Exploring Neonatal Intensive Care Nurses’ Affective Responses to Providing End-of-Life Care

Significance. The Joint Commission established standards to evaluate comprehensive end-of-life infant care and the positive outcomes of such care are well documented. However, findings from multiple studies conducted over the last decade indicate that end-of-life care in the neonatal intensive care unit is not provided consistently or holistically to all dying infants. Because nurses are the healthcare professionals most often responsible for providing this care, anything that detracts from their ability to provide it, including their own affective responses, needs to be addressed. Aim. The purpose of this study was to explore—through lived and told stories—the affective, interactional, and meaning-related responses that NICU nurses have while caring for dying infants and their families. Sample, Design, and Methods. Neonatal intensive care nurses were recruited through the online membership discussion boards of the National Association of Neonatal Nurses. Participants were asked to access an online survey link and provide a written narrative describing an end-of-life care situation in which they experienced strong emotions. Demographic data also were collected. Findings. Narrative analysis revealed many affective responses, but three were the most frequent: responsibility, moral distress, and identification. Feelings of responsibility included (a) a commitment to deliver the best end-of-life care possible, (b) professional inadequacy, (c) disbelief, and d) advocacy. Feelings associated with moral distress were quite common and often related to conflicts between nurses, physicians, and families. Nurses reported feelings of identification with families of dying infants through (a) sharing their grief, (b) forming excess attachments, and (c) experiencing survivor-like guilt. Implications. Nurse educators are encouraged to discuss more extensively and perhaps through the use of simulation, the positive and negative emotions that may be experienced by nurses who are involved in end-of-life care situations. Nurse leaders are encouraged to promote supportive environments in NICUs and ensure debriefing opportunities for nurses who have recently cared for a dying infant. Significant associations, such as NICU nurses not perceiving their EOLC education as being helpful in providing that care clinically and the percentage of NICU nurses reporting the presence of an end-of-life care policy in their units of employment, also merit further examination

Christian communication in the twenty-first century: patterns and principles relative to the effective use of internet-based communications

https://place.asburyseminary.edu/ecommonsatsdissertations/1445/thumbnail.jp

Addressing Religion and Spirituality in Psychotherapy: Clients\u27 Perspectives

Twelve adult clients described the role of religion and spirituality in their lives and in therapy as a whole, as well as their specific experiences of discussing religious-spiritual topics in individual outpatient psychotherapy with nonreligiously affiliated therapists. Data were analyzed using Consensual Qualitative Research (CQR; Hill, Thompson, & Williams, 1997). Results indicated that clients were regularly involved in religious-spiritual activities, usually did not know the religious-spiritual orientation of their therapists, but often found them open to such discussions. Specific helpful discussions of religion-spirituality were often begun by clients in the 1st year of therapy, were related to clients\u27 presenting concerns, were facilitated by therapists\u27 openness, and yielded positive effects. Specific unhelpful discussions were raised equally by clients and therapists early in therapy, made clients feel judged, and evoked negative effects. Implications for practice and research are addressed

The Influence of External Factors in the Overrepresentation of African American Males in Minnesota Special Education Programs

Nationally African American males are disproportionately represented in special education programs. The city of Minneapolis closely mirrors the national trend in this regard. According to the Minneapolis Board of Education black males represent 40 percent of the enrollees in the learning disability, and educational behavior disorder classrooms, even though they are only 21 percent of the total school population. Research in this area is important because if black males are inappropriately assessed for special education placements, it may lead to the following: 1) academic and social segregation from their mainstream peers; 2) inappropriate labeling and education of African American males; and the perpetuation of life choice inequality and limitation of vocational opportunity. In order to assess the perceived causes and possible solutions to this concern interviews were conducted involving educational professionals, social workers, and parents who are/were involved with the Minnesota public school system. A guided interview format was used and the themes investigated were the perceptions of the influences of race, parenting, teacher expectation, and gender on the referrals of African American males to special education. The participants share their evaluations of the current system, and suggestions for future improvements. The findings of the literature review and the qualitative research revealed the following: 1) In most instances once African American boys are labeled EBD they are placed in a closed and segregated system until they drop-out or graduate, 2) There are more factors involved in labeling an African American boy EBD besides his observable behaviors 3) African American parents and teachers often have behaviors that place black boys at risk for special education placement

Accuracy of Supervised Classification of Cropland in sub–Saharan Africa

Mali is a country in sub–Saharan Africa where monitoring of cropped land area would greatly benefit food security initiatives and aid organizations. More importantly village–scale studies on cropped land are fundamental to making a difference in the way we look at cropped land area and food availability in this region of the world. Using Landsat surface reflectance imagery and World View–2 derived labeled data, this study focuses on accuracy of supervised classification methods while addressing various levels of scale. Several classification methods are taken into account to determine the best method possible to produce cropped area estimates using this data. The relationship between classification and scale is addressed by taking into account how distance and proximity affect accuracy. Accuracy is measured by kappa coefficients, and results among the different methods vary. Kappa coefficients generated are very low, and results suggest that estimates between labels are more accurate than estimates far from labels

