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Faculty Abstracts (jump to Students)

Adolescent’s Access to Sexually Transmitted Disease Services in Duval County, Florida

Problem: The purpose of this study was to determine problems adolescents have with accessing STD services in Duval County, Florida.

Sample: Interviews were conducted with key informants. Chain sampling was used to find other informants for individual interviews, casual conversation and focus groups.

Method: Ethnography was used to determine the concerns of the community. When possible interviews were taped and transcribed. Field notes, historical data, statistical information and local documents were used in the data analysis.

Findings: Adolescents have specific needs for accessing services. The primary finding was that adolescents learn about STD services “word of mouth”. Additional findings include the absence of symptoms, being unsure of where, when and how to access health care services and the lack of transportation. Basic needs takes precedence over health care. Community values and the stigma surrounding STDs and sexuality education contribute to the problems. Failure to publicize, market and coordinate the services offered by numerous agencies available to provide care is a major obstacle.

Recommendations: Access can be improved by providing services at non-traditional hours and days. Primary care clinics in neighborhoods would also meet the needs of the community and eliminate the stigma of being seen at an “STD clinic”. Education regarding STDs and sexuality needs to be in the schools and involve the community. Non-judgmental education regarding sex, sexuality, refusal skills and protective skills should be delivered accurately to those who need it the most, adolescents, and young adults. STDs will continue to be a silent plague until the delivery system is changed to facilitate access across economic, age and gender lines.

Cultural Knowledge Related to Overweight Children and the Role of Health Ministry

Andra Opalinski, RN, MSN, PhDc
Predoctoral Fellow
School of Nursing
University of Colorado at Denver and Health Sciences Center
Denver, CO

Purpose: The purpose of this study is to examine the cultural knowledge of members of three cultures (Hispanic community members, Haitian community members and faith community members) regarding overweight children and to examine cultural attitudes about the role of faith communities in addressing this chronic problem. Focusing on these three cultures will allow for exploration of cultural knowledge of potential users of a community health promotion program (Haitian and Hispanic) and potential providers of a health promotion program (faith community members). A long term goal will be the potential use of information gained to partner with faith communities in developing community-based nursing care actions in response to childhood overweight in a culturally appropriate way.

Background: Childhood overweight is increasingly a national concern. It is now estimated that 1 in 4 children is either overweight or at risk of being overweight. Both Hispanic and Haitian children are disproportionately affected by childhood overweight.  This may suggest that there are specific cultural issues that need to be taken into consideration when developing interventions. Exploring the cultural knowledge of these groups will provide a basis from which to start examining those cultural issues related to childhood overweight. In addition, there is a national push to develop faith-based initiatives to address issues affecting this nation’s most vulnerable individuals. This study will also explore the attitudes of both faith community leaders and Hispanic and Haitian populations about feasibility of offering community based programs for childhood overweight reduction/prevention through faith communities as a part of health ministry.  
 
Methods: The research approach for this study will be a focused ethnographic design utilizing a systematic ethnographic method known as consensus analysis. Data collection will involve an approach known as freelisting. The participants will be asked questions such as “Can you list all the reasons why children are more overweight today than ever before?”  Another question will be “Can you list all the things you would like to see done about childhood obesity?” This will allow participants to share their cultural knowledge about childhood obesity in a specific way. This design will also allow for the exploration of any shared knowledge that may exist between these three groups.

Implications: By comparing different cultural groups in their knowledge of childhood overweight and preferred treatment, evidence may be provided that childhood obesity reduction/prevention programs are beneficial and feasible to implement within ethnically diverse communities. If the cultural groups are different, future research/programming would need to focus on additional avenues for community interventions that target very specific ethnic groups.

