The Student Honors Papers collection represents exemplary work in nursing at Illinois Wesleyan University. The Ames Library is proud to archive these and other honors projects in Digital Commons @ IWU, the University's online archive of student, faculty and staff scholarship and creative activity.
School nurses have a large scope of practice (American Nurses Association [ANA] & National Association of School Nurses [NASN], 2011). However, school administrators often misunderstand, and therefore under appreciate, the school nurses' role (Junious et al., 2004). In addition, few schools meet the 1 :750 nurse to student ratio recommended by the NASN and the ANA (2011); high nurse to student ratios negatively affect school nurses' job satisfaction (Maughn & Adams, 2011). Several studies found that interventions by the school nurse positively impacted students (Bonauito, 2007; Denny et al., 2012), while others have linked the presence of a school nurse with improved attendance (Pennington & Delaney, 2008; Telljohann, Dake, & Price, 2004). The current study surveyed nurses working at schools in Illinois, and adds to this body of research by examining the relationship between the time school nurses spend on classroom health education and their job satisfaction as well as the correlation between classroom education, job satisfaction, and student attendance. School nurses were more satisfied when they made more visits to the classroom for health education, and when they thought that students received adequate health education from the school nurses. School nurses who served higher numbers of students were less likely to think that students received adequate health education. Attendance rates were not significantly correlated with nurses' job satisfaction or number of classroom visits. This results suggest that when nurse are able to practice to the extent of their education, they are more satisfied with their jobs, and feel like they are able to impact students.
Problem: Since the landmark Institute of Medicine report, To Err is Human, was published in 1999, patient safety has become a major concern in healthcare systems. Although attention is being given to patient safety and preventing patient morbidity and mortality, experts indicate that little progress has been made in decreasing healthcare errors. Vigilance is a phenomenon often identified in the literature as a means to promote patient safety and well-being. Purpose: The aim of this study was to establish content validity in a newly developed instrument designed to measure nurse vigilance from a patient perspective. Method: Generated 130 items and following a card sort reduced that to 70 items. Four steps were completed to design the instrument: 1 ) A pool of 70 items was developed from five domains of vigilance, previously established from research: knowledge, connectedness, hope, going beyond the call of duty, and shared vigilance, as well as a domain to reflect quality patient outcomes such as safety and quality care. The domains were derived from a qualitative study of patient, family, and nurse experiences of vigilance and existing research literature; 2) An expert panel, consisting of eight professionals with knowledge about vigilance, quality, and safety was identified and they were asked to rate items for content validity; 3) A content validity survey was developed to rate each individual item according to the expert analysis of the relevance to its proposed domain of vigilance. 4) Using Statistical Package for the Social Sciences (SPSS) 21 , items were analyzed for internal consistency and content validity. Results: Statistical evidence and theoretical relevance guided the individual items to be retained as well as eliminated, which led to the delineation of a 35-item instrument. The instrument demonstrated an adequate degree of reliability with an alpha of 0.982, and an acceptable total CVI rating of 0 . 8 3 .
Optimal head to toe assessment frequency in hospitalized pediatric patients is unknown. Although pediatric patients have many accommodations based on their age, developmental state, and varied needs, healthcare professionals have not published any research regarding the optimal frequency for registered nurses to perform head-to-toe assessments in hospitalized pediatric patients. Healthcare professionals must make decisions based on evidence-based practice. A change in pediatric assessment intervals was proposed at a Midwestern regional medical center. The purpose of this pilot study was to ensure patient safety and staff satisfaction following a policy change in head-to-toe assessment frequency Chart audits were performed on all patients upon discharge and after any status upgrade to ensure the decline in status was not related to the change in head-to-toe assessment frequency. A total of 421 patients were included in the study. Seventeen patients had a change in status; eleven patients were upgraded to an intermediate level of care and six were transferred to the intensive care unit. Both registered nurses and primary care providers responded that they were satisfied with the change in assessment frequency. All registered nurses reported they believed there was no increase in unplanned upgrades or transfers after the change. Following the pilot period, the unit policy was changed to reflect the new head-to-toe assessment interval. While our research has demonstrated safety in the policy change, additional studies are needed to assure safety in a wider variety of patients and settings.
