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Military Nursing Research: Bibliographies (1996)

Chapter: 6 Research in Progress

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Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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6

Research in Progress

TRISERVICE NURSING RESEARCH PROGRAM

The following abstracts are those submitted in the grant proposals for studies that were funded by the TriService Nursing Research Program, fiscal years 1992–1995. These abstracts have been reproduced from the originals. They have not been edited.

Abel E. (Navy Reserve; University of Texas-Austin, Austin, TX). 1993. Sexual Risk Behavior of Ship and Shore Based Women. $61,131.

Human immunodeficiency virus and other sexually transmitted diseases (HIV/STDs) and unintended pregnancy have been linked to a variety of costly health problems, both in financial and human terms. The mortality from HIV infections, the morbidity related to STDs (ectopic pregnancy, infertility, cervicitis, cervical cancer, conjunctivitis and pneumonia), and the complications from unintended pregnancies (low birth weight babies, premature labor) are National health promotion and disease prevention priorities. Risk reduction efforts focus on understanding behaviors which influence safer sex practices, such as the use of condoms. Similar to the civilian sector, unintended pregnancies of active duty women have been found to be related to adverse perinatal outcomes such as low birth weight babies, cesarean sections, and hypertensive syndromes. Research related to sexual risk behaviors among civilian as well as military women had been limited to adolescent and young women (usually <22 years) attending obstetrical or gynecological clinics. Little is known about the sexual risk behaviors of older women (>22 years) outside of these settings. The purpose of this study is to examine the factors influencing the choices that active duty Navy women make that place them at risk for HIV infection, STDs, and unintended pregnancy. This study will examine whether there are differences in the sexual

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

risk behavior of active duty Navy women aged 18 to 44 years assigned to a ship based command or a shore based command. Cox's Interactive Model of Client Health Behavior provides the organizing framework for this study. Cognitive, affective, motivation and background variables (demographic, social, environmental, and previous health care experience) will be evaluated in relation to the health outcome of condom use. A cluster sample of at least 300 women will be selected from the ship and shore based commands at a southeastern naval base. Data will be collected using the Coopersmith Self-Esteem Inventory (25 items), the Problem Solving Inventory (32 items), the modified Health Self-Determination Index (17 items), and modified sexual history form. The data will be analyzed using descriptive and multivariate statistics. Before prevention programs can be considered, it is essential to understand why women practice behaviors that place them at risk for HIV/STDs or unintended pregnancy. The findings from this study will provide knowledge of the factors which influence safer sex among active duty Navy women.

Anderson FD. (Army Active; Eisenhower Army Medical Center, Fort Gordon, GA). 1994. Efficacy of Case Management in a Military Medical Center. $97,564.

The dramatic rise in health care has provided impetus for thoughtful evaluation of how medical care is organized within the Military Health Care System. In response to a mandate to maximize access to and quality of care, to minimize the cost of care, and to utilize resources more appropriately, the Department of Defense implemented a managed care program in January of 1992. Managed care is a comprehensive approach to the delivery of health care designed to efficiently direct quality health care within a cost-contained environment. The overall goal is to achieve optimal patient outcomes, within fiscally responsible time frames, and with an appropriate utilization of resources. Case management is a patient-focused strategy often used in managed care systems. As an approach to health care delivery, it makes one identified individual responsible for the coordination of a patient's care across the continuum of care. A critical path is a paper and pencil tool, often used in conjunction with case management, that identifies expected patient/family and staff behaviors that must occur in order for a desired health care goal to be reached. The plan is plotted against a time line for a specific diagnosis or case type. Implementation of case management, in combination with critical paths, has been reported to result in increased quality of care as measured by patient satisfaction, decreased inpatient length of stay, decreased readmission rates in high-risk patients, and decreased cost of care through more appropriate utilization of resources. Case management has been associated with increased job satisfaction in nurses, and increased communication and collaboration between health care providers. Most of what has been reported has been anecdotal in nature. Indeed, efficacy of case management in a military health care setting has not been scientifically studied as of this date. The purpose of this study is to examine the effects of nursing case management and implementation of critical paths on select variables at Dwight David Eisenhower Army Medical Center. This is an intervention study, with a pre- and post-evaluation design. The patient study sample will consist of a convenience sample of the patients in need of case

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

management in the areas of medicine, cardiology, cardiothoracic, oncology, psychiatry, and general/vascular surgery. The health care providers study sample will consist of the nursing and medical staff assigned to the same areas, in addition to the nurse case managers. Variables to be measured include: patient satisfaction, nurse-physician communication, work environment and job satisfaction, inpatient length of stay, inpatient acuity, and readmission rate of case-managed populations. Findings will be descriptive in nature and will be analyzed through the use of paired t-test and multiple regression. Testing of a nurse case management model in a military medical center will provide valuable data regarding implementation of case management in other Department of Defense activities.

Anderson FD. (Army Active; Eisenhower Army Medical Center, Fort Gordon, GA). 1995. Efficacy of Clinical Case Management in the Military. $163,526.

The dramatic rise in health care cost has provided impetus for thoughtful evaluation of how medical care is organized within the Military Health Care System. In response to a mandate to maximize access to and quality of care, minimize the cost of care, and utilize resources more appropriately, the Department of Defense implemented a managed care program in January of 1992. Managed care is a comprehensive approach to the delivery of health care designed to efficiently direct quality health care within a cost-contained environment. The overall goal is to achieve optimal patient outcomes, within fiscally responsible time frames, and with an appropriate utilization of resources. Clinical case management is a patient-focused strategy often used in managed care systems. One individual is held accountable for the coordination of a patient 's care across the continuum. A critical path is a paper and pencil tool, often used in conjunction with clinical case management, that identifies expected patient/family and staff behaviors that must occur in order for a desired health care goal to be reached. The plan is plotted against a time line for a specific diagnosis or case type. Implementation of clinical case management, in combination with critical paths, has been reported to result in increased quality of care as measured by patient satisfaction, decreased inpatient length of stay, decreased readmission rates in high-risk patients, and decreased cost of care through more appropriate utilization of resources. Clinical case management has also been associated with increased job satisfaction in nurses, and increased communication and collaboration between health care providers. Study of the efficacy of clinical case management in select variables began at Eisenhower Army Medical Center this year. The purpose of this study is to continue examination of these same variables at Dwight David Eisenhower Army Medical Center and to extend the study to Blanchfield US Army Community Hospital. This is an intervention study, with a pre- and post-evaluation design. Patient samples at Eisenhower consist of those patients in need of case management in the areas of diabetes, cardiology, cardiothoracic, oncology, pulmonary, and vascular surgery. Patient samples at Blanchfield will be drawn from the obstetric, medical, surgical, and psychiatric populations. Health care provider study samples

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

will consist of nursing, medical, and ancillary staff assigned to these same areas. Variables to be measured include: patient satisfaction, nurse-physician communication, work environment and job satisfaction, inpatient length of stay, inpatient acuity, and readmission rate in case-managed populations. Findings will be descriptive in nature and will be analyzed through the use of the paired t-test and multiple regression. Testing of a clinical case management model in both a military medical center and a community hospital will provide valuable data regarding implementation of case management in both settings.

Birgenheier P. (Army Active; Madigan Army Medical Center, Tacoma, WA). 1993. Effects of Military Parent's Separation on Children. $52,131.

Family separation to perform military duties is a common occurrence for today's active duty soldier. During the 1960s, the military force was composed of 2% women; today it is greater than 10%. Additionally, 14% of the women and 4% of the men in the military are single parents (Magnusson & Payne, 1991). The traditional military family is no longer limited to single soldiers or an active duty male with dependents. With these changes, it is common for children to be separated from their mothers or fathers for varying periods of time. Some soldiers will spend months and even years away from their spouses and children in the line of duty. The purpose of this study is to provide the military and military community with valuable information on the experiences of children during periods of parental separation for military duty. Specifically, the study will answer the following two research questions: (1) When separated from a parent for military duty, do school-aged children from military families have more behavioral problems than military children not separated from a parent? (2) Do school-aged children separated from their mothers for military duty demonstrate different behaviors than those children separated from their fathers for military duty? In this descriptive study, 360 school-aged children will be divided into three main groups (father absent, n = 120; mother absent, n = 120; and no parent absent, n = 120) each containing four sub-groups (males ages 6–10, n =30; females ages 6–10, n =30; males ages >10–14, n =30; females ages >10–14, n = 30). Achenbach's 1991 Child Behavior Checklist and Scoring System will be used to measure competencies and behavior problems in the children as reported by the primary care giver. Information obtained from the study will be used as a basis in the development of future nursing interventions aimed at enhancing military family relations during periods of deployment.

Bond EF. (Navy Active; University of Washington, Seattle, WA). 1994. Irritable Bowel: A Nursing Study of Symptoms and Coping. $38,730.

Irritable bowel syndrome (IBS) and other functional bowel distress conditions affect predominantly women, interfere with quality of life, cause absence from duty, and challenge health providers in provision of effective care in that few suitable treatments are available. IBS is the most common diagnosis among women seen in civilian gastroenterology clinics and is commonly seen in military clinics as well. There is evidence that many women experience similar symptoms,

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

yet seek no assistance from health providers; these are designated IBS-like ([IBSL]). Differences between IBS and IBSL are not defined, and are the subject of the proposed work. Groups may differ in symptom pattern/intensity or may differ in coping strategies. This study will compare gastrointestinal (GI) symptoms and coping strategies in 3 groups (IBS, IBSL, asymptomatic) of women across 2 menstrual cycles. Because GI symptoms are modulated by menstrual cycle phase, diet, stress exposure and stress response, each of these potentially confounding variables will be measured. GI symptoms are measured via daily health diary; coping strategies are measured via questionnaire; menstrual phase is identified by the lutenizing hormone surge (Ovuquick), first menstruation day, and selected urinary ovarian hormone levels; diet composition is recorded in daily food records; perceived stress exposure is measured with the daily diary and other tools; stress response is measured via urinary content of stress-related hormones. It is hypothesized that IBS and IBSL groups will be similar in symptom intensity and pattern, but will differ in coping strategies. The project will be performed as part of my Masters program. My overall objective is to enhance my understanding of a clinical problem relevant to women's health in which symptoms are modulated by physiologic, psychologic, and environmental stressors. This model of illness is highly relevant to military nursing, where often are seen patients with an underlying physical illness exaggerated under conditions of stress. My specific training objectives are to enhance my knowledge of GI and ovarian hormone physiology, my technical skills performing and evaluating psychological and physiological tests, and to develop an ability to integrate physiological and psychological observations in a manner that informs and advances understanding of underlying disease processes. Training objectives will be achieved by carrying out the study, consulting with experts, assisting with biochemical assays, and formal coursework. The proposed study will contribute importantly to ongoing studies of IBS, and prepare me as an advanced clinician.

