Molly Rebecca Allen
Nursing in Critical Care: An Oral History Project
Advisor: Janna Dieckmann, PhD, RN, Clinical Associate Professor
I chose to go into nursing because I wanted to help people. I come from a family of nurses, and it has simply always seemed like the right fit for me. I love the one-on-one patient contact, and the unique opportunity to form lasting relationships with patients and their families.
Currently, there are almost 2.6 million registered nurses living and working in the United States, representing the largest portion of healthcare professionals in America. Nurses provide constant bedside care every minute of every day, acting as advocates, educators, friends, companions, and listeners for their patients. Nursing in critical care can be particularly challenging, as a patient’s condition can be relatively unstable and often requires more specialized care. Through their work, nurses can gather individual stories and descriptions of the patients and events they see on a daily basis. There is power in hearing these stories, as they represent the lived experiences of being a critical care nurse. This case study was conducted to look at the oral history and personal journey of nurses working in critical care.
Interviews were performed with two expert intensive care nurses using an oral history methodology. Subjects were interviewed about their reasons for entering into nursing, changes they had seen occurring in the healthcare environment, and their thoughts and perceptions about critical care. Overall, both interviewees expressed similar positive experiences through their work, particularly in regards to patient interactions and relationships. They also commented on the satisfactory learning environment and team atmosphere present within the critical care unit. Both oral histories represent the everyday and real-life experiences of the nursing profession, and show the real impact nursing can have on caring for a vulnerable patient population.
Zhyra Serrano Barber
Examining Nursing Knowledge of Medical Supply Costs and Potential Wastefulness of Nurses in the Hospital Setting
Advisor: Louise Fleming, MSN, RN, Clinical Instructor
I never knew what I wanted to be “when I grew up,” but I took a look at the highlights of my life and found the answer. I was born in poverty in a third-world country; had a memorable, childhood experience with an incredible nurse; developed a fascination of the functions, malfunctions, and treatments of the human body; and wished I had the skill set to know what was going on and what to do when my children were injured. These life experiences combined with my love of learning, compassionate nature, and desire to help others set a trail of breadcrumbs directly to the nursing profession—a field that is a continuous learning opportunity; challenging, yet highly rewarding; and makes a difference in everyday life. Oh, how proud I am to be a nurse!
Despite the vast research on the importance of cost containment in the hospital setting, little is known about nursing knowledge of the cost of medical supplies and their views on being potentially wasteful with such supplies. Nurses, being the largest, single, unified continent of health care professions (BLS, 2009), can make a significant impact on preserving lean budgets without sacrificing quality patient care and reducing the ecological footprint that the health care makes every year through cost awareness. The purpose of this study was to examine nursing knowledge of the cost of frequently used medical supplies and the potential wastefulness of nurses. Specifically to: 1) Examine nursing knowledge on the costs of commonly used medical supplies; 2) Examine whether demographic data contribute to nurses’ knowledge of costs; and 3). Examine nurses’ beliefs on wasteful behaviors. Interviews were conducted with three nurse managers from different-sized hospitals and surveys were collected from 20 registered nurses. There was little significant difference between the three hospitals when looking at nurses’ knowledge of the cost of commonly used medical supplies. Furthermore, this study demonstrated that a majority of nurses are not knowledgeable about the actual costs of their unit’s most frequently used medical supplies. In addition, most nurses believe wasteful behaviors are a problem on their unit. Further research and interventions such as education and cost awareness programs are future implications identified in the study.
Danielle Cathryn Fried
The Lived Experiences of Pediatric Oncology Parents Through the Use of Online Communication Pages
Advisor: Diane Yorke, MBA, PhD, RN, CPNP, Clinical Assistant Professor
I have always had an interest in going into the healthcare field. When I was 16, I was hospitalized for jaw surgery, and what really resonated with me was how the nurses were the ones who were really on the front lines of patient care. When it came time to choose what area of healthcare I wanted to go into, I really reflected on this experience and decided that this kind of direct patient contact was for me. Best decision I ever made!