Cultural Knowledge Related to Overweight Children and the Role of Health Ministry

Andra Opalinski, RN, MSN, PhDc
Predoctoral Fellow
School of Nursing
University of Colorado at Denver and Health Sciences Center
Denver, CO

Purpose: The purpose of this study is to examine the cultural knowledge of members of three cultures (Hispanic community members, Haitian community members and faith community members) regarding overweight children and to examine cultural attitudes about the role of faith communities in addressing this chronic problem. Focusing on these three cultures will allow for exploration of cultural knowledge of potential users of a community health promotion program (Haitian and Hispanic) and potential providers of a health promotion program (faith community members). A long term goal will be the potential use of information gained to partner with faith communities in developing community-based nursing care actions in response to childhood overweight in a culturally appropriate way.

Background: Childhood overweight is increasingly a national concern. It is now estimated that 1 in 4 children is either overweight or at risk of being overweight. Both Hispanic and Haitian children are disproportionately affected by childhood overweight.  This may suggest that there are specific cultural issues that need to be taken into consideration when developing interventions. Exploring the cultural knowledge of these groups will provide a basis from which to start examining those cultural issues related to childhood overweight. In addition, there is a national push to develop faith-based initiatives to address issues affecting this nation’s most vulnerable individuals. This study will also explore the attitudes of both faith community leaders and Hispanic and Haitian populations about feasibility of offering community based programs for childhood overweight reduction/prevention through faith communities as a part of health ministry.  
 
Methods: The research approach for this study will be a focused ethnographic design utilizing a systematic ethnographic method known as consensus analysis. Data collection will involve an approach known as freelisting. The participants will be asked questions such as “Can you list all the reasons why children are more overweight today than ever before?”  Another question will be “Can you list all the things you would like to see done about childhood obesity?” This will allow participants to share their cultural knowledge about childhood obesity in a specific way. This design will also allow for the exploration of any shared knowledge that may exist between these three groups.

Implications: By comparing different cultural groups in their knowledge of childhood overweight and preferred treatment, evidence may be provided that childhood obesity reduction/prevention programs are beneficial and feasible to implement within ethnically diverse communities. If the cultural groups are different, future research/programming would need to focus on additional avenues for community interventions that target very specific ethnic groups.

Improving STD Services in Florida:
Capitalizing on Department of Health and University  Collaboration
to Enhance Current Programs and Develop New Ones

SH Simpson(1) and KM Hood(2)
(1) University of Florida, Gainesville, FL; (2) Jacksonville University, Jacksonville

Background: In 2001 a collaboration arrangement was developed between the University of Florida College of Nursing and the Florida Department of Health, Bureau of STD Prevention and Control.  The purpose was to encourage innovative research on problems related to STD prevalence and access to services in the public health sector and to develop future STD nurse researchers.  Several projects involving qualitative and quantitative methods have been completed and several more are in process.

Objectives: To describe the range of research projects that have emerged from this collaboration.   To discuss ways to use this information to improve access, services and prevention, particularly among low income minorities and adolescents.

Content: The first presentation is an ethnographic study focused on community perception and declining attendance at DOH STD clinics in the Jacksonville area.  The second presentation compares male and female teens with repeat STDs and how gender and power differences may affect utilization of services.  The third presentation takes an in-depth look at Black male adolescents and how concepts of masculinity relate to STD risk.  The fourth presentation looks at how college students use the internet for sexually explicit information and whether this may affect sexual behavior.  The fifth presentation features the Chief of the Florida Bureau of STD Prevention and Control who will discuss the policy and program implications of these studies and the collaborative arrangement.

Implications for Programs, Policy, and/or Research: This session will provide information about STD acquisition and prevention gathered through a number of innovative approaches.  It will offer information that may be useful for STD programs, clinic staff and researchers.

Measurable Learning Objectives: By the end of this session, participants will be familiar with how information yielded by innovative approaches has provided guidance in program improvement and development for diverse populations.  Participants will also understand the importance of state and university collaboration to develop future STD researchers and the potential impact this may have.

Contact: Sharleen H. Simpson, PhD, ARNP
simpssh@nursing.ufl.edu 
352-273-6415

Parents of Children With Asthma:
An Examination of Family Hardiness, Family Stressors, and Family Functioning

Eileen Donnelly, PhD, RN

As the incidence, severity, and mortality associated with asthma has risen, the numbers of families caring for children has grown.  This study used a descriptive correlational design to examine relationships among family hardiness, family stressors, and family functioning in families of children with asthma using the Resiliency Model of Family Stress,  Adjustment and Adaptation.  The Family Hardiness Index, Family Stress Index, and FACES II instruments were completed by 27 parents of children with asthma.  Correlations were found to be significant.  Family type was also determined.