Bulach BA. (Navy Active; University of Cincinnati College of Nursing and Health, Cincinnati, OH). 1995. Validation of the Military Recruiter Stress Scale (MRSS). $16,735.

The proposed research study is designed to identify stressors among military recruiters. From the identified stressors, the Military Recruiter Stress Scale (MRSS) will be developed to measure the level of stress in this vulnerable group. A three phase study is planned to develop and assess the psychometric properties of the MRSS. Betty Neuman's Systems Model will be utilized as the theoretical framework for this study. From the model, stressors will be categorized as intrapersonal, interpersonal and extrapersonal. During phase I of the study content validity will be employed to support this theoretical model. Phase II will focus on content validity and internal consistency. Phase III will assess test-retest reliability, internal consistency and construct validity using factor analysis, Spielberger's State/Trait Anxiety Inventory (STAI), the Jalowiec Coping Scale (JCS), and the Medical Outcome Survey SF-36 (MOS). The focus of this research proposal is on the primary prevention aspect of the Neuman Systems Model. The aim is to strengthen military recruiter's “flexible lines of defense ” in order to

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

prevent acute chronic disease states. The implications of this research will result in healthier military recruiters with improved quality of life. By promoting healthier recruiters, the military will maintain operational readiness of service members involved in the highly stressful and visible occupation of military recruiting.

Bushnell K. (Army Active; Vanderbilt University, Nashville, TN). 1994. Tobacco Use Cessation Intervention in Military Personnel. $333,826.

Smoking tobacco is the single most important preventable cause of death and disability in the US military. Estimates of smoking incidence in the military range from 41% in 1988 to 37% in 1992, compared to 26% in the general population. The negative health effects of smoking are well documented, however intervention approaches have only been subject to rigorous evaluation in the last 3–5 years. The aims of this randomized clinical trial are to: (1) evaluate the relative effectiveness of two tobacco use cessation interventions (American Cancer Society FreshStart and the Vanderbilt University Medical Center behavior counseling program) in reducing tobacco use among military personnel and dependents, and (2) evaluate the relative contribution of moderate physical activity as an alternate behavior when added to both of these programs. Approximately 400 adult (18–65 years of age) military personnel and dependents who wish to stop tobacco use will be recruited by: (1) five project personnel in the Fort Campbell clinic and (2) two of the project investigators who will recruit locally and on the military installation. Subjects will be randomly assigned to the experimental group (VU program) and the control group (FreshStart program, currently in use at the Ft. Campbell clinic under the direction of a project co-investigator). Half of the subjects in each group will also be advised to add a 15-minute walk, 6 days per week, to introduce and evaluate the effect of moderate activity on tobacco use cessation. At intake, all subjects will be asked to complete a Health Risk Appraisal, a Smoking Questionnaire, a saliva screen for cotinine (a long-term smoking cessation marker) and an exhaled carbon monoxide test (a short-term smoking cessation marker). Follow-up smoking markers will be collected at one month (carbon monoxide), three months (cotinine and carbon monoxide), and six months (cotinine and carbon monoxide) to verify continued abstinence. An additional questionnaire and a saliva cotinine will be administered 6 months after subjects quit tobacco. The two questionnaires provide information on smoking history, reasons to quit, nicotine dependence, health status, physical activity, perceived stress, and depression. All subjects will have the option to receive nicotine replacement with gum (2 mg or 4 mg) or patches at no cost. Data will be examined for within and between-group differences, including compliance with moderate activity and assessment as to whether it provided significant difference in the outcomes of the project.

Carr MA. (Army Active; Madigan Army Medical Center, Tacoma, WA). 1993. Crisis Intervention with Critical Care Families. $64,404.

This year, over 1.5 million people will experience an acute myocardial infarction (AMI); 80% who are treated will survive. The problem is that thousands of family

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

members must adjust to a sudden, unexpected and life-threatening AMI which results in crisis for the family each year. If appraisal of the crisis threat is not relieved; needs are not satisfied; or if resources remain inadequate to deal with the stressor obstacles, disorganization and inability to function as a person and family will deplete the health state of those involved. During the crisis, individuals may be more receptive to help from family, friends, and health care professionals. The nursing intervention, crisis intervention, with the family may enhance the family's ability to support the patient and decrease patient stress. Since AMI patients include active duty soldiers who are frequently retained on active duty, it is significant to military nursing that active duty patients have the maximum opportunity to return to duty with the optimum support from their families. The purpose of this study is to measure the effect of a family crisis intervention program on family need satisfaction, family functioning, and patient stress following acute myocardial infarction. The design is a post-test-only control group design with random assignment of subjects. The experimental group will receive family crisis intervention at least three times during the hospitalization. A family representative from both groups will complete the Family Need Satisfaction/Need Importance and the Family Adjustment of Medical Stressor Questionnaire; patients will complete the Stress of Discharge Assessment Tool (SDAT) within 48 hours of discharge. Multivariate statistics will be done to measure for significant outcomes differences between groups as a result of the independent variable: crisis intervention. Results will also provide military nurses with a theoretical crisis intervention process model to use with all patients and families in similar life-threatening medical and separation crises.

Chamings PA. (Air Force Reserve; University of North Carolina at Greensboro, Greensboro, NC). 1994. Flight Nursing and the US Air Force Nurse Corps. $103,142.

The purpose of this research is to develop a scholarly history of the Air Force Nurse Corps with particular attention to the aeromedical evacuation components of this history. This research will review and analyze existing documents relevant to aeromedical evacuation and the Air Force Nurse Corps in military archives located primarily in Washington, DC and San Antonio, TX (Brooks Air Force Base). Selected Air Force Nurse Corps chiefs and flight nurses who participated in significant events in this history will be interviewed. These interviews will be analyzed for content themes and significance documented as part of the written final report. Specific aims include: (1) Explicate the initiation and contributions of flight nursing in the Army Air Corps during World War II. (2) Document the establishment and evolution of the education for flight nursing from its beginning at Bowman Field to its current location at Brooks AFB, TX. (3) Explore the leadership of the Air Force Nurse Corps (1947–1994) and the significant contributions of those leaders to the corps and professional nursing at large. (4) Chronicle major events of the Air Force Nursing over its life time and delineate the meaning of these events in the context in which events occurred. (5) Describe the significance of special missions undertaken by the Air Force using flight nurses, such as transportation of BAMC's Burn Team, evacuation of respiratory

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

dependent patients (started during poliomyelitis epidemics), and “mercy missions” of civilian patients. (6) Develop a scholarly work that chronicles Air Force Nursing in the first 50 years. This research is a significant and essential component of the history of nursing and will entirely focus on the contributions of the Air Force Nurse Corps and predecessors in aeromedical evacuation.

Chamings PA. (Air Force Reserve; University of North Carolina at Greensboro, Greensboro, NC). 1995. Flight Nursing and the US Air Force Nurse Corps. $75,401.

The purpose of this research is to develop a scholarly history of the Air Force Nurse Corps with particular attention to the aeromedical evacuation components of this history. This research will review and analyze existing documents relevant to aeromedical evacuation and the Air Force Nurse Corps in military archives located primarily in Washington, DC and San Antonio, TX (Brooks Air Force Base). Selected Air Force Nurse Corps Chiefs and flight nurses who participated in significant events in this history will be interviewed. These interviews will be analyzed for content themes and significance documented as part of the written final report. Specific aims include: (1) Explicate the initiation and contributions of flight nursing in the Army Air Corps during World War II. (2) Document the establishment and evolution of the education for flight nursing from its beginning at Bowman Field to its current location at Brooks AFB, TX. (3) Explore the leadership of the Air Force Nurse Corps (1947–1994) and the significant contributions of these leaders to the corps and professional nursing at large. (4) Chronicle major events of Air Force Nursing over its life time and delineate the meaning of these events in the context in which events occurred. (5) Describe the significance of special missions undertaken by the Air Force using flight nurses, such as transportation of BAMC's Burn Team, evacuation of respiratory dependent patients (started during poliomyelitis epidemics), and “mercy missions ” of civilian patients. (6) Develop a scholarly work that chronicles Air Force Nursing in the first 50 years. This research is a significant and essential component of the history of nursing and will entirely focus on the contributions of the Air Force Nurse Corps and predecessors in aeromedical evacuation.

Cobb G. (Army Active; Brooke Army Medical Center, Fort Sam Houston, TX). 1995. Pressure Ulcers: Patient Outcomes on Kinair Bed or EHOB Mattress. $89,990.

Approximately one million hospitalized or nursing home patients are diagnosed with pressure ulcers each year, and about 60,000 patients die each year as a result of pressure ulcer complications. There has been little change in the incidence of pressure ulcers in the past decade. Most pressure ulcers could be prevented by simple measures. Pressure ulcer treatment is costly to the health care system and to the patient, especially in terms of the pain and suffering. The primary aim of this research is to compare outcomes related to pressure ulcer development when high risk patients are placed on a Kinair low air loss bed compared to an EHOB waffle air mattress. More specifically, this study will address the following research questions: (1) What is the demographic profile of the patient at high risk

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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for pressure ulcer development in a large military acute care setting? (2) Is there a difference in the number of pressure ulcers or the seriousness of pressure ulcers that develop among high risk patients when Kinair low loss specialty beds are used compared to EHOB waffle air mattress overlays? (3) Is there a difference in length of stay, related to pressure ulcers, among high risk patients when placed on the Kinair bed compared to the EHOB waffle air mattress? (4) Is there a difference in cost expenditure related to pressure ulcer development when Kinair low air loss specialty beds are used compared to EHOB waffle air mattresses? DESIGN: A quasi-experimental design will be used. Quantitative instruments employing skin assessment, and pressure ulcer risk measurement will be administered at intervals during subjects' hospital stay. A pressure ulcer staging tool will be used if pressure ulcers develop. A total of 120 subjects will be recruited from surgical wards and surgical intensive care units at Brooke Army Medical Center. ANALYSIS: Descriptive information will be used to address research question #1. Chi-square analyses and the t-Test will be used to answer research question #2. The Student 's t-Test will be used to address research questions #3 and #4. The broad goals of this project are to determine the efficacy of prevention and treatment devices for patients at high risk for pressure sores. This may contribute to improved patient care and a cost-savings to the health care system.