The purpose of this study is to better understand how parents of pediatric oncology patients use online communication pages to record and share their experiences with the aim to gain insight into how we as healthcare providers can provide better support for these patients and their families. Many studies have been conducted about the lived experiences of parents and families with children diagnosed with cancer, though few do so through the use of online communication pages. Three subjects were purposefully selected to provide a variety of cancer diagnosis, age, and sex. The online communication pages the parents used to share their experiences were www.carepages.com and www.caringbridge.com. Any writings the parents shared during the first cycle of their child’s chemotherapy that were reflective, emotional/affective, or described the care they received were recorded and then sorted into themes to be analyzed for reflection and possible implications for practice. The identified themes were seeking knowledge, relationships with others, care received, and sharing emotions. Parents sought to educate themselves and others on their child’s diagnosis and treatments and served as advocates for their children. They expressed thankfulness for the support they received as well as camaraderie with other patients and their families and found comfort in these relationships. Both positive and negative experiences with care they received from healthcare providers were expressed through the participants’ writings, providing insightful possible implications for practice. Finally, pediatric oncology parents experienced a wide range of emotions and changing perspectives throughout their child’s cancer journey, but were generally optimistic.
Latorya Delois Hill
Case Study: Symptom Management in Home-Based Palliative Care
Advisor: Beth Perry Black, PhD, RN, Assistant Professor
I have always had the strong desire to help others. It began in high school with volunteering for the American Red Cross. I wanted to make it a career. After seeing my aunt (who is a nurse) care for my mother who was in a terrible traffic accident, I came to admire her knowledge, skill, and agility. It is something that completes me as a person. Nursing is a gift, one that I hope to share for a lifetime.
The transition period in which physical and emotional changes increase risk for vulnerability to prolonged recovery, ineffective coping, or decline in health status is an important concept in nursing (Meleis et. al, 2009) Nurses are key providers of palliative care during this period of transition (Meleis et. al, p. 13, 2000). The purpose of this ethnographic case study is to describe the essential role of the nurse in symptom management for a patient receiving palliative care and their primary caregiver. The specific aims are: 1) to describe the symptoms encountered by the patient and caregiver and the nurse’s responses to those needs; and 2) to determine the changes in symptoms over time and how the nurse responds to those needs during the transition to the end of life. Participants were a patient and primary caregiver with an advanced cancer that has a somewhat predictable trajectory and the patient’s primary care nurse in a home-based palliative care setting. Medical records were reviewed and interviews conducted with all participants to determine essential functions of the nurse with regard to symptom management and needs of the patient/caregiver. In addition, major symptoms were identified and their interventions described. Thematic content analysis found the concepts of knowledge, anticipation, presence, insightfulness, and resourcefulness as main features required of the nurse during the transition period. The issues of cost-benefit ratio in palliative care, and implementation of home based palliative care into national programs have implications for future research.
A Meta-Analysis of Qualitative Findings on the Role of Spirituality Among Women Laboring with Epidural Anesthesia
Advisor: Sara L. Hubbell, RN, MSN, NP-C, FCN, Clinical Instructor
My B.A. in Religious Studies gave me a unique perspective on the human condition, the healing process, and the powerful role a nurse has in this interchange. I went back to school to become a nurse because it is a career that allows me to continue to learn and be challenged while also impacting the lives of those around me. Nursing is a defining part of who I am and who I want to become. The desire to combine compassionate care and my love of people with my interests in anatomy and physiology naturally led me to pursue nursing. It has been a privilege to be part of this program, and I hope to never stop learning from the incredible nurses in my life.
The aim of this paper was to explore the concepts and themes surrounding the maternal spiritual experience of childbirth with epidural anesthesia. Pregnancy and birth have been recognized and documented to have a spiritual nature by women and the health professionals caring for them. This work identifies the connection of spirituality and birth in the health care setting and the need for implementing practices to enhance this experience for women choosing epidural anesthesia during labor. Nurses are expected to have a holistic approach to care that should include all patients regardless of pharmaceutical interventions employed. The author preformed a review of the literature and meta-analysis of current qualitative research to generate implications for future research and practice. The review demonstrates the value women place on the sacredness of pregnancy and birth, and that the spiritual nature of the labor process with epidural anesthesia should be further examined for its potential impact on maternal birth experience. This paper shows the views and values women have of pregnancy and birth and the powerful, spiritual nature of the labor experience. These findings indicate that further discussion and research needed in this area. It is recommended that all who work with women who are pregnant should recognize the spiritual nature of the labor process when providing care.