School Environments & Childhood Overweight

Purpose: The purpose of this article is to examine school environments and in particular, pouring rights contracts and how this relates to childhood overweight from a critical theory perspective.

Conclusions: Pouring rights contracts provide a profit to powerful mega-corporations at the expense of children health. There is a need to move beyond a solely individual approach to addressing childhood overweight and involve a social ecology approach. This would involve a push for social change including removal of soda machines from schools and a change from marketing practices targeted at children.

Practical Implication: Nurses are poised in the community in situations to actively affect social changes to improve health outcomes of our nation’s most vulnerable people, but nurses must get involved.

Sexually Transmitted Diseases in Young Women and Female Adolescents in Florida:
The Burden of the Disease

Background: Sexually transmitted diseases (STDs) remain a major public health challenge in the United States. Adolescents continue to have the highest rates of STDs in Florida. The CDC estimates that 19 million new infections occur each year, almost half of them among young people ages 15 to 24. In 2004, Florida had over 40,000-reported cases of STDs in the 15-24 year old group. 70% of those cases were in women.  
Policy and Programs: Recent research has revealed that adolescents learn about STDs  “word of mouth”. Community values and the stigma surrounding STDs and sexuality education contribute to the problems. Adolescents needs for accessing services have been identified in the past; little has changed in the delivery system to meet these needs.

Non-judgmental education regarding sex, sexuality, refusal skills and protective skills should be delivered accurately to those who need it the most, adolescents, and young adults. Education regarding STDs and sexuality needs to be in the schools and involve parents and the community. Failure to publicize, market and coordinate the services offered by agencies available to provide care is a major obstacle.

According to multiple studies, comprehensive sexuality education, not abstinence promotion, is most effective in reducing teenage pregnancy levels.

Implications for Programs: STDs will continue to be a silent plague until the system is changed to facilitate education, parental involvement, prevention and access to care across economic, age and gender lines.

Proposal

Background: Sexually transmitted diseases (STDs) remain a major public health challenge in the United States. Regionally, the south has higher rates of chlamydia, gonorrhea and primary and secondary syphilis. The reasons for this are not generally understood though it is believed that it may include differences in the racial/ethnic distribution of the population, poverty, and the availability and quality of health care services are primary factors. Adolescents continue to have the highest rates of STDs in Florida. The CDC estimates that 19 million new infections occur each year, almost half of them among young people ages 15 to 24. In 2004, Florida had over 40,000-reported cases of STDs in the 15-24 year old group. 70% of those cases were in women.

Policy and Programs: Adolescents lack knowledge about sex, sexuality, STDs, negotiation and resources. Recent research has revealed that adolescents learn about STDs  “word of mouth”. Community values and the stigma surrounding STDs and sexuality education contribute to the problems. Adolescents needs for accessing services have been identified in the past; little has changed in the delivery system to meet these needs.

Adolescents, in particular, need walk in services since they have limited control over their lives. These limited controls include their ability to keep what is perhaps a secretive appointment, and physically getting to get to the clinic. Adolescents think very much “in the moment” and therefore often cannot plan several weeks ahead. Adolescents do not want to disclose their need to be seen for a suspected STD or family planning to a clerk on the telephone. They may be unable to discuss the nature of their visit due to lack of privacy when they are making the telephone call.

Non-judgmental education regarding sex, sexuality, refusal skills and protective skills should be delivered accurately to those who need it the most, adolescents, and young adults. Education regarding STDs and sexuality needs to be in the schools and involve parents and the community. Failure to publicize, market and coordinate the services offered by agencies available to provide care is a major obstacle. According to multiple studies, comprehensive sexuality education, not abstinence promotion, is most effective in reducing teenage pregnancy levels.