Condron S. (Air Force Active; Duke University Medical Center, Durham, NC). 1993. Cancer Prevention and Early Detection in Military Nurses. $72,441.

Cancer is anticipated to exceed heart disease by the year 2000 as the leading cause of death in the United States. Many cancers appear to be preventable, while others have a high survival or cure rate when detected and treated early. For this reason, the National Cancer Institute has proposed that cancer mortality be reduced by 50% by the year 2000. To this end, guidelines have been published by the American Cancer Society (ACS) for the prevention and early detection of cancer as a means of decreasing the incidence, mortality, and morbidity associated with cancer. Despite a wealth of information and attention from the media, studies show that many Americans, including physicians and nurses, do not practice recommended cancer prevention and early detection behaviors (National Health Interview Survey Cancer Control Supplement, 1987; US Department of Health, Education, and Welfare, 1975; Healthy People 2000, 1991). In addition, only a small number of studies have specifically assessed health professionals ' assimilation of cancer prevention and early detection behaviors into their own lifestyles (Germino, 1992; McMillian, 1990). The purpose of this study is to ascertain the extent to which active duty military nurses are in compliance with the American Cancer Society's recommendations for cancer prevention and early detection. Specifically, this study will address three questions: (1) is there a relationship between compliance with the ACS guidelines and selected demographic variables, (2) what are the differences and commonalties in cancer prevention and early detection between active duty Army, Air Force, and Navy nurses, and (3) do military nurses who practice cancer prevention and early

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

detection behaviors themselves use this knowledge in teaching patients? This descriptive study will survey approximately 11,000 active duty Army, Air Force, and Navy nurses, using the Modified McMillian Health Habits Assessment (MMHHA) questionnaire. The sample size includes all active duty nurses not deployed to hostile areas. Descriptive and inferential statistics will be used to analyze the data collected. Data will be analyzed for each cancer prevention and early detection behavior for the military as a whole and for each branch of the service. This data set will be the largest and most comprehensive data set available on cancer prevention and early detection behaviors in nurses, and the only data set available for military nurses (male and female) across the three services.

Davis JW. (Navy Active; Naval Hospital, Camp LeJeune, NC). 1992. The Effects of Diet and Exercise on Blood Lipid Panels and Body Compositions of the Marine Corps Officer Candidate Population. $6,299.

BACKGROUND: The leading cause of death in the US is cardiovascular disease, responsible for almost half of the nation's mortality and cost estimates exceeding $90 billion annually. Elevated serum cholesterol levels, or, more specifically, elevated low density lipoprotein (LDL) cholesterol levels, are causally related to an increased risk of coronary heart disease (CHD). The national priorities for health promotion and disease prevention for the year 2000 specifically target increasing physical activity, decreasing obesity, and improving nutrition. Risk reduction objectives outlined for heart disease and stroke include reductions in mean serum cholesterol levels and dietary fat intake. Health promotion efforts for the Department of Defense, likewise, are focused on ensuring optimal combat readiness of its forces and controlling spiraling health care costs. Few research opportunities exist for the examination of the effects of a programmed diet and exercise routine on a healthy population as ideal as in the setting of the Marine Officer Candidates School. However, because there are many instances in the Department of Defense when uniformed military personnel are in controlled diet situations for extended periods (e.g., on surface ships, on submarines, in the field on maneuvers, in extended training courses, etc.), it would behoove the DOD to analyze the effect of the Armed Forces Meal Plan on its personnel. PURPOSE OF THE STUDY: The purpose of the study is to determine if the programmed diet and exercise routines of the Marine Corps Officer Candidates School (OCS) in Quantico, VA, result in significant changes in the individual students' blood lipid panels and body compositions during the course of the 10-week program. METHODS: Throughout the training program, the candidates' meals will be provided by a contracted food service which utilizes the 28 day rotating cycle from the Armed Forces Meal Plan. With the exception of scheduled training events and very minimal liberty opportunities, candidates are restricted to the barracks, prohibited from snacking or smoking, and permitted to eat only the food provided. Blood lipid profiles, body fat percentages, weights, and blood pressure measurements will be obtained in the first days of indoctrination on the Fall 1992 OCS candidates, an estimated population of 250 healthy males with a mean age of 26 years. Candidates will also complete two

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

questionnaires, the Army Health Promotion Program Health Risk Appraisal and a revised version of the Naval Health Research Center's Health and Physical Readiness Program Evaluation. All measures will be repeated in the final week of training for comparison. No change in the normal OCS routine is planned in this study. Information from this project will serve as a baseline for the design of a second study planned for the Fall 1993 Marine Corps OCS class which will employ a nutrition education strategy and substitute a diet based on recommendations from the American Heart Association and the American Cancer Society. The investigators of this study believe the results of this research will have broad applications for the Department of Defense. DATA ANALYSIS: A series of paired t-tests will be performed with alpha set at 0.05 (p < .05) to test for significance between pre- and post-test mean values on all the primary variables of the study. An initial cross-section analysis using the Pearson product-moment correlation coefficient will be done separately for the pre-test and post-test measures to determine the strength of linear relationships. Then a multiple regression analysis of the dependent and independent variables will be utilized to determine the relationships between changes in variables. Analysis will be executed in a cooperative arrangement with the Naval Health Research Center in San Diego, California. SIGNIFICANCE TO NURSING: Primary prevention must become a priority for nurses and all other health professionals in these days of spiraling health care costs and national health care reform. Nurses are strategically positioned for leadership roles in providing invaluable education programs designed to prevent disease and promote the health of individuals in a multitude of clinical settings.

DeCesare E. (Army Active; DeWitt Army Hospital, Fort Belvoir, VA). 1993. Army Women's Breast Cancer Risk. $49,513.

The proposed study is a descriptive epidemiological study investigating the occurrence of risk factors for breast cancer among Active Duty (AD) Army women using an existing military health appraisal data base. The specific aims of the study include: describe the overall occurrence of risk factors for breast cancer among AD Army women; describe the occurrence of risk factors for breast cancer among AD Army women based on rank; explore the differences of risk factors based on rank; describe the occurrence of risk factors among AD Army women based on ethnicity; and explore the differences of risk factors based on ethnicity. The sample size will be 15,000 Active Duty Army women who completed the US Army Health Risk Appraisal, (DA Form 5675) in 1992. Data will be analyzed using descriptive statistics and one-way analysis of variance. Reliability testing of the tool will be done using Cronbach's-Alpha. This is a foundational study to develop a program of breast cancer epidemiology and early detection research for military women. This program of study would lead to a better understanding of breast cancer, aid health care providers who care for military women, and assist those who plan and allocate resources for women's health care in the Department of Defense.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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DeRuvo S. (Army Reserve; Tripler Army Medical Center, HI). 1992. Differentiated Group Professional Practice: Evaluation of a Nursing Care Delivery System. $63,110.

OVERVIEW: This proposed project is designed to test the effectiveness of a unit-based professional practice model on nurse satisfaction, nurse resources, quality of care, and fiscal outcomes. The purpose of this study is to implement and evaluate Differentiated Group Professional Practice (DGPP) in nursing. DGPP is an integrated model with three major components: group governance, differentiated care delivery, and shared values in a culture of excellence. Group governance entails four subcomponents directed toward creating a participatory nursing group practice at the unit level. The subcomponents are: participative unit management, shared decision-making through staff bylaws, peer review, and a professional salary structure. Differentiated care delivery consists of three subcomponents: differentiated registered nurse (RN) practice, the use of nurse extenders, and primary case management. Shared values in a culture of excellence includes three subcomponents: quality of care, support for entrepreneurship, and internal and external recognition. The implementation of this literature-based professional practice model is expected to strengthen the professional environment and to increase nurse satisfaction with practice. Increased nurse satisfaction is hypothesized to increase nurse resources. This, in turn, is hypothesized to increase quality of care while decreasing or maintaining the level of fiscal resources. The demonstration of this project is anticipated to last one year for which time funding is requested. The following two years are planned for longitudinal data collection to test the sustainment of the DGPP Model. Additional funding from other sources will be sought for the following two years. The DGPP Model will be demonstrated on two test units and two comparison units at Tripler Army Medical Center (TAMC). Data to test the research model will be analyzed using causal modeling and multiple regression statistics. SPECIFIC AIMS: The primary purpose of this project is to test the effectiveness of a unit-based Differentiated Group Professional Practice (DGPP) Model on professional practice, nurse satisfaction, nurse resources, quality of care, and fiscal outcomes. The specifc aims are to: (1) replicate the DGPP Model in a military setting (original study jointly funded by the National Center for Nursing Research and the Division of Nursing to demonstrate the DGPP Model in hospital nurses practicing in Arizona).

DeRuvo S. (Army Reserve; Tripler Army Medical Center, HI). 1993. Differentiated Group Professional Practice. $74,060.