Olga Kinsfator Long
A Review of Preoperative Children Books and the Effects of Preoperative Education
Advisor: Diane Yorke, MBA, PhD, RN, CPNP, Clinical Assistant Professor
I chose to go into nursing because I like helping people. I’m a compassionate and caring person and I find it personally rewarding to be able to help others get through difficult periods in their lives. I also like the fact that this profession has a universal demand, with many opportunities in a wide range of applications that I might challenge myself on. The United States has the best health care system in the world and I hope to one day return to my home country of Georgia and use my experiences and knowledge I’ve gained to help improve their healthcare system as well. I am excited and looking forward to my future career as a nurse.
A hospital stay can be a challenging and unfamiliar experience for children and their families. Parents are provided with explanations of pre- and post-surgery expectations. However, children may not be provided with as much detail about their hospitalization. Better education for pediatric patients about upcoming surgical procedures may minimize misunderstanding and decrease fear of not knowing what is going to happen in the hospital. One method for preparing children (and giving them an avenue for asking questions) is to use age-appropriate children’s books at home prior to a planned hospital visit. Children’s literature can be used to educate patients not only about illness, surgery, and hospitalization, but also about the entire perioperative process. This project examines customer reviews of books written for children aged 3-6 years about going to the hospital and provides an analysis of the language and illustration techniques and then compares the customer review ratings and the techniques used in the books to determine what consumers of these books find most appealing. Fifteen children’s books addressing surgery and hospitalization are examined here.
Brittany Nicole Napier
Assessment and Intervention Strategies to Improve Healthcare Management in Elementary Classrooms
Advisor: Marianne Cockroft, MNEd, RN, Clinical Assistant Professor
I have always been fascinated by the sciences. Even as a child, I knew I would pursue a career in the healthcare field. After being accepted to UNC-Chapel Hill, my dreams started to become reality, and I began contemplating what aspect of healthcare I wished to pursue. I knew I wanted a career where I would be immersed in the science of medicine, working at the bedside, and caring for patients at a time when they needed an advocate as much as a cure. It became clear to me then that nursing was the obvious answer. I felt compelled to become a nurse, knowing that on a daily basis I would be making a difference in someone’s life through the act of caring.
This study attempted to better understand and improve the teachers’ ability to assess and implement healthcare management strategies within the elementary classroom. A comprehensive review of literature was used to create a focused educational module for student teachers addressing the management of asthma, allergies, and diabetes in the classroom setting. The educational module was composed of two components, a PowerPoint presentation including material on signs, symptoms, and interventions relating to the three aforementioned conditions and a demonstrational component that allowed participants to practice using necessary healthcare equipment. The presentation was given to student teachers at a school located in Durham, NC (n=6). Positive post- test survey results indicate that this presentation could be helpful in providing supplemental healthcare education to student teachers regarding assessment and intervention strategies for asthma, allergies, and diabetes within the elementary classroom setting. Participants commented that the material presented to them was beneficial to their career and post-test survey results unanimously showed an “extreme” improvement in their understanding of what would be expected of them in regards to the healthcare management of their students. Educational modules addressing the healthcare needs of students are beneficial to the teacher and also the student. As the teacher gains an increased understanding of how to manage the healthcare needs, the student will receive improved care which can lead to increased medical safety, decreased absenteeism, and improved educational outcomes.
Jessica Alyse Palombo
The Complexities of Delivering Effective Spiritual Care
Advisor: Theresa Raphael-Grimm, PhD, CNS, Clinical Associate Professor
I have chosen to go into nursing because I believe it is what I am called to do. Nursing is a challenging profession—mentally, physically, and emotionally. It is also incredibly rewarding. I love serving others, hearing their stories, and learning from them. To be invited into another’s journey and to help them in whatever way I can is a beautiful privilege. In the words of an anonymous source, “I want to dwell with you even in your darkest of days—if only to shed a little light.”
Spirituality is considered an integral part of nursing care. Even though most healthcare disciplines endorse the sensitive provision of spiritual care, many clinicians avoid addressing patients’ spiritual needs. Ambiguity surrounding the definition of spirituality, difficulties in establishing appropriate boundaries around what constitutes spiritual care by non-clergy, and the lack of practical guidelines for how to provide basic spiritual care are significant barriers. These barriers keeps patient from receiving the spiritual comfort that could ease some of the stress associated with their illness experience. This paper will explore common themes in the varying definitions of spirituality and the current spiritual interventions recommended. From this review, recommendations for a preliminary strategy will be offered in an effort to provide nurses with a more concrete outline to guide them in their spiritual care practice. Ultimately, the goal of this paper is to bring clarity to the scope of spiritual care and to provide a beginning template from which nurses can base their spiritual care interventions.