Implications for Programs: Adolescents are different. They have a different view of the world, a failure to think in the long term, and a strong belief in their invincibility. Elements that should be included in programs directed to teens are culturally appropriate information and instructors, comprehensive sexuality education, access and opportunities. One of the most obvious ways societies socialize youth about attitudes and expectations related to sexual and reproductive behavior is through school based sexuality education. Guided by the principles of autonomy and beneficence, we should provide comprehensive STD/HIV prevention education to adolescents. STDs will continue to be a silent plague until the system is changed to facilitate education, parental involvement, prevention and access to care across economic, age and gender lines.

The Use of ST-Segment Monitoring by Nurses in the Emergency Department

Purpose: Chest pain is a common complaint in the emergency department (ED). Deciding which patients to admit to the hospital and which patients to discharge presents a challenge, especially given the high cost of hospitalization. A consensus statement released by the ST-Segment Monitoring Practice Guideline International Working Group recommends continuous ST-segment monitoring in the emergency department as a less-costly alternative to hospital admission for patients with symptoms suggestive of ischemia who do not show electrocardiogram (ECG) or enzyme evidence of ischemia. Although ST-segment monitoring is recommended for use in the emergency department, little is known about its actual use. The purpose of this study was to explore the use of ST-segment monitoring technology by ED nurses in the United States. In addition, this study sought to identify the characteristics of emergency departments that are associated with its use. 

Design: This study was a replication of a descriptive study that used a survey to explore the use of ST-segment monitoring among nurses in the intensive care unit. 

Setting: Surveys were mailed to ED nurses in emergency departments throughout the United States. The emergency departments varied by ED level and hospital size.

Sample: A sample of 500 ED nurses were randomly selected from a complete list of Emergency Nurses Association members. Institutional review board approval was obtained prior to conducting the study.

Methodology: Permission was obtained from the authors of the original study to use their instrument, and slight modifications were made to reflect differences in the ED environment. The modified survey contained closed-ended questions about hospital and ED size, cardiac procedures conducted at the facility, brand of monitors in the emergency department, and whether or not ST-segment monitoring was used. Those who reported ST-segment monitoring use were asked to complete questions about lead selection and additional Likert scale items concerning perceptions of the usefulness and value of this technology. Those who did not report its use were asked to discuss reasons for the lack of use in a short answer section. Respondents were asked not to provide their name on the survey.

Results: One hundred surveys (20% response rate) representing all levels of emergency departments from a broad geographical region of the United States were returned. Thirty-three percent of respondents indicated use of ST-segment monitoring in their emergency department. Chi-square and t-test analyses indicated no relationship between use of ST-segment monitoring and ED level, hospital size, monitor brand, hospital location, or mean ED bed number. Respondents who reported that their emergency department did not use ST-segment monitoring cited omission from standards of care, lack of education, and inadequate monitoring systems as reasons. Written comments indicated that respondents utilized ST-segment monitoring more often as a means to monitor cases of known cardiac ischemia, and less often as a method to evaluate questionable or intermittent cardiac ischemia. 

Conclusions:  This research indicates that there is a need for additional nursing education regarding the use of ST-segment monitoring. Emergency department clinicians should discuss the potential benefit of using this technology to serve their patient population. If ST-segment monitoring is determined to be a potential benefit, standards of care and equipment should be evaluated and updated as indicated.

The World Wide Web, Sexuality Information and Adolescents
Self-described as Gay, Lesbian, Bisexual or Transgendered

Background: The Internet is a powerful and inexpensive way for people to make connections, share information and exchange ideas. 68 percent of people ages 15-24 search the Internet for health information. Between 3-5 % of youths self identify as gay, lesbian or bisexual (GBLT). This does not included transgendered, questioning or those fearful of sharing this information. The Internet can be an especially important source of information for youth who may feel uncomfortable or unsafe seeking assistance through more traditional channels. GBLT teens have fewer resource s than mainstream adolescents.

Purpose: This study was done to determine the number of and content of sites available on the Internet utilizing key words, gay, lesbian and bisexual adolescents, sexuality, STDs and sexual health.