Few studies have examined the effects of nursing practice models on patient outcomes. In fact, previous research on patient outcomes rarely included variables representing the organization of nursing services. Despite this paucity of empirical evidence, many hospitals are implementing various models of nursing practice using work redesign or nurse extenders. In response to this, the National Center for Nursing Research and the Division of Nursing has funded two research demonstration projects in New York and Arizona. The Arizona project, Differentiated Group Professional Practice (DGPP), is designed to test the

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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effectiveness of a unit-based professional practice model on nurse satisfaction, nurse resources, quality of care, and fiscal outcomes. The purpose of this study is to implement and evaluate the DGPP Model in a military health care setting. DGPP is an integrated model with three components: group governance, differentiated care delivery, and shared values in a culture of excellence. Group governance entails four subcomponents directed toward creating a participatory nursing group practice at the unit level. The subcomponents are: participative unit management, shared decision-making through staff bylaws, peer review, and a professional salary structure. Differentiated care delivery consists of three subcomponents: differentiated registered nurse (RN) practice, the use of nurse extenders, and primary case management. Shared values in a culture of excellence includes three subcomponents: quality of care, support for entreprenuership, and internal and external recognition. The implementation of this literature-based professional practice model is expected to strengthen the professional environment and to increase nurse satisfaction with practice. Increased nurse satisfaction is hypothesized to increase nurse resources. This, in turn, is hypothesized to increase quality of care while decreasing or maintaining the level of fiscal resources. The demonstration of this project occurred during Year One of funding from the TriService Research Award. Year Two will be used to strengthen the DGPP Model in demonstration units and to begin longitudinal data collection to test the sustainment of the DGPP Model. The DGPP Model is being demonstrated on two test units and two comparison units at Tripler Army Medical Center (TAMC). Data to test the research model will be analyzed using causal modeling and multiple regression statistics.

Dolter KJ. (Army Active; Fort Sam Houston, TX). 1994. Identifying Process Variations Via Risk-Adjusted Outcome. $63,467.

Outcomes assessment as a means to improve patient care processes in the Military Health Services System is important, yet many obstacles block its accomplishment. Use of the easily obtainable indicators of crude morbidity, mortality, and resource consumption is inappropriate. Risk-adjustment of outcomes is necessary to account for the differences in patient severity of illness and other patient specific characteristics to ensure the comparability of these outcome measures. Comparison of actual versus predicted outcome rates via risk-adjustment modeling is being utilized in the civilian sector as a screening mechanism to identify quality of care and resource consumption outliers for the purposes of appropriately directing scarce quality improvement process review resources where they might be most needed. Outliers with lower than actual versus expected negative outcomes could be reviewed to see what they are doing right, while those with higher than expected negative outcomes could be reviewed to determine areas for improvement. Risk-adjustment modeling of outcomes (RAMO) is being utilized at the federal, state, and civilian institutional level. No Department of Defense utilization of risk-adjustment of provider outcome has been identified. RAMO has been used in statewide and regional studies to screen providers performing the high risk, high volume, high cost procedure of Coronary Artery Bypass Graft Surgery (CABGS). Although these studies have identified

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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outliers with greater than expected mortality, the quality of care investigations which have followed have focused on institution and surgeon characteristics, ignoring the impact of post-operative nursing and physician care processes on patient outcome. The purpose of this study is to assess the validity of using risk-adjusted mortality as a screening mechanism to identify variations in provider practices impacting on CABG patient quality of care in Department of Defense (DOD) hospitals. It will utilize a DOD database to risk-adjust CABG patient mortality to identify medical centers having potential positive and negative CABG patient care process variations. The identified DOD medical centers will then undergo an in-depth review of their post-operative patient care processes, specifically focusing on nurse and physician hemodynamic and organizational practices. The study will utilize a case control design to assess input, process, and outcome variables of the CABG patient care process at 3 DOD medical centers with higher than suspected CABG mortality (the cases) and 3 DOD medical centers with lower than expected mortality (the controls). A combination of chart audit, observation of provider hemodynamic assessment and intervention practices, and provider hemodynamic knowledge and organizational process assessment questionnaires will be utilized for the in-depth process reviews. Data will be analyzed utilizing descriptive statistics.

Driscoll DM. (Army Active, LTCHE—Academy of Sciences, University of Rochester, Rochester, NY). 1995. Plasma β-Endorphins in Response to Wound Care. $84,464.

Pain is a major health care problem in the United States. Sixty million individuals annually seek health care for complaints of pain. Of these individuals, it has been estimated that almost 17% will suffer from pain that will persist to the extent that they will ultimately become disabled. Pain associated with acute injury or therapeutic interventions has been less than optimally identified by health care providers. One reason for the failure to identify the presence of pain in the acutely injured is that injured individuals may be either slow to respond or nonresponsive and thus unable to provide information regarding their perception of pain. Moreover, because pain associated with acute injury involves life-threatening alterations in both the psychologic and physiologic status of that individual, pain has been difficult to assess using the traditional techniques. Therefore, it is important that health care providers be able to assess pain in the acutely injured using measurements that do not rely on the patient's ability to provide subjective input. The long-term objective of this research program is to identify physiologic markers that may be used to identify the presence of pain in the acutely injured who are slow to respond or nonresponsive. The major goal of this research proposal is to identify the presence of plasma concentrations of ß-endorphin, an endogenous opoid-like substance, in response to wound care of thermally-degraded epithelial tissue when around-the-clock non-opoid analgesic medication is provided. Male Sprague-Dawley rats will be used for this study. The design is experimental and multifactoral with repeated measures. Analysis of Variance (ANOVA) will be performed followed by Tukey's HSD test for comparison of means and a simple main effect analysis. Correlations will also be computed. Although basic research will be conducted using a laboratory animal model for

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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the wound care of thermally-degraded epithelial tissue, it is anticipated that the findings will advance nursing and medical science. The objective assessment of pain in acutely injured individuals poses an enormous challenge to health care providers. Hopefully, identification of an objective physiologic clinical marker of pain will lead to the development of new pain assessment strategies. New pain assessment strategies then may lead to optimal interventions for the control of pain and to timely implementation for acutely injured individuals who are compromised in their ability to respond.

Dyer RE. (Army Active; Madigan Army Medical Center, Tacoma, WA). 1995. Soldier HIV Behavior Modification. $152,805.

Once infected with the HIV, a soldier is no longer available for deployment outside the United States. As there is no cure expected in the near future for HIV, nursing interventions aimed at prevention must be as effective as possible. Research indicates that programs that focus on education alone are not successful in promoting change in behavior. Knowledge of HIV and AIDS is required in order to understand the consequences of high risk behavior. Studies currently indicate that perceived values of peer norms have more influence on changing behavior than knowledge of HIV or AIDS. In the Army, the high risk behaviors are primarily unprotected sexual encounters. The purpose of this study is to determine if the use of a peer leader as opposed to the HIV nurse or the size of the group receiving the intervention makes any change in the outcome measures of knowledge of HIV and AIDS, beliefs toward HIV and AIDS, and risk behaviors. The theoretical model for this proposal is the Health Belief Model The design of the study will include four groups receiving the intervention and a control group. The units requesting HIV education classes will be assigned to either a large or small group depending on the size of the unit and will receive the intervention from either the peer leader or the HIV nurse. The units will be further stratified by their mission to allow for differences based on individual requirements to meet the unit mission. The control group will consist of units that do not request HIV education classes during the intervention period. The research questions will be analyzed using analysis of variance upon the data gathered from three questionnaires, and post hoc tests will be performed on significant differences. The first questionnaire will be administered prior to the intervention and will consist of a comprehensive assessment of knowledge, beliefs, and risk behaviors. The second questionnaire will be administered immediately after the intervention and will focus on knowledge. The third questionnaire will be administered after three months and will focus on beliefs and risk behavior.

Greenwood MI. (Navy Active; ED Navy Hospital Camp Pendleton, Camp Pendleton, CA). 1995. Orthostatic Vital Signs in Healthy Young Male Marines. $23,950.

Orthostatic vital signs (VS) are routinely performed in emergency and ambulatory care settings. Despite wide acceptance and use of this simple, non-invasive test for the assessment of hypovolemia, great confusion exists about how to perform

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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the test and what obtained results mean. Is passive tilting, sitting, or standing the preferred method of posture change? At what time interval after a posture change should VS values be obtained? What are the normal orthostatic VS changes? What are abnormal orthostatic VS changes? The purpose of this quasi-experimental study is two-fold. In the first part, the researcher will investigate the sequential steps of performing orthostatic VS, including patient positioning and timing. Identifying the specific, optimum time to obtain the VS data will be accomplished. Secondly, the researcher will identify normal VS changes which occur in the physically conditioned, healthy, young Marine as postural changes are assumed. Research subjects in published orthostatic VS studies are most frequently elderly or “healthy” young men and women with resting heart rates of 60–100 beats per minute (bpm). Physically conditioned young males possess lower resting heart rates (40–60 bpm) than the general population. Despite variability in the textbook literature, positive orthostatic VS are usually interpreted as an increase in heart rate of 20 or more bpm, or a systolic BP decrease of 20 mm Hg or more, upon assuming increasingly upright positions. Use of these criteria to determine fluid deficit states in the physically conditioned young male Marine may be inaccurate, resulting in over or under treatment of these patients. Study results will impact on clinical practice in a variety of ways. Clarification of when blood pressure and heart rate values should be obtained while performing orthostatic VS testing will be accomplished. This clarification will result in more accurate assessment of the patient's fluid states. Time intervals of normally accepted practice may lengthen or shorten as a result of this study. A decrease will result in cost savings related to time savings. Orthostatic VS procedural standards, based on scientific findings, will be developed. Identification of VS changes which normally occur in physically conditioned young men may reveal that current practices are inaccurate in identification of fluid volume deficit states. Patients previously thought to be normovolemic may be identified as hypovolemic, necessitating fluid replacement therapies, and averting hypovolemia complications. Patients previously thought to be identified as hypovolemic, may be identified as normovolemic, averting the potential complications of fluid overload caused by aggressive intravenous rehydration.

Griffin-Agazio JB. (Army Active; Walter Reed Army Medical Center, Washington, DC). 1995. Effects of Separation on Families During Hospitalization. $114,529.

