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.

Family Experience with Eating Disorders Scale: Exploring Reliability and Validity and Evaluating the Clinical Utility of its Use in Treatment
by Kathleen M. Hoff

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 Survey of Foreign-Educated Nurses: Workforce Experience
by Melissa Giegerich

The United States (US) is currently undergoing a nursing shortage. As a result, many health care agencies in the US and around the world are turning to nurses educated in other countries to fill vacant positions. Despite the increased utilization of foreign-educated nurses, there is a lack of understanding of how these nurses transition into the US workforce. This study describes foreign-educated nurses who work in Illinois and the factors that affected their transition into the US professional nursing workforce. By focusing on nurses who were educated abroad and work in Illinois, this study will help Illinois nurses and Illinois nursing employers to better understand the transition process foreign-educated nurses undergo. An original questionnaire, entitled "A Survey of Workforce Experience of Foreign-educated Registered Nurses," was developed based upon a literature review and two related studies. This tool was used to survey 18 foreign-educated nurses working in Illinois in two agencies. Results demonstrated that the demographic and workforce characteristics of the foreign-educated nurses working in Illinois are similar to national foreign-educated nurse data. Most nurses in this study indicated they encountered limited communication problems and were respected.

Detecting Suicide Risk in Adolescents in an Emergency Department: An Implementation Study
by Rebecca L. Hahn

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.

Detecting Suicide Risk in Adolescents and Adults in an Emergency Department: a Pilot Study
by Katie N. Davis

A pilot study was conducted to detect suicide risk in adolescents and adults presenting to an Emergency Department (ED) in the Midwest, as well as to test the reliability and validity of the 4-item Risk of Suicide Questionnaire (RSQ) developed by Horowitz, et al. (2001). Participants consisted of a convenience sample of 104 ED patients ranging in age from 12 to 82 regardless of chief complaint or psychiatric history. The RSQ was verbally administered to 39 adolescents (age 12 to 24) and 65 adults (over 25). Demographic data, chief complaint, and discharge diagnosis were also obtained. Psychometric analysis demonstrated an adequate degree of reliability and criterion related validity. Results support a reduced 2-item form of the RSQ to determine imminent risk of suicide.

Nurses' Attitudes, Knowledge, and Use of Nonpharmalogical Pain Management Techniques and Therapies
by Erin Bicek

Each day millions of people suffer from pain whether they are in the hospital, their homes, or assisted living facilities. The experience of pain negatively influences their daily lives. As nurses and physicians interact with patients and families, they assess and treat their pain. Nurses and physicians attitudes and knowledge of pain management can affect their patient's treatment options. Most of the time drugs are prescribed to relieve the pain including narcotics and non-steroidal anti-inflammatories. However, pain is often under-treated and patients continue to suffer from the ill effects of pain and lack of management (Yates et aI., 1998). Nonpharmacological pain management therapies are increasing in popularity; however, medical personnel as well as patient's knowledge of these therapies are not well researched. Physicians and nurses level of knowledge and attitudes of nonpharmacological pain management greatly affects whether a patient is given these options. Nonpharmacological pain therapies and techniques have great potential to relieve someone's pain and can be used with or without pharmacological methods. There are many benefits to using nonpharmacological methods in relieving pain, therefore, the barriers keeping patients, nurses, and physicians from using them need to be explored. Nurses' attitudes and knowledge ofnonpharmacological pain management therapies needs to be assessed, and any deficits identified need to be rectified so patients have access to other options to more effectively manage their pain.