Examining Disparities in Care in an Uninsured, Diabetic Population
by Emily R. Manninen
Type 2 diabetes is a common health problem that requires continuing medical care, self-management, and education. However, different populations experience diabetes and diabetes-related care differently. This study examined diabetes care and health outcomes at a Midwest community health clinic serving the uninsured. Two waves of data were obtained from medical records. Wave 1 consisted of 88 medical records of people who were diagnosed with type 2 diabetes and also had previous medical record reviews regarding routine diabetes care and outcomes. Wave 2 consisted of in-depth review of 20 medical records of male patients, diagnosed with type 2 diabetes, whose primary language was either Spanish or English. Wave 2 data collection utilized the list of medical records from Wave 1. Statistical analyses utilized non-parametric tests, due to the small sample size. Research questions compared the quality of diabetes care and related health outcomes for Spanish-speaking and English-speaking patients, as recorded in the medical record. Spanish-speaking patients were found to be patients at the clinic for a longer period, have poorer glycemic control, and be less adherent to medication recommendations. A few results from Wave 1 varied from those of Wave 2, including emergency department visits and hospitalizations related to diabetic complications. These conflicting results reflect conflicting outcomes in research, showing the need for further research. Additional research should address reasoning behind these disparities so as to better address them in the future.
Lesbian, gay, bisexual, and transgender (LGBT) patients experience barriers to health care that include fear of discrimination and limited access to providers knowledgeable about and sensitive to the LGBT population and their specific health needs. This study examined the effectiveness of an educational intervention conducted at Illinois Wesleyan University designed to improve knowledge level and attitudes of nursing students toward LGBT patient care. The educational intervention focused on key terminology, health disparities, medical needs of transgender patients and culturally sensitive communication skills necessary for competent LGBT patient care. Knowledge level and attitudes were evaluated before and after the educational intervention using a survey based on a modified Attitudes Toward Lesbians and Gay Men Scale, and two assessment tools developed for this study. The results of this study showed both an improvement in attitudes and an increase in knowledge level directly after the educational intervention. Implications of this study support the inclusion of content related to LGBT patient healthcare into undergraduate nursing curricula to enhance knowledge as well as to promote cultural competence and sensitivity.
Mild Traumatic Brain Injury: Educational Techniques
by Katherine R. Racanelli
The awareness of mild traumatic brain injury as a health concern has increased across a multitude of athletic settings due to a plethora of research and clinical findings that indicate the serious threat concussions pose, particularly to young athletes. The need to provide risk reduction and health promotion education to athletes and parents necessitates an innovative approach. This study explores the effectiveness of an educational intervention based on information from the Centers for Disease Control and Prevention to promote awareness regarding the pathophysiology, symptoms, consequences, and prevention of sports-related mild traumatic brain injury. An interactive educational program was administered to student athletes, parents, coaches, and athletic trainers at three public high schools in the midwest. The sample included 147 athletes and 141 parents. Knowledge of the participants was evaluated with a questionnaire created for this study entitled Protecting Athletes from Injury through Knowledge and Education (PIKE) which was administered prior to and following the intervention to determine changes in comprehension and provide direction to design future programs that promote traumatic brain injury awareness. Results showed an increase in mean scores from pretest to posttest in the athlete and parent samples, indicating the educational intervention was effective at increasing knowledge of mild traumatic brain injury.
Roughly one-third of all emergency department (ED) visits by both insured and uninsured individuals in the United States (US) are for non-urgent health conditions that can be effectively treated at a reduced cost by a primary care provider (Hossain, 2011). The purpose of this study is to identify trends of ED visits by uninsured individuals. This study is a secondary data analysis of patient visits to a midwest community ED. This study examined the services provided in the ED for non-urgent visits that could be provided at a less costly and non-urgent care facility, such as a Community Health Care Clinic (CHC), Nurse Managed Health Center (NMHC), or prompt care. Implications of the analysis are discussed, including community resources needed to reduce non-urgent ED visits and the associated cost burdens of uncompensated health care dollars on this midwest community.