Hospitalization of a child is a stressful experience for families even under the best of circumstances. But, when the hospitalization involves medical evacuation to a treatment facility in a different state or country, the family is not just stressed by the unknown implications of the illness. They must also deal with a separation made more stressful by the distance away from existing support systems and the increased burden from the travel involved. The purpose of this study therefore is to systematically identify the stressors associated with family separations during the circumstances of medical evaluation or treatment, identify coping mechanisms and resources used by families to mediate these stressors, and to determine the effects of the separation on family functioning. No other studies have investigated the relationship of coping, resource use, stressors, and perception of severity upon

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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family functioning during family separation for medical evaluation or treatment. Guided by the Resiliency Model of Family Stress, Adjustment, and Adaptation (McCubbin & McCubbin, 1991), the design for this study is a prospective two-group comparison using methodological triangulation. This study will also test an hypothesized causal model developed from Resiliency Model of Family Stress, Adjustment, and Adaptation (McCubbin & McCubbin, 1991). Group I will include 250 families who have a child medically evacuated or transferred from the primary duty location or health care facility which is over 200 miles away, referred for diagnosis or treatment of a new or ongoing disease or condition, and accompanied by only one parent. Another 250 families will be recruited for Group II who will be admitted from the local area. Subjects will be matched for age and diagnostic type (medical acute; medical chronic; surgical acute; surgical chronic; oncology) for data analysis. A subset of 20–30 Group I participants will be purposively sampled for series of focus interviews (Knafl, 1989) throughout the hospitalization. Family members will be asked to complete the research instruments 72 hours after admission. These include (a) a demographic data sheet; (b) Family Inventory of Life Events (FILE); (c) Visual analogue severity scale; (d) Family Crisis Oriented Personal Scales (F-COPES); (e) Family Inventory of Resources for Management (FIRM); (f) Parental Stress Scale, and the outcome measure; (g) Feetham Family Functioning Survey (FFFS). Descriptive statistics will be used to describe the characteristics of the sample and the stressors, perceptions, coping mechanisms, and resources identified by the separated families. MANOVA will be used to test the instrument subscales' relationship to family functioning for differences between Group I and Group II. Relationships between the variables and to family functioning will be analyzed using hierarchical multiple regression to test causal modeling as hypothesized in the proposed model of relationships. Qualitative data analysis as described by Miles and Huberman (1984) will be used to simultaneously analyze and direct data collection to describe the experience of families separated for medical evaluation and treatment. Ethnograph computer software program will be used to facilitate initial coding and clustering. By identifying the needs and concerns of these families, results of this study will shape anticipatory guidance and active interventions structured to relieve the stressors associated with medical evacuation. Also, by supporting optimal family functioning through these interventions, there would be less impact upon the family system itself and, by extension, the military member(s) physical and emotional availability for military duties.

Hall SR. (Air Force Active; David Grant Air Force Medical Center, Travis AFB, CA). 1993. Impact of Storytelling on Burnout and Nurse Expertise. $74,949.

High patient acuity, rapid patient turnover, and fiscal pressure to do more with less have made the need for highly skilled care-givers at the bedside more important than ever. At the same time, nurses report being “stressed out” and “burned out”. Burnout is physical and emotional exhaustion involving loss of concern for co-workers, clients, and/or patients. Emotional burdens felt by care

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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givers may be secondarily placed on patients. This crisis at the bedside is of particular interest to military nursing leaders seeking to retain experienced, caring nurses. Benner, et al (1992) propose that storytelling in a natural group setting may help nurses “get back to care” by facilitating the transformation of clinical practice from novice to expert and decreasing the stressors associated with burnout. However, no studies documenting this benefit were found by the investigators. Thus, the objective of this study is to pilot test a procedure to evaluate whether sharing narrative exemplars, storytelling, impacts burnout and the transformation to expert clinical practice and, if so, do these benefits occur as a result of sharing clinical stories or because of having group support. The study is a four group pre- and post-test quasi-experimental design. One hundred twenty nurses from two military medical centers will be recruited and asked to complete a level of practice rating and Maslach Burnout Inventory (MBI). The experimental group will be introduced to storytelling and randomized to three treatment groups. Subjects in the treatment groups, will be asked to write three clinical exemplars and then be further exposed to storytelling through: twicemonthly group meetings; written stories and audiotapes; or no further discussion. After six months, all data collection will be repeated and analyzed using descriptive, nonparametric, and parametric statistics.

Hochhausen AK. (Army Active; Landstuhl Regional Medical Center, Germany). 1995. The Lived Experience of Military Women Who Discontinued Breastfeeding Before Planned: A Heideggerian Hermeneutical Inquiry. $50,668.

Although breastfeeding is recognized as the most nutritionally appropriate food source for newborn infants in the first year of life, many women decide either not to breastfeed or to stop breastfeeding before the end of the first year. Because there is evidence in the United States that the incidence of breastfeeding is declining, much research has been focused on the factors that contribute to “successful breastfeeding ” and the reasons why women stop breastfeeding. To date, there have been no studies which focused on military women's infant feeding practices, their experiences with breastfeeding, or how a military woman would define successful breastfeeding for herself. The purpose of this study is to make visible military woman's experiences of breastfeeding and stopping breastfeeding as lived by the woman themselves. The long-term goals of the study are to address the following questions: (1) What are the military woman's (officer, NCO, or enlisted) experiences of breastfeeding and what does it mean to them to have to stop, perhaps before planned? (2) What are the meanings of breastfeeding and its perceived significance to a military woman's life, to her new baby, husband or significant other, job, and personal life? (3) Are there common meanings and shared understandings among military women about breastfeeding that if uncovered could lead to further scientific investigation and intervention strategies helpful to military women, nurses, and commanders. DESIGN: Heideggerian Hermeneutical Inquiry. Fifteen active duty military women will self-identify for having breastfed their infants but stopped breastfeeding before they planned to. Subjects will be recruited by posted notices in military obstetric, pediatric, and family practice clinics in the greater

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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Kaiserslautern area. Heideggerian hermeneutics is a phenomenological approach that seeks understanding of lived experiences through shared cultural meanings and practices. Subjects will be asked to respond to questions phrased in first person like #1 and #2 above. Specific probes are identified to focus the participant on feelings and events that elicit the meaning of the experience. Analysis is accomplished by a research team in multiple stages to elicit themes that may be useful to direct further study. Themes may also offer greater understanding to people associated with military women who choose to breastfeed while serving on active duty.

Holder MA. (Navy Active; Naval Medical Clinic, Quantico, VA). 1993. Evaluation of Selected Health Promotion Programs. $39,010.

In 1990 the Department of Defense paid over 14 billion dollars for health care services. These costs will continue to rise unless there is a change in the lifestyle habits of the population. Each year unhealthy lifestyles are responsible for at least 50% of the deaths in the United States. Spiraling health care costs have placed an increased emphasis on health promotion to improve health habits and lower risk of disease. Little research has been done to date on the effectiveness of health promotion programs either in the military or civilian sectors. The purpose of this study is to evaluate the effectiveness of three select health promotion programs at the Nurses ' Wellness Center, Quantico, Virginia. This project will determine if the Tobacco Cessation, Weight Reduction, or Cholesterol Education Programs result in significant changes in the lifestyle of the participants. Through pre and six month post-intervention evaluations, the study will measure changes in health related lifestyle practices of an experimental and control group. The Army “Fit to Win” Health Risk Appraisal and the Health Promoting Lifestyle Profile developed by Nola Pender, RN, Ph.D. will be used to assess the lifestyle practices of participants in the program and control group. Measurements of cholesterol levels, weight, blood pressure, and body fat will be analyzed on both groups. A series of paired t-tests will be performed to test for significant differences between pre and post-test values in both groups and a regression analysis will be utilized to determine the relationships between changes in variables. This pilot study will provide scientific analysis to measure the effectiveness and benefits of the Quantico Health Promotion Programs. Firm data about health promotion programs is essential to validate their quality and effectiveness. If these finding are significant, replication of this study at other Military Treatment Facilities will demonstrate the adaptability of the programs to all the branches of the military.

Johnson AD. (Air Force Reserve; University of Texas Health Sciences Center, San Antonio, TX). 1993. The Effect of Health Belief Teaching Strategy. $78,458.

AIDS has been termed the nation's number one public health priority. With the absence of vaccine or cure, the only method of reducing the incidence of the disease is through effective education. The primary aim of this study is to determine if a teaching program based on the health belief model is effective in

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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increasing knowledge about AIDS and, more importantly, decreasing high risk behaviors among ROTC students. The long-term goals of the study are to address the following questions: (1) What are their risk behaviors for acquiring HIV (Human Immune Virus)? (2) What is their knowledge level regarding transmission of HIV? (3) What are their health beliefs regarding AIDS? (4) Are there correlations among AIDS risk behaviors, AIDS knowledge levels, and AIDS health beliefs? (5) Is an educational program based on the Health Belief Model effective in increasing AIDS knowledge, AIDS health beliefs, and decreasing AIDS risk behaviors? DESIGN: A pretest/posttest experimental design will be used. A total of 392 subjects will be used (196 in the experimental group and 196 in the control group will be used). The subjects will be recruited from colleges and universities that have ROTC programs. Subjects will be assigned to an experimental (those receiving classes based on the health belief model) or to a control group. Pearson R will be used to determine if there are statistically significant correlations among the variables of health beliefs, knowledge of AIDS, and risk behaviors. Analysis of variance will be used to determine if there are statistically significant differences between the experimental and control groups in terms of health beliefs, knowledge of AIDS, and risk behaviors.

Johnson AD. (Air Force Reserve; University of Texas, San Antonio, TX). 1995. The Effects of Culturally Sensitive Messages and Health Beliefs. $111,275.