On vs. Off: Coronary Bypass Surgery from a Patient's Perspective
by Ann Steele

Throughout the years, technological advances have changed the face of cardiac surgery, but at times, it is a return to a previous technique, which proves beneficial. Prior to the introduction of cardiopulmonary bypass, cardiac surgery was performed on a beating heart, but due to the lack of an appropriate immobilizing device, the surgery was extremely complicated. With the introduction of new stabilization devices, immobilization of the heart has become easier and beating heart surgery has gained popularity once again. Multiple studies have been done which discuss the benefits of off-pump coronary artery bypass surgery (OPCAB), but none of the studies have explored the surgery from a patient's perspective. The patient is medicine's most important ally and as such, it is important that health care providers understand the fears, anxieties, and experiences that their patients undergo. Studies have compared OPCAB with conventional coronary artery bypass (CABG), but the patient's experience has not been explored. The purpose of this study was to determine how people who have had both OPCAB and CABG view the surgical experience, their outcomes, and the fears they had prior to surgery. The sample was comprised of four men living independently in a small midwestern community. The sample was recruited with the help of a local cardiovascular surgeon's office. The participants were interviewed using an interview guide. Interviews were audiotaped and transcribed. Inductive data analysis was completed using the transcribed interviews as well as field notes from the researcher. From the data, eight categories and five subcategories were formed. The categories included suggestions to other patients, recommendations to healthcare professionals, preoperative preparation, medications, symptoms prior to surgery, trust in doctors, postoperative depression, and comparisons between CABG and OPCAB. The last category was further subdivided into five subcategories, which included general comparison, subjective look of patient, length of stay, recovery period, and intubation experience. The information gleaned from this study is of importance to nurses as well as other healthcare professionals as they work with patients before and after either type of bypass surgery. "It's a lifetime experience," and, therefore, it is important that healthcare professionals are fully prepared to care for and educate patients as their hearts are mended. The findings of this study may help to provide insight and knowledge about the patient's experience as they undergo one of these life-changing surgeries.

The Effects of Personality Characteristics and Stress on Physical Illness
by Carly A. Andersen

Recent research has indicated that personality characteristics and stress may influence the incidence of illness (Dreher, 1995). The majority of studies have examined personality characteristics and stress in acutely and chronically ill populations. However, this phenomenon has not been extensively studied in healthy populations. The purpose of this study was to examine the relationships among personality characteristics, subjective stress, and physical illness in a sample of undergraduate students. This study tested a moderator model in which personality characteristics interact with stress to influence the incidence of physical illness using hierarchical multiple regression. Study participants included 55 undergraduate students selected from two classes at a small mid-western university. These two classes were chosen to represent the diversity of majors, gender, and academic level at the university. Personality characteristics were assessed with measures of hardiness and assertiveness. A series of four surveys assessing hardiness, assertiveness, subjective stress, and physical illness as well as a demographic sheet were distributed to study participants to be completed during class time. The analyses revealed significant correlations between the personality characteristics, hardiness and assertiveness, and subjective stress. The data did not offer empirical support for the moderator model, thus suggesting that personality characteristics do not interact with subjective stress to influence the incidence of physical illness. However this finding should be considered with caution since the measure used to assess physical illness may have limited sensitivity in this population. Future research is indicated using different measures of physical illness with greater sensitivity in healthy populations.

Living With Unstable Coronary Artery Disease
by Marcie M. Tempel

Coronary artery disease (CAD) remains a leading cause of mortality and morbidity in the United States. CAD can be a long term, recurrent health problem placing a heavy burden on the afflicted individual. Although the mean age of individuals experiencing their first clinical sYmptoms of CAD is usually reported to be in the fifth or sixth decade of life, individuals may also experience sYmptoms of disease at an earlier age when actively engaged in career, family, and vigorous leisure activities. There is a sparsity of experiential information and nurses need to be sensitive to the psychosocial impact of this experience on daily living. This study proposes to examine the lived experience of one middle-aged man with unstable CAD using qualitative research methods.

The Scope and Practice of Rural Nurse Practitioners in Central Illinois
by Lisa L. Lovegren

In today's atmosphere of escalating health care costs, limited access to health care, and changes in the health care delivery systems, it is necessary to evaluate the roles and responsibilities of non physician health care providers. The advanced Nurse Practitioner is one such health care professional who currently provides vital services to the public. However, utilization of Nurse Practitioners has been limited within Illinois. The purpose of this study was to: 1) examine current perceived roles of rural Central Illinois Nurse Practitioners, and 2) determine perceived practice-related changes and trends for the future.

Identification of Inner-City, African-American Caregivers' Informational Needs in Providing Care for Their Children
by Stacie De Lair

The purpose of this study was to identify the information inner-city, African-American caregivers wanted in order to provide better care for their children. Thirty-five African-American caregivers of children, aged three to seven years, were interviewed. The gender, relationship to child, number of children cared for regularly, and the desired informational needs were identified. Frequencies and descriptive statistics were used for data analysis. Results showed that parenting-discipline and safety were each identified by approximately 25% of the respondents as desired informational needs. Almost 20% of the responses indicated no need for information. Other categories where a need for information was identified were nutrition (10.1 %), other topics (8.5%), health state (6.7%), and parenting-education (5%). Future educational programming is recommended regarding identified informational needs. Further research needs to be done in a variety of settings to determine more about areas of informational need.