Virginia Elise Seay
Nurse-Pharmacist Relationships in the Hospital Setting
Advisor: Meg Zomorodi, RN, CNL, PhD, Clinical Associate Professor
I chose to go into nursing out of a desire to provide care and comfort for people during difficult times. I began working as a pharmacy technician in a hospital after graduating high school, and I found that my favorite thing to do was leave the pharmacy and have the opportunity to interact with patients and family members. I wanted to be at the bedside of the patients providing care and comfort. Nursing gives me that opportunity.
Effective communication is critical to patient safety. The Institute of Medicine report “To Err is Human” reported that 7,000 deaths occurred annually because of medication errors. For medication administration, pharmacists verify the medications and the nurse is responsible for administration. While research has explored the nurse-physician relationship, no study has been conducted assessing the communication practices between pharmacists and nurses in the hospital setting. The purpose of this study was to develop an instrument from existing literature to assess the relationship of nurses and pharmacists. Research questions include: 1) What similarities and differences do the nurse and pharmacist possess in terms of communication and conflict resolution? 2) What factors influence the relationship and communication between pharmacists and nurses? 3) How often do nurses and pharmacists communicate? A modified version of the ICU Nurse-Physician Questionnaire was sent to registered pharmacists in the state of North Carolina through a listserv obtained from North Carolina’s Board of Pharmacy and to nurses through Durham Veteran’s Administration Medical Center, UNC- Chapel Hill’s School of Nursing alumni newsletter, and other listservs. Data was analyzed using statistical software SPSS with independent t-tests. While hospital nurse and pharmacist relationships are generally viewed as positive by nurses and pharmacists, there are still areas for improvement and interventions that can be taken, such as increased in person communication opportunities between nurses and pharmacists. Future research should include the development of interventions to improve collaboration and communication between these two professions.
Lisa Marianne Skiver
Pediatric Subcutaneous Injection Medication: A Teaching Tool for Pediatric Nurses and Educational Booklet for Families
Advisor: Diane Yorke, MBA, PhD, RN, CPNP, Clinical Assistant Professor
I knew I always wanted a job where I got to work with people all day. I have also always loved working with kids, and nursing seemed like the perfect profession. Caring for others has become a passion, and I cannot wait to start my career!
Subcutaneous injection medication is being prescribed more frequently in the pediatric population and many chronically ill children are being discharged with subcutaneous injections to be given at home by parents and caregivers. Although existing literature does give some instruction for the injection procedure in the health care setting, a thorough review revealed that there has been neither research regarding parents who have to inject their children nor any standardized instruction available for parents of children being discharged with home injections. During this difficult time, parental boundaries are often changed and tested as a new and unfamiliar skill has to be learned and performed effectively in order to make or keep their child well (Sullivan-Bulyai et al, 2003). The purpose of this project was to develop an educational teaching tool for parents of children being discharged with subcutaneous injection medication. It is intended to be used by nurses in the hospital to effectively teach parents how to inject their child and then be taken home by the family as a reference guide after discharge. Research has shown that when parents have sufficient and quality information, they cope better, therefore resulting in better learning and consequently better outcomes once home with their child’s injection medications (Davies & Hall, 2005; Kelly & Porock, 2005; Starke & Moller, 2002). This teaching tool may be used to facilitate caregiver confidence during the learning process in the hospital as well as at home with their child and his or her new medication.
Jordan M. Snow
Nonpharmacological Interventions for the Management of Aggressive Behaviors in Nursing Home Residents with Dementia: A Systematic Review of Literature
Advisors: Beth Perry Black, PhD, RN, Assistant Professor and Anna Song Beeber, PhD, RN, Assistant Professor
I chose to become a nurse so that I could help people. Beginning college as journalism major, I soon learned I wanted to reach people in a more direct way than the printed word. I am excited to begin my career as a nurse so I can interact with and care for people as part of my daily life.