AIDS is the nation's number one health priority. Every eight minutes a person dies from AIDS. Hispanics are disproportionately affected by AIDS; they represent 8% of the population and yet account for almost 18% of the cases. Heterosexual acquired AIDS among Hispanics is 10 times as high as nonHispanics. There is little research to determine what strategies are effective in increasing knowledge of AIDS and decreasing risk behavior particularly among Hispanics. A determination of the effectiveness of specific programs for Hispanics is urgently needed. The primary purpose of this study is to determine if a culturally sensitive message and a program based on the health belief model are effective in increasing knowledge, and more importantly, decreasing risk behavior among acculturated and non-acculturated Hispanic ROTC students. The specific aims of this study are to: (1) determine if their AIDS risk knowledge is correlated with their AIDS risk behaviors; (2) determine if their beliefs relative to the subscales on the Health Belief Model (susceptibility, seriousness, benefits, barriers, and cues to action) are correlated with the AIDS knowledge; (3) determine if their beliefs relative to the subscales on the Health Belief Model (susceptibility, seriousness, benefits, barriers, and cues to action) are correlated with their AIDS risk behaviors; (4) determine if a culturally sensitive message compared to a health belief strategy and control group makes the difference in their knowledge of AIDS; (5) determine if a culturally sensitive message compared to a health belief strategy and a control group makes a difference in their risk behaviors; (6) determine if a culturally sensitive message compared to a health belief strategy and a control group makes a difference in their AIDS health beliefs; (7) determine if a culturally sensitive message compared to a health belief

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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strategy and a control group makes a difference in their specific AIDS health belief (susceptibility, seriousness, benefits, barriers, and cues to action); (8) determine if a culturally sensitive message makes a difference in AIDS risk behaviors, AIDS knowledge, and AIDS health beliefs within the culturally sensitive message group in the acculturated and non-acculturated. DESIGN: The study will be an experimental, pretest/posttest design. A total of 375 (125 in each group) Hispanic ROTC students will be randomly assigned to one of three groups: Culturally Sensitive Message; Health Belief Strategy; or a control group. Subjects will complete the Acculturation Scale of AIDS knowledge; AIDS Health Beliefs; and Risk Behavior Scales at the beginning of the semester. Three months later the subjects will complete all of the scales with the exception of the Acculturation Scale. ANALYSIS: Pearson R will be used to determine if there are significant differences among the three groups.

Kamin D. (Navy Active; George Washington University, Washington, DC). 1992. Consumer Use of Information in Selection of Hospitals for Open Heart Surgery. $4,064.

The historical lack of consumer information in medical markets threatens the success of market-based reforms which depend on informed consumers to “shop” for hospitals based on some knowledge of their cost and quality. Although there have been a number of private and public sector attempts to improve consumer information, the effect of these programs on consumer behavior is not clear. The research proposed here will use a mail survey of open heart surgery patients to identify factors which influenced their choice of hospitals, sources of information they used in hospital selection, and the extent to which they participated in choosing a specific institution. Demographic differences in types of information used, extent of participation, and type of hospital selected will also be examined. Results from the proposed study are intended to contribute to policy analysis relating to (1) the effectiveness of competition as a cost control mechanism, (2) appropriateness and effectiveness of information dissemination programs now in place, and (3) the role of physicians in guiding patient selection of quality hospital care.

LeGrande-Engebretsen SLG. (Navy Reserve; Brigham Young University, Salt Lake City, Utah). 1995. Infant Outcomes and Psychosocial Profiles of Mothers. $203,488.

A major objective for national health care by the year 2000 is to reduce low birth weight to no more than 5% of live births. (US Department of Health and Human Services, Public Health Service [US DHHS, PHS], 1991). Studies have examined the link between preconceptual prenatal variables and pregnancy outcome, including birth weight. But, until recently, few have focused on psychosocial factors, such as personal and family stress (including family violence), social support and self-esteem. Little attention has been given to working mothers, whose presence in the workforce is constantly rising. Of the more than 38 million women ages 18–44 in the labor force, about 1 million have babies each year.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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Complicating already stressful and complex lifestyles, each day hundreds of babies are born to these mothers. The cost of caring for handicapped and low birth weight babies reaches well over $2.5 billion dollars annually. In the military, these issues are gaining more attention due to rise in female personnel. Determining those factors which affect working pregnant women is an important topic for the Department of Defense, especially within the current downsizing environment where the productivity of individual service members is a paramount concern. The purpose of the current research is to examine the multivariate relationship between assessments of psychosocial risk factors, medical risks and lifestyle variables and their relationship to adverse infant outcomes, including birth weight, in a military population. This population includes two groups, active duty women and full-time working partners of active duty members. In this study, 300 women at a major military hospital prenatal clinic will be interviewed using a previously tested psychosocial assessment tool. Medical risk data will be obtained from the medical records of these mothers; and the birth weights of their infants, as well as adverse infant outcomes, will be recorded after delivery. Multivariate analyses using multiple regression will be performed. It is hypothesized that those with highest risk measures in the areas of stress, and the lowest measures of selfesteem and social support will have a higher incidence of adverse infant outcomes including low birth weight infants. The identification of those mothers at highest psychosocial risk for delivering infants with adverse infant outcomes, including low birth weight, will aid in social service referral and the planning of nursing care.

Leander DJ. (Army Active; Madigan Army Medical Center, Tacoma, WA). 1993. Exogenous Surfactant Therapy in Premature Infants. $344,532.

The leading cause of death for prematurely born infants born in the United States is Respiratory Distress Syndrome (RDS) (Wegman, 1992). Although exogenous surfactant has reduced the death from RDS by up to 87%, the incidence of major sequela such as patent ductus arteriosus (PDA), bronchopulmonary dysplasia, and intraventricular hemorrhage have not been reduced. It has become a nursing responsibility to administer the exogenous surfactant, and care for the premature infant before, during, and after the administration. The purpose of this study is to incorporate findings from the current study and extend knowledge on exogenous suffactant administration (ESA) in premature infants. This will be achieved by systematically examining two types of exogenous surfactant, three methods of administration, the resulting neonatal outcomes, and nursing interventions in response to respiratory and cardiovascular physiologic responses of the neonate. Specific aims are to: (1) Examine the effect of a bovine and protein free exogenous surfactant administered without interruption in ventilation. (2) Examine the effect of a bovine preparation exogenous surfactant administered with interruption in ventilation but based on product guidelines. (3) Examine the five nursing clinical cues for hemodynamically significant PDA following exogenous surfactant administration. (4) Examine the premature infant's outcomes following exogenous surfactant administration. The sample will consist of 48 intubated and mechanically ventilated infants with RDS. Infants will be randomly assigned to one of the three groups. Data from eight physiologic

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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parameters will be selected and recorded simultaneously and continuously for a two hour and thirty minute period prior to and following ESA. Nursing clinical cues, based on neonate physical assessment, regarding the presence of a hemodynamically significant PDA following ESA will be annotated and tracked. Data based on the infants' outcomes following ESA will be collected by concurrent chart reviews, Results from this study will give nurses data on infant outcomes and physiologic responses to two types of surfactant and three methods of administration.

Messecar DC. (Army National Guard; Oregon Health Sciences University, Portland, OR). 1993. Family Stress Associated with Wartime Separation. $12,338.

Although extensive research has been conducted on the impact of separation on military families living in a military community, not much is known about wartime separation effects on the otherwise civilian families of Guardsmen and Reservists. The aims of this study are to describe families' perceptions of their experiences, coping processes and outcomes of wartime separation on family functioning and individual family member's growth and development. The purposes of these aims are to begin developing theory about this type of wartime separation, to specify variables that can be used in future research, and to provide qualitative data for development of measures of related constructs. This knowledge will increase nurses' awareness of and sensitivity to the issues families face under this unique form of family separation and will enable them to improve their skills of effective facilitation of family coping and adaptation. Grounded theory methodology will be used to address the aims of this study. The method is designed to primarily generate theory from empirical data rather than to validate existing theory and is especially useful in areas where there is limited research data. Respondents will consist of approximately 12 members of families of guardsmen or reservists recalled to active duty during Desert Storm. Qualitative data from interviews with family members will be analyzed with the grounded theory approach of constant comparative analysis.

Mueggenborg B. (Air Force Active; Wilford Hall Air Force Medical Center, Lackland AFB, TX). 1993. Thrombus Prevention in Tunneled Central Venous Catheters. $47,500.

The purpose of this study is to evaluate the effect of scheduled urokinase cleansing on the incidence of withdrawal occlusion (able to flush catheter, but unable to withdraw blood) and thrombus formation in tunneled central venous catheters (CVCs). These problems affect the utilization of these catheters and may even necessitate their removal. Thrombus formation in and around the tunneled CVC is felt to occur as a result of blood vessel wall injury caused by the CVC (1). Obstruction of the catheter tip by thrombus is felt to be the most frequent cause of withdrawal occlusion and occurs in 30% of tunneled CVCs (2,3,4). To treat thrombus buildup, investigators have attempted varying schedules of urokinase to “declot” or lyse the fibrin clot. One of the earliest studies published reported a

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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98.6% success rate in clearing occluded catheters (5). This study helped define the role of urokinase in catheter declotting. Today, urokinase declotting is a common and, unfortunately, frequent necessity for maintaining the patency of tunneled CVCs. Most CVCs require declotting with urokinase as a response to catheter and/or withdrawal occlusion. In a small study at MD Anderson Hospital, 10 catheters with withdrawal occlusion were treated with urokinase to “cleanse” them of thrombus formation with good results. These catheters remained cleared with prophylactic urokinase (6). These results led the investigator to recommend studying the use of a prophylactic schedule of urokinase to decrease withdrawal occlusion in CVCs. Based on these study results and our knowledge of thrombus formation around CVCs, this study plans to use urokinase on a schedule designed to prevent or treat early thrombus formation around the CVC. The study design is a prospective randomized clinical trial utilizing a convenience sample of oncology patients requiring tunneled CVCs. A total of 130 consecutive patients (2 groups of 65) will be enrolled over a 2 year period. The control group will receive no scheduled urokinase; the experimental group will receive scheduled urokinase cleansing. Data analysis will include the use of chi-square methods to detect a reduction in overall withdrawal occlusion and analyses of variance to compare CVC tip clot sizes obtained via catheter dye studies. Kruskal-Wallis non-parametric statistics will be used to detect other differences between the two groups.

Mygrant BI. (Army Active; Madigan Army Medical Center, Tacoma, WA). 1994. Postoperative Wound Healing: Hydration and Oxygenation. $385,994.