Method: Three popular search engines were utilized to locate sites utilizing key words. The sites were examined for where they appeared in the search, content, and authors.  The top forty sites from each search were examined. Content analysis utilizing SEICUS criteria were employed. Other researchers verified the analysis.

Findings: Quality sites are usually very deep into the search, usually further than teens are known to look. Advertisements for dating services were often at the top of the lists.  Sites developed outside the United States often provide more comprehensive information

Conclusions: Very little good information comes up early in the Internet search, often little information is good for teens.  Gay, lesbian and bisexual teens need quality sites that come up early (first page) in Internet searches. We have the responsibility to provide young people with the information they need to safeguard their sexual health.



Student Abstracts (jump to Faculty)

African American Asthma Literature Review

Objective: To provide a critical review of literature published between 1990 through early 2006 on the use and effectiveness of the Asthma Control Questionnaire (Juniper) in the African American asthma population.

Data Sources: Computerized searches MedLine, CINAHL, Proquest, and PubMed.

Design: Literature from indexed journals relevant to the topic were reviewed. The search was initially restricted to information that addressed the Asthma Control Questionnaire (Juniper) in the African American asthma population; however, there were none found. The search was then expanded to include word descriptors used in the asthma population, perception of asthma symptoms, cultural differences related to asthma management, assessment of the Juniper, differences in lung function, and genetic variations related to asthma among African Americans and Caucasians.

Results: Six dominant themes were identified in the literature: the perception of asthma symptoms; words used in the asthma population to describe asthma symptoms; differences in asthma symptoms across cultural groups; use and effectiveness of the Asthma Control Questionnaire (Juniper) in the asthma population; differences in lung function; and, genetic links. There is a lack of literature related to the African American asthma population with regards to symptoms and word descriptors. A discussion of the methodological issues arising in the literature, possible recommendations for further asthma research, and implications for nursing practice are outlined.

Conclusion: The mortality associated with asthma is nearly three times greater in the African American population. Although the reason for this is unclear, the lack of studies that address cultural disparities surrounding asthma may show to be significantly important. Research has shown that words used by patients to describe symptoms are culturally sensitive. It is therefore logical to predict that a more culturally sensitive asthma questionnaire may be beneficial.

Keywords: Asthma, Word descriptors, Culture, Asthma Control Questionnaire, Perception, Communication, Asthma symptoms, African American, Ethnicity, Lung function, Genetics.

The Effectiveness of a Rapid Response Team

Background: The Institute for Healthcare Improvement (IHI) 100,000 Lives Campaign targets changes in care proven to prevent avoidable deaths in hospitals. The goal of the 100,000 Lives Campaign, is to save lives across the country. In 2004, IHI encouraged American hospitals to implement Rapid Response Teams (RRT). The use of RRTs was one of six lifesaving strategies recommended by the IHI to improve patient’s outcomes. Deployment of RRT at the first sign of patient decline is crucial. Failure to recognize changes in a patient’s condition until major complications, including death, have occurred is referred to as failure to rescue.

Objective: The objective of this study was to explore the use of a RRT in a 525 bed hospital and to compare the number and location of cardiac arrests since the implementation of the RRT.

Method: This study used a descriptive, retrospective design. Data was collected from medical records of patients who were seen by the RRT. Data collected compared the number of cardiac arrests and mortality before and after the implementation of the RRT.

Results:  The number of cardiac arrests from January 2004 to January 2005 had 679 cases with an average monthly volume of 52.2 (+-) 8.5 cardiac arrests. The number of cardiac arrests from March 2005 through December 2006, had 872 cases with an average monthly volume of 39.6 (+-) 8.7 cardiac arrests, (t = 4.2, df = 33, t-test comparing sample means, and P < 0.01). More than 50% of patients seen by the RRT remain on the unit that called upon the RRT.

Conclusion: This study lends supports to the effectiveness of the RRT. The number of cardiac arrests had a significant decrease. A larger sample warrants further exploration.