Approximately 1.3 million older adults live in skilled nursing facilities in the U.S. This number will likely double by 2030. Half of new nursing home residents are diagnosed with dementia, challenging nursing staff to develop ways of providing safe and quality care to this large population. Up to 86% of persons with dementia will present with behavioral symptoms such as agitation, wandering, or verbal and physical violence. These disturbances are disruptive and may contribute to the high turnover rates of nursing staff in nursing homes. Nurses report feeling inadequately prepared to deal with agitated and aggressive behavior in persons with dementia. Often, pharmacological therapies are used to control these behaviors, despite their significant side effects. With nurses and nursing assistants being the primary providers of care in nursing homes, they are in a prime position to use nonpharmacological therapies to manage aggressive behavioral symptoms in patients with dementia. Many of these interventions have been found to be equally or more effective than pharmacological therapies, without unwanted side effects. A review of the literature of these therapies yielded 18 papers addressing nonpharamcological interventions in patients with dementia-related aggression. These therapies were found to generally reduce agitated and aggressive behaviors, although some were found to be more effective than others. Staff education, environmental modification, resident stimulation and frequent pain assessment were all found to reduce aggressive behaviors. Interventions incorporating patient preferences and incorporating person-centered care were especially effective.
Stephanie Virginia Sun
Barriers to Exclusive Breastfeeding in Latinas at Piedmont Health Services
Advisor: Rhonda Lanning, RN, MSN, CNM, IBCLC, Clinical Instructor
To me, nursing is about caring for others; connecting with and meeting them where they are. It’s about sharing life’s joys as well as sorrows, and learning about the human condition together. I chose to go into nursing because I have always felt called to serve others. Nursing allows me to do all these things. It allows me to make a tangible difference in the lives of others through caring, empowering, and educating. As a child, I was also fascinated by the miracle of life. That fascination eventually grew into an interest in maternal and child health. Nursing allows me to pursue a career in nurse-midwifery where I can care for women, infants, and the family as a whole. It also allows me to share in the joy of welcoming little ones into this world.
Exclusive breastfeeding provides an array of protective factors against short and long term health problems for newborns, infants, and toddlers. It is well established that breastfeeding provides health benefits even beyond the breastfeeding years. Early supplementation is a practice well documented in the Latina population. However, there is a paucity of literature explaining the rationale behind the supplementation practices in this population. Early supplementation of breast milk with infant formula leads to a decreased duration of breastfeeding and thus a decrease in health benefits incurred by the formula supplemented child. Understanding the decision making processes of Latina women in their choice to supplement breast milk with infant formula has the potential to create more culturally relevant educational materials that can more effectively teach Latina women about the benefits of exclusive breastfeeding. The World Health Organization (WHO) and the American Academy of Pediatrics (AAP) recommend exclusive breastfeeding in the first six months of infant life. This paper provides a literature review of trends in infant feeding practices, focusing on the practice of early supplementation of infant formula in the Latina population. This paper also conveys the results of a pilot survey study gauging infant feeding knowledge, beliefs, and attitudes of Latina women seeking prenatal care at Piedmont Health Services in Carrboro, North Carolina.
Violence Against Nurses Toolkit: A Step by Step Guide for Nurses Who Have Been Victims of Physician Initiated Violence in Hospital Settings
Advisor: Rumay Alexander, EdD, RN, Clinical Professor & Director, Multicultural Affairs
I was motivated to become a nurse by a sincere desire to alleviate the pain and suffering that I had both witnessed and experienced in this world.
Violence against nurses by physicians in the workplace has been called by many names. Some refer to it as incivility. Others refer to it as bullying. Some call it disruptive behavior. Violence against nurses in the workplace refers to a range of unacceptable behavior on a continuum of violence extending from rudeness on the low end to full-fledged battery and assault on the extreme opposite end (ANA, 1994). Regardless of the specific terms used to describe varying degrees of violence against nurses, the underlying proscribed behavior remains the same. It is typically hostile, threatening, intimidating, and often criminal. Workplace violence includes verbal, psychological, sexual, and physical abuse in all of its forms.
Statistics indicate that over 90% of nurses have been the victims of abuse initiated by a physician in their workplace (Sofield & Salmon, 2003). Nurses who have been the targets of abuse often find themselves without assistance or resources to help them navigate the legal and regulatory complexities that emerge in the aftermath of an attack. Thus the purpose of this project was to create a step by step emergency resource booklet for nurses to guide them on what they need to do to protect themselves and their patients after a physician initiated attack. This resource is based on the laws of the State of Georgia, and it is designed to inform nurses of their legal rights.