Tissue wounding may result from surgery or accidental trauma and convalescence may be slowed by complications. Delayed wound healing and wound infection result in prolonged hospital stay, increased health care costs, and contribute to morbidity and mortality. While many factors are important for wound healing and resistance to wound infection, tissue blood flow and oxygen levels are critical. However, therapies to improve tissue perfusion and oxygenation have not been fully developed or tested. Postoperative hypovolemia is a common contributor to tissue hypoxia with resultant reductions in tissue oxygen levels. Patients undergoing cardiac surgery are especially vulnerable to fluid replacement quandaries because of the clinical dilemma existing between the strain of circulatory overload and suitable tissue hydration needed to promote tissue healing and resistance to wound infection. The specific aims of this study are (1) to compare the effects of augmented postoperative fluid replacement and conventional fluid replacement on subcutaneous tissue oxygen (PscO2), subcutaneous tissue perfusion, and cellular markers of wound healing; and (2) to determine the relationships between a) subcutaneous tissue oxygen levels and wound healing indicators; and b) the incidence of wound complications/infection. Using a randomized, two group quasi-experimental repeated measures design, subjects scheduled for cardiac surgery will receive either augmented (n = 81) or conventional (n = 81) fluid replacement postoperatively. PscO2 and perfusion will be measured on the 8th, 20th, and 36th postoperative hours with an optode tonometer system. Wound healing will be evaluated by analysis of tissue

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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cellularity and hydroxyproline from a tissue sample obtained from a small, polytetrafluorethylene tube placed subcutaneously and removed on the 7th post-operative day. Wound complications/infections will be evaluated using the ASEPSIS scoring method. Differences between groups on tissue oxygen, perfusion, and wound healing variables will be tested with Student's t test, Chi-Square, ANOVA for repeated measures, or the Mann Whitney U test. Relationships will be tested with Pearson 's product moment correlation coefficients. Determining fluid replacement levels that support tissue oxygen, blood flow, and healing without increasing added stress on the heart have a long range of consequences of promoting cost-effective care and sustaining a healthy military force, in both times of war and peace.

Mygrant BI. (Army Active; Madigan Army Medical Center, Tacoma, WA). 1995. Postoperative Wound Healing: Hydration and Oxygenation. $353,286.

Tissue wounding may result from surgery or accidental trauma and convalescence may be slowed by complications. Delayed wound healing and wound infection result in prolonged hospital stay, increased health care costs, and contribute to morbidity and mortality. While many factors are important for wound healing and resistance to wound infection, tissue blood flow and oxygen levels are critical. However, therapies to improve tissue perfusion and oxygenation have not been fully developed or tested. Postoperative hypovolemia is a common contributor to tissue hypoxia with resultant reductions in tissue oxygen levels. Patients undergoing cardiac surgery are especially vulnerable to fluid replacement quandaries because of the clinical dilemma existing between the strain of circulatory overload and suitable tissue hydration needed to promote tissue healing and resistance to wound infection. The specific aims of this study are (1) to compare the effects of augmented postoperative fluid replacement and conventional fluid replacement on subcutaneous tissue oxygen (PscO2), subcutaneous tissue perfusion, and cellular markers of wound healing; and (2) to determine the relationships between a) subcutaneous tissue oxygen levels and wound healing indicators; and b) the incidence of wound complications/infection. Using a randomized, two group quasi-experimental repeated measures design, subjects scheduled for cardiac surgery will receive either augmented (n = 81) or conventional (n = 81) fluid replacement postoperatively. PscO2 and perfusion will be measured on the 8th, 20th, and 36th postoperative hours with a tonometer/sensor system. Wound healing will be evaluated by analysis of tissue cellularity and hydroxyproline from a tissue sample obtained from a small, polytetrafluorethylene tube placed subcutaneously and removed on the 7th postoperative day. Wound complications/infections will be evaluated using the ASEPSIS scoring method. Differences between groups on tissue oxygen, perfusion, and wound healing variables will be tested with Student's t test, Chi-Square, ANOVA for repeated measures, or the Mann Whitney U test. Relationships will be tested with Pearson 's product moment correlation coefficients. Determining fluid replacement levels that support tissue oxygen, blood flow, and healing without increasing added stress on the heart have a long

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

range of consequences of promoting cost-effective care and sustaining a healthy military force, in both times of war and peace.

Nelson BJ. (Army National Guard; Beth-El College of Nursing, Colorado Springs, CO). 1994. Activation Experiences During the Persian Gulf War. $148,714.

Military members in all branches of the service require family support; however, in wartime the activation and mobilization of National Guard and Reserve forces is believed to increase family support needs. The stress associated with activation may stem from the threat of bodily harm or the changes associated with a new employer, socioeconomic status, and family situations. The purpose of this ethnographic study is to describe and analyze patterns and experiences of activation and mobilization from the perspective of the military members, their families, family support personnel, and commanders of the National Guard forces during the Persian Gulf War. The specific aims of this study are: (1) to describe the patterns of experience throughout the activation and mobilization of military members, families, family support personnel, and selected military commanders in the National Guard forces during the Persian Gulf War; (2) to describe the lived experience of military members, families, family support personnel, and selected military commanders in the National Guard forces during activation and mobilization for the Persian Gulf War; (3) to explore practices of National Guard members and their families that facilitated living with the experience of activation and mobilization during the Persian Gulf War; and (4) to identify problems in military organizations which affected the military members' ability to perform their assigned duty or caused families to experience undue hardship or stress related to the military member's activation or mobilization during the Persian Gulf War. The long-term goal of this study is to develop a comprehensive questionnaire to continue to explore the needs, experiences, and possible interventions for military members, families, and family support personnel in all branches of the military during activation and mobilization situations. Data collection in ethnography includes: (1) interview with military members, military families, family support personnel, and selected military commanders; (2) participant observation in selected military units; and (3) examination of cultural artifacts such as documents, journals, newspapers, and photographs. Ethnographic data analysis will provide categories, domains, and themes to describe patterns and experiences of family support systems used by the study participants during the Persian Gulf War. Results of this study will enable the researchers to propose nursing interventions related to family support services. The significance of this study is that it will assist military nurses and other health care professionals to develop models of care for military members and their families during National Guard and Reserve personnel activation and mobilization. In addition, the results of this study will assist the military leaders to modify regulations related to family support.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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Nelson F. (Navy Active; Portsmouth Naval Medical Center, Portsmouth, VA). 1993. Reduction of Pain Responses Using Guided Imagery. $6,034.

In one hundred non emergent Emergency Room patients requiring insertions of intravenous catheters, the effect of relaxation on procedural pain will be examined. The purpose of this study will be to determine if guided imagery decreases the perception of pain during needle insertion. Roy's adaption model states human resources influence coping and adaptation for physiological integrity and wellness. This study will extend a laboratory experiment of the effect of music and imagery on laboratory pain. Four hypotheses state that guided imagery will decrease pain rating and cardiovascular responses during needle insertion. Patients will be randomly assigned to either the guided imagery (n = 50) or control (n = 50) groups. Pain intensity will be measured against four interval-ratio indicators of pain: (a) short-form McGill Pain Questionnaire, (b) Visual Analogue Scale, (c) blood pressure, and (d) heart rate. T-tests of group mean scores will show lower score in the guided imagery group compared to the control group.

Newman-Giger JN. (Army Reserve; University of Alabama School of Nursing, Birmingham, AL). 1995. Behavioral Risk Reduction Strategies for Chronic Indicators and High Risk Factors for Premenopausal African American Women (25–40) with Coronary Heart Disease. $750,000.

This innovative dual site project connects two major cities (Birmingham and Atlanta) and two major universities, University of Alabama at Birmingham and Emory University, for the purpose of designing a culturally appropriate risk reduction intervention program for pre-menopausal African American women with coronary heart disease (CHD) or high risk factors for the development of the condition. The purpose of this study is to: (1) further specify the risk factors of CHD, (2) determine if there are particular genetic phenotypes which include lipoprotein(a), apolipoprotein E, Endothelin-1, tumor necrosis factor alpha and mutations within the beta subunit of the epithelia sodium channel which are genetic predictors of CHD, hypertension and overt diabetes in pre-menopausal African American women; and (3) test the impact of a comprehensive risk reduction program designed to reduce risk factors for the worsening of CHD in pre-menopausal African American women. We propose to conduct a two-phase study. In phase I, we will recruit a sample of 150 pre-menopausal (25–45 years of age) African American women who have CHD or have high risk for CHD and compare then with a sample of 150 African American women who are low risk for CHD in order to specify risk factors for CHD in pre-menopausal African American women. In phase II, we will randomly assign a minimum of 150 eligible women with CHD or risk factors for CHD to either a culturally appropriate comprehensive risk reduction program (CACRRP) (n = 75) or a control group (n = 75) to determine its impact on risk factors for CHD in this population.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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Newmark-Sammons L. (Navy Reserve; NR Naval Hospital Oakland, San Ramon, CA). 1995. Daily Stresses Affecting Women and Men in the Fleet. $76,287.

As the Armed Forces move towards fuller integration and expanded opportunities for women, challenges are presented in assuring that these processes occur in a manner that maintains each Service member in optimal health for operational readiness. The environment and demands of life in the Navy fleet provide their own stresses, which may be magnified by change and transition as women enter new workplaces, assume new roles, and move into living spaces on previously prohibited vessels. Identification and reduction of stress is a key element in the creation and maintenance of high-level quality of life, optimal wellness, disease prevention, and maximum contribution to mission accomplishment. The time to initiate research into shipboard stress is now, while the initial combatant vessels are taking on their first female crew members, and other ships are preparing for the embarkation of women. The aims of this study are to describe the daily stresses of shipboard life in the gender-integrated fleet and the relationship of stress to selected health care behaviors. The following research questions will be addressed: (1) What are the frequency and severity of daily hassles experienced by enlisted women and men in the fleet? (2) Do perceptions of daily hassles vary by gender? rate? berthing arrangements? (3) Are perceived daily hassles related to a) the frequency of health care use? b) general feelings of well-being? c) smoking behavior? Based on transactional stress theory, a correlational design will be employed in a study to survey 400 sailors deployed on a gender-integrated combatant vessel. Questionnaires will include demographic and health data and the Daily Hassles Scale, a well-established 117-item instrument for measurement of daily life stresses. Descriptive, correlational, and multiple regression statistical approaches will be used to answer the research questions. Results may be used to provide a profile of sailors at risk for somatic and psychological health symptoms; to suggest areas for future interventions and studies to promote wellness in the shipboard environment; and for guidance in the formulation of services and policies to enhance health and productivity in the fleet.