Reliability Measurement of the Premature Infant Oral Motor Intervention
by Clare A. Goebel
A study was conducted at a Level III Neonatal Intensive Care Unit (NICU) at a large Midwestern teaching medical center to determine the reliability of the Premature Infant Oral Motor Intervention (PIOMI). The PIOMI is a five minute, oral motor intervention using a gloved finger in the mouths of premature infants of at least 29 weeks post-menstrual age (PMA) developed by Dr. Brenda S. Lessen to improve feeding skills in preterm infants. The PIOMI was first introduced in a pilot study done by Dr. Lessen and the results demonstrated a decrease in the amount of time needed for premature infants to reach full bottle feedings and be discharged (Lessen, 2008). Three registered nurses (RNs) were recruited as subjects for this study and trained to perform the PIOMI on preterm infants. A training video and a reference sheet were developed and distributed during a two hour training session. A reliability rating tool was developed for this study based on a four-point Likert scale according to three criteria: order, technique, and time. Two observers rated three RNs performing the PIOMI twice on premature infants. The reliability among the observers (interobserver), the reliability among different RNs (interuser), and the reliability of the same RN performing the PIOMI twice (test-retest) were calculated. The PIOMI demonstrates high interobserver reliability (97.57%), interuser reliability (97.59%), and test-retest reliability (97.58%).
The family plays a significant role in the development and maintenance of eating disorders, and may be equally influential in recovery. The deliberate use of an instrument that addresses the perceived family environment is useful in engaging the family in treatment and enhancing treatment outcomes. The Family Experience with Eating Disorders Scale (FEEDS) was used in this study because it addresses the psychometric deficits common in existing general family assessment instruments and captures family dynamics specific to eating disorders. The 53-item FEEDS was design to illicit the parental perception of the family environment and assesses family dynamics specific to eating disorders, including relational dynamics, interaction skills, and modeling of weight, shape, and eating. A client version of the FEEDS was developed for this study to test the degree of congruence in parent-child perceptions of family dynamics. Moreover, a scoring rubric was created for clinical use based on previous normed data comparing parental responses between families whose child has either an eating disorder, a non-eating disorder psychiatric disorder, or no mental health condition. This paper examines additional psychometric properties of the FEEDS and evaluates its appropriateness for use in clinical practice. Emphasis was placed on the unique challenges of expanding the use of an instrument used only for research purposes to utilize in the clinical setting. A sample of 10 matched dyads revealed adequate levels of reliability; construct validity with known groups was not supported in this sample. Client and parent satisfaction with the FEEDS in the clinical setting was confirmed. The outcome of this study has clinical and research implications; the consistent use of the FEEDS (Parent and Child Versions) will guide the direction of therapy when familial factors are identified at the beginning of treatment and incorporated into the plan of care.
A study was conducted to detect suicide risk in adolescents and adults seeking treatment in an Emergency Department (ED) in the Midwest, as well as to test the reliability, validity, and inter-rater reliability of the 4-item Risk of Suicide Questionnaire (RSQ) developed by Horowitz et al. (2001). The feasibility and need for the ED staff to conduct suicide screening of all patients who present to the ED was also assessed. This study expanded the implementation of the RSQ beyond its initial use with children and adolescents with psychiatric symptoms seeking treatment in a pediatric ED to include adolescent, adult, and geriatric patients in a Level II Trauma Center, regardless of chief complaint or psychiatric history. This study also included the training of Registered Nurses in the ED to administer the RSQ. Participants consisted of a convenience sample of 202 patients comprised of 59 adolescents (age 12 to 24) and 143 adults (over 25), including 36 geriatrics (65 and older). Demographic data, chief complaint, discharge diagnoses, and referrals were also obtained. Psychometric analysis demonstrated a lower than expected degree of reliability and an adequate level of criterion-related validity for the RSQ in this sample. Inter-rater reliability was also established. Approximately 42% of all patients who participated screened positive for suicide risk. Results support suicide screening by nurses as part of the admission assessment to determine suicide risk in all patients who present to an ED.