The Effect of Fluorouracil on Pathogenic and Non-pathogenic Oral Microorganisms and Microbial Interactions with Preventative Measures: A Preliminary Study

Cancer chemotherapy compromises the patient’s oral health through dysbiosis of oral microbiota and increases the prevalence of dental cavities, gingivitis, oral mucositis, and xerostomia. This research aimed to evaluate the effect of a common chemotherapeutic agent, Fluorouracil (5-FU), on certain microorganisms that are common within the oral cavity. Varying concentrations (50 μM, 75 μM and 100μM) of 5-FU were used to simulate the dosage that reaches the oral cavity after intravenous delivery. The microorganisms tested were Pseudomonas aeruginosa, Staphylococcus aureus, Enterococcus faecalis, Streptococcus mutans, Lactobacillus rhamnosus and Streptococcus salivarius. These are some of the most common ones found in the diverse oral microbiota and would, therefore, be beneficial to study. Some are associated with different oral conditions like periodontitis, the progression of cavities and lesions, and inflammation, while others are probiotics. There are topical and oral products that can be applied or consumed in order to prevent the overgrowth of certain bacteria, while also protecting the oral mucosa. In evaluating the effect of 5-FU on the microorganisms, two preventative treatments were tested in order to reduce and/or improve their effect on a patient’s oral cavity: chlorhexidine (CHX) and salt water. 5-FU altered all microbial growth curves, yet it least affected P. aeruginosa, S. mutans and S. salivarius. CHX was successful in preventing the growth of most pathogenic bacteria, except P. aeruginosa, and all non-pathogenic bacteria, while salt encouraged the growth of probiotic L. rhamnosus and pathogenic P. aeruginosa yet suppressed the growth of most pathogenic microbes

Understanding Why Older Adults With Type 2 Diabetes Join Diabetes Online Communities: Semantic Network Analyses.

BackgroundAs individuals age, chronic health difficulties may disrupt physical and social well-being. Individuals can turn to online communities to interact with similar peers, which may help buffer negative effects resulting from health difficulties.ObjectiveThis study investigated the reasons that older adults join a diabetes online community to better understand the specific resources that are being sought.MethodsWe used semantic network analyses to categorize the reasons participants provided for joining a community during the sign-up process.ResultsThe most frequent reasons for joining were to seek information about their health condition, to help with self-management of health difficulties, for feelings of informational and social support, and for having a community with whom to share. Women were more likely to go online for sharing and companionship as well as for information and social support reasons, whereas men were more likely to go online for general information and self-management reasons.ConclusionsThis study shows the reasons older adults seek to join a diabetes online community: for increased information and support regarding chronic health difficulties. Practitioners may want to consider ways to promote access to online communities among their older patients as a source of health information and a resource to provide a sense of community

The Picture the Homeless Oral History Project

The Picture the Homeless Oral History Project is an ongoing work in progress. My thesis explores both preliminary findings from interviews with eleven long time homeless leaders of this grass roots organization, and it describes the research methodology guiding the project. The larger purpose of this project is to support the collective political leadership of homeless folks in the social justice movement. Integrating elements of oral history, participatory action research and community organizing towards a participatory oral history research model, this work reveals how inherited and collective memory may fuel collective resistance, as well as preliminary themes which emerged from the interviews, including resistance relationships, representation, being welcoming, organizing, race, justice, the system and leadership

Experience of Dying: Concerns of Dying Patients and of Carers

Background: Terminally ill patients frequently express concerns about what dying will be like: how their bodies may change as disease progresses, how medication may alter the effect of these changes and whether and how their preferences will be respected as they become more ill.----- Methods: Thirty-six patients admitted to a hospice were interviewed and 18 carers of patients of the Palliative Care service,whohad died participated in focus groups. Thirty-three patients had advanced malignant disease, 13 were women; their mean age was 68 years (range 44–92 years).----- Results: The areas of concern consistently identified by patients were (i) privacy and autonomy, principally in regard to families, (ii) a lack of information about physical changes and medication use as death approached and (iii) the desire to shorten life, which was expressed by all patients. Carers recalled problems accessing services and support and had needed more help with practical issues such as medication timing and dose. They believed that not enough information about the patients’ illnesses had been given to them and they were insistent that carers should have information against the wishes of patients.----- Conclusion: Some of the patients’ and carers’ concerns can be readily addressed. Others, particularly access to confidential information, cannot be addressed without a realignment of professional ethical standards and community expectations. The patients’ discussions of their desire to shorten life may have implications for the debate on euthanasia and physician-assisted suicide