deficiencies, and problems with growth and development. As such, well-informed and vigilant nursing care is vital to the prevention, early detection, and prompt treatment of NEC. In order for this to occur, nursing staff should be provided with educational materials and programs that incorporate the most current research evidence about NEC and the associated nursing care. In a review of the recent literature, no studies were found related to the education of nurses about NEC. Through personal experience in an NICU, the author recognized the need for nursing education about NEC and developed this service learning project to provide educational materials for staff nurses about NEC. The ultimate goal of the project is that nurses will be more competent and effective in providing care to help prevent NEC, to recognize early signs of NEC, to facilitate prompt treatment, and to provide quality nursing care for infants with NEC and their families.
Amy Elizabeth Sober
Preemie Pearls: An Educational Intervention for Adolescent Parents of Premature Infants
Advisor: Beth Perry Black, PhD, RN, Assistant Professor
I wanted a career where I could make a difference. Nursing provides you with tools to potentially change the world one patient at a time. It is also a field that allows me to use my natural caring attitude.
Adolescent parents are at risk for preterm delivery, infants with very low birth weight, and many other complications. Babies born to teen parents are more likely to spend time in the newborn intensive care than babies born to mothers over the age of 20. This project focuses on the experience of adolescent mothers in the newborn intensive care unit, and what nurses can do to help facilitate the relationship between mother and baby. Adolescents often feel overwhelmed by the experience and ashamed to ask questions about the care of their infant. Preemie Pearls is based on the premise that using positive reinforcement will increase parents’ self-confidence and facilitation of the infant-mother relationship while learning to provide proper care for their baby. The project consists of two components including a review of current relevant literature, and a set of learning tools ranging from kangaroo care to perinatal loss, tailored to the learning styles of the adolescent. Each learning tool is associated with a colored bead that is given to the parent once that particular aspect of care is achieved, in hopes of encouraging adolescents parents increased involvement in care. The educational sheets and beads are also a means to open up lines of communication between the nurse and parents leading to more effective care.
Catherine Lea Suitt
Get Heart Smart! The Development of Educational Classes for Patients Diagnosed with Hypertension
Advisor: Christina Harlan, BSN, MA, Clinical Associate Professor
I chose to go into nursing in high school after working with a geriatric population in a nursing home setting for a class project. I loved the human contact and connection that is available with nursing and having the potential to truly impact someone else’s life. To me, nursing is not only about healing the physical body, but focusing on the whole person. By basing my nursing practice on this philosophy, not only do I have the potential to help others, but I can gain personal fulfillment also, making this career a rewarding and exciting journey for me as well.
Hypertension affects one out of three Americans. There are many controllable risk factors for this disease including being overweight, not being physically active, using tobacco, consuming too much sodium, excessive alcohol consumption, and stress. Since hypertension does not have symptoms, people often do not feel the need to keep it under control. Problems stemming from uncontrolled hypertension include heart failure, kidney failure, glaucoma, and strokes. A need was identified in a rural community for education about this disease and subsequently the program Get Heart Smart! With Information on Hypertension was developed. This paper begins with a literature review discussing evidence based information related to hypertension and provides the basis for the program. It continues by providing a description of the program along with the evaluation and analysis. The Get Heart Smart! sessions were designed to target three important areas in hypertension education: general knowledge regarding the diagnosis, nutritional modifications, and exercise and stress management. The purpose of the classes is to inspire, equip, and empower participants with the knowledge and tools necessary to become proactive in their health and controlling their hypertension. Finally, recommendations are made regarding the program and subsequent programs of this type.
Jeanne Elizabeth Vodicka
Exploring Pediatric Oncology Patients’ Memories of Their Diagnosis
Advisor: Diane Yorke, MSN, MBA, PhD, RN, CPNP, Clinical Assistant Professor
Nursing allows me to express and implement my willingness to work hard, love others, learn and take care of the body in a holistic way. I have been known to have a big heart because no matter what I will drop anything I am doing to help others. I truly have a passion for helping those in need because I feel that everyone deserves a chance to live life to the fullest, and that begins with physiological and emotional health and stability. The perfectionist in me will not forget the science involved and I will not let a patient be diagnosed without all things considered. Therefore nursing is the profession that matches my life’s desires and I chose it as it has chosen me.
The experience of being diagnosed with cancer as a child has not been documented from the child’s perspective. This study proposed to ask children ages 4-17 to tell the story of and/or draw or make an artistic representation of what they remember being told when they were first informed they had cancer. Following precedent set by other investigators participants were to be at least 3 months since first being diagnosed with cancer as well as be able to speak and understand English. This study was designed using the qualitative method of research involving emphasis on the personal experience of the event of diagnosis. Approval for the study of this vulnerable population was granted by both the Oncology Protocol Review Committee and the Institutional Research Board. This paper reports the intricacies of seeking permission to perform research with children.
Peer-to-Peer Education as a Nutrition and Weight Loss Intervention for Overweight Adolescent Latinos: A Literature Review and Program Recommendation
Advisor: Julee Waldrop, MS, PNP, FNP, Clinical Associate Professor
Nursing is a rewarding profession with many opportunities where I can truly make a difference in patients’ lives. I look forward to a career in which I use knowledge, critical thinking, and compassion each day while interacting with patients and families.
The prevalence of overweight and obesity continues to increase across all age groups in the pediatric population. Latino children have the highest rates, which is significant because of the growing number of Latinos in the United States. Serious physical, social, and emotional outcomes are associated with childhood obesity including Type II diabetes, hypertension, low self-esteem, and depression. The objective of this paper is to review the evidence in support of utilizing a Peer-to-Peer education approach for weight maintenance or loss in the Latino adolescent population. A review of the literature shows that peer-based nutrition and weight management education interventions have been used among adolescents and among Latinos. However, there is a gap in the literature as such an intervention has not been attempted with adolescent Latinos specifically. The available research suggests that development of a Peer-to-Peer nutrition education program based on social cognitive theory and the American Heart Association Guidelines for nutrition in the school setting is feasible.