Resuscitation Study

Background:  The research literature suggests that allowing families to witness resuscitation on their loved ones is beneficial.  Despite these findings, this remains a controversial topic among health care workers and most health care institutions have not adopted this practice.

Objective:  The purpose of this study was to determine if nurses and physicians supported family presence during CPR and the rationale for their opinions.  It also investigated previous experience of staff members who had allowed family presence.

Method:  A survey was distributed to nurses and physicians practicing in critical care and medical surgical units at a full-service tertiary hospital in Northeast Florida.  Statistical significance was determined using chi-square analysis and written responses were analyzed using content analysis.

Results:  Out of the 71 respondents, 43% of physicians and 25% of nurses preferred a policy prohibiting families at the bedside (p=0.25).  When asked if they believed being present during CPR facilitates the grieving process, 69% of the nurse respondents agreed or strongly agreed, with 85% of physician respondents disagreeing or strongly disagreeing (p=0.004).  Most nurses (63%) and physicians (84%) agreed or strongly agreed families could sustain psychological damage if witnessing CPR (p=0.079).  Four major themes related to family presence emerged from the written responses.  These themes included (1) Having a choice, (2) Beneficial to families, (3) Traumatizing for families, and (4) Family gets in the way.

Conclusion:  The results of this research suggest that nurses and physicians are not aware of the benefits of family presence.  Also, if there are no written policies, guidelines should be available allowing staff the option of bringing families to the bedside.

Self-Efficacy, Stage of Change and Medication Adherence in HIV Disease

Author: Ashley Reynolds, MSN, RN

Keywords: Self-Efficacy, Transtheoretical Model, Adherence, HIV, Stage of Change, Healthy Behaviors, Behavior Change, Spearman Rho Correlation, Chronic Disease Management

Objectives: HIV medication adherence is vital to the success of treatment. Non-adherence can result in poor outcomes including: drug resistance, shorter duration of regimen and decreased options to treat HIV disease. The purpose of this pilot study was:  a) to assess a patient’s perception of self-efficacy and stage of change using an assessment tool for those who have been prescribed an HIV medication regimen, and b) to discover relationships between the concepts of self-efficacy, stage of change, and medication adherence.

Methods: A convenience sample of HIV positive adults (N=32) was interviewed in a large, metropolitan HIV clinic setting.  Self-Efficacy for HIV specific tasks was assessed using a previously validated tool called the HIV-SE scale. Stage of change for medication adherence was measured using a two-part questionnaire (SOC). Adherence to HIV medication was assessed using self-reported adherence questions (MAS). Multilevel logistic models were used to study the impact of self-efficacy and stage of change on adherence, as well as the effect of medication characteristics (such as the average length of time on HIV medication therapy), length of HIV diagnosis, and patients' sociodemographic characteristics.

Results: The link between self-efficacy and medication adherence was significantly correlated (-0.63, P = 0.002).  The negative correlation represents that the higher a self-efficacy score, the lower the score for medication adherence. A lower MAS score means better adherence to medications.  Neither the variables of self-efficacy and stage of change (0.31, P = 0.20), nor stage of change and medication adherence (-0.25, P = 0.10) were significantly correlated in this sample. More data is needed with a larger sample size to determine significance of the results between the SE-SOC and SOC-MAS. The time a participant was HIV positive appears to be a significant predictor of Medication Adherence (P = 0.05).  In addition, a participant’s race appears to be a significant predictor of self-efficacy (P = 0.05).

Conclusions: Further analysis is needed to observe whether certain demographic variables such as race or sexual orientation can be effective predictors of medication adherence, a person’s stage of change or self-efficacy. In addition, certain variables were just above the (P = 0.05) level of significance and should be studied further with a larger sample to observe whether they truly are significant factors. The concept of self-efficacy appears to be the strongest variable observed in this study with several analytical methods demonstrating significance (P = 0.002).  The concept of the stage of change appeared to not be significantly related to the other two concepts and requires further study to ascertain if any relationships exist.

Author Contact Info:
Email: AshleyReynolds30@comcast.net 
Phone: (904) 571-1797​​