Nichols MR. (Army Reserve; Georgetown University, Washington, DC). 1994. Maternal and Paternal Adjustment to Parenthood. $55,598.

It is unknown if military families have unique needs or if they are a microcosm of their civilian counterparts as they become parents of a new baby. Information on differences between military and civilian perinatal experiences is essential if the military health care delivery system is considered as a model for future health care reforms in America. This longitudinal, multisite study will compare military and non-military parents to describe their experiences as they adjust to the birth of an infant. Approximately 125 couples from each group will complete self-report questionnaires providing measures of adjustment to parenthood during the last trimester of pregnancy and six weeks after delivery. Indicators of prenatal influences, intrapartal events, and new parent experiences will be measured. The prenatal influences include demographic and contextual factors, prenatal attachment, and global self-esteem; intrapartal events include paternal childbirth

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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involvement and childbirth satisfaction; and new parent experiences include parenting sense of competence, ease of transition to parenthood, and global self-esteem. Additional descriptive information about pregnancy, childbirth, and parenthood will also be collected. Measures for mothers and fathers, prepared and unprepared couples, and primiparous and multiparous parents will be compared within military and non-military populations. The primary goal of this study is to provide information about adjustment to the birth of a new family member for military and non-military parents. It will also provide data for the development and testing of nursing interventions designed to promote adjustment to parenthood and optimal family function. The findings of this study are expected to provide nurses in military settings with additional information needed for family-focused care and health promotion during pregnancy, childbirth, and the puerperium for mothers and fathers. The development of innovative assessment and intervention strategies are needed to promote and strengthen healthy adjustment to parenthood in both military and civilian care settings.

Odom J. (Army Active; Brooke Army Medical Center, San Antonio, TX). 1993. Simulation Modeling in Planning Health Care Services. $40,986.

Today's health care administrator, nurse executive and manager are all confronted with a number of crucial decisions relative to the management of operations. Increasingly, pressure is mounting to maintain the availability of quality of health care while reducing costs through more effective resource utilization. Given the relative lack of work that has specifically addressed the use of computer simulation modeling relative to capacity management decision-making in an ambulatory pediatric clinic setting, this proposed study is aimed at (1) identifying those factors that influence resource consumption and utilization in an ambulatory clinic, and (2) developing and testing a model through application of computer simulation. Using a time-series design with a repeated measurements process, this study will be conducted in two phases. Phase I will address the first aim. During Phase II, a model that can be used for effective capacity management decisions will be developed and tested.

Peniston JB. (Army Active; Madigan Army Medical Center, Tacoma, WA). 1994. Wellness Intervention with Pregnant Soldiers. $44,246.

The Army's total strength is comprised of approximately 5,000 pregnant soldiers at any one time, the size of a light division. Studies suggest that service women have higher rates of complications, poorer pregnancy outcomes, and higher infant mortality rates than non-active duty women who receive prenatal care at the same facility (Fox, 1977; Madagan, 1991). Unfortunately, none of these investigators discussed the physical fitness program the active duty women followed prior to, or during pregnancy. One preliminary study, however, indicates that pregnant soldiers who participate in a wellness-directed program appear to have less complications and better pregnancy outcomes than soldiers who do not participate (Urich, 1993). The purpose of this study is to evaluate the effects of a pre-existing Wellness Program Intervention for pregnant soldiers. The hypothesis is that

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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pregnant soldiers who engage in the Wellness Program will have (1) more favorable health risk appraisals, (2) more successful return to Army Fitness standards at the first post-delivery PT test, (3) fewer complications, (4) more favorable deliveries, (5) more favorable pregnancy outcomes, and (6) lower health care costs per delivery, than those pregnant soldiers who do not participate. The study consists of a retrospective review and analysis of 200 active duty Army: (a) obstetric and newborn patient records, (b) Community Health Risk Appraisals, (c) fitness activity and physical assessment records, and (d) subjective questionnaires. A random sampling of records will be selected and divided into two groups: Group I (n = 150) will include soldiers who received the Wellness Program Intervention; and Group II (n = 50) will include soldiers who did not receive the Wellness Program Intervention. Group I will be further divided into three subgroups according to level of Wellness Program Participation: light (n = 50); moderate (n = 50); and frequent (n = 50). Demographics and variables will be compared using multivariate methods of analysis to evaluate the impact of the independent variable: Wellness Program Intervention. It would benefit soldiers, infants, and the Department of Defense if a wellness-focused intervention program assisted in reducing complications, improving delivery and pregnancy outcomes, reduced health care costs, and helped decrease health risks which are connected with poor pregnancy outcomes.

Phyall G. (Army Active; Army Medical Department, Tacoma, WA). 1995. Fatigue Following Childbirth: Military Family Outcomes. $405,426.

Military readiness and productivity are closely related to home and family life. The birth of an infant is one of the major transition points for any family. During this transition, fatigue following childbirth is consistently reported by new mothers and fathers. Research demonstrates that there are three central groups of factors contributing to this fatigue: parent factors (marital satisfaction, stress, depression, physical fitness, anger, sleep, and resources), infant factors (infant characteristics, temperament, neurobehavior, and sleep pattern), and environmental factors (child care resources, challenges, and support). In the childbearing family, fatigue produces effects in three areas: job well-being (job satisfaction, absences, retention in the military, return to duty), parenting ability, and infant health/development. The purpose of this study is to determine if an advanced practice nursing intervention to reduce fatigue after birth of an infant will promote job well-being, parenting ability, and infant outcomes among military personnel and their spouses. A two group quasi-experimental design with repeated measures will be used. A total of 400 subjects will be entered; 200 during the first year and an additional 200 during the second proposed year. Subjects will be randomly assigned to experimental and control groups and stratified according to the active duty status of their parents into four subgroups (1) mother active duty, spouse not; (2) father active duty, spouse not; (3) both parents active duty; and (4) single mother who is active duty. Subjects in the control group will receive routine care. The experimental group will be cared for by an advanced practice nurse who will prescribe interventions related to sleep hygiene, sleep environment regulation, and sleep consolidation for both the parent(s) and the infant. Outcome measures include marital satisfaction, parenting ability, physical fitness, return to duty,

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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infant temperament, infant development, and life circumstances. The analysis includes cross-sectional and repeated measures to evaluate differences in the dependent variables. This research has benefits for the entire military community. Reduction of fatigue in the military family should improve the function of the active duty soldier and improve infant outcomes.

Pierce JD. (Navy Reserve; University of Kansas Medical Center, Kansas City, KA). 1995. Effects of Three Types of Mechanical Ventilation. $115,698.

In 1992, the American Association of Critical Care Nurses announced that the techniques to optimize pulmonary function, to prevent pulmonary complications and for weaning of mechanically ventilated patients are the top research priority in critical care nursing. This proposal will provide valuable data concerning the physiological effects of three control modes of mechanical ventilation. The type of ventilation mode applied to the patient is often based on physician preference or clinical experiences. With the use of a miniaturized ultrasound sensor, we will be able to determine the effects of these modes of ventilation on diaphragm contractility in rats. Therefore, the specific aims of this proposal are: AIM 1: to investigate the differences in diaphragm shortening during and following pressure regulated volume control (PRVC), volume control (VC), and pressure control (PC). AIM 2: to examine the differences in cardiovascular and respiratory parameters during and following PRVC, VC, and PC. The anesthetized rat will be placed on either pressure regulated volume control (PRVC), volume control (VC), or pressure control (PC). During the 10 minute pre-ventilation period, control values for diaphragm shortening (DS), cardiac output (CO), arterial blood gases (ABG) (pH, CO2, PaO2, HCO3, O2Sat), intrathoracic pressure (ITP), blood pressure (BP) (systolic, diastolic and mean), and end-tidal carbon dioxide (PetCO2) will be obtained. Diaphragm shortening will be measured during spontaneous breathing and during a tetanic contraction of 10 seconds duration. Spontaneous and tetanic DS measures will provide a method of determining if there is any change in diaphragmatic performance. Intrathoracic pressure, BP, and PetCO2 will be measured continuously throughout the experiment. One of the pre-randomized modes of mechanical ventilation (PRVC, VC, PC) will be applied for 10 minutes. At 8 minutes of mechanical ventilation, tetanic DS, ABG, CO will be measured. After a total of 10 minutes of mechanical ventilation, the rat will be disconnected from the ventilator. Cardiac output, ABG's and tetanic DS will be determined immediately after disconnection and again 8 minutes later. This will be followed by one of the 2 remaining modes of mechanical ventilation. Currently, there is no direct method of measuring diaphragm performance in the clinical setting. This study will provide data concerning types of mechanical ventilation that could assist clinicians in determining the best mode of ventilatory support for critically ill patients.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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Pierce P. (Air Force Reserve; University of Michigan, Ann Arbor, MI). 1992. Health and Psychosocial Readjustment of Gulf War Veteran Women. $336,721.

A total of 40,782 women served in the Gulf War with the Air Force alone deploying 4,246 women, which is more than half the 7,166 women who served in Vietnam (Kulka, 1990). Women in the military have been an under-served population with respect to health care (Rothman, 1984), veteran's services (Harris, 1985; Page & Stuckford, 1984), and recognition as veterans (Sandrick, 1990) that need to be studied more thoroughly (McVicker, 1985). Using a randomized representative sample of 420 Air Force women veterans, we propose an initial one-year study for conducting a survey with telephone interviews and mailed self-administered questionnaires to examine: (1) the effects of deployment and military service during wartime on women's physical and emotional health; (2) the effects of war-induced separation on the marital relationship, parent-child relationships, and family health; (3) the health, social, and psychological problems that are encountered by female veterans as they return to their families, work, and military service; and (4) how deployment and war experiences affect the intention to reenlist or to leave the armed forces. It will also include data collected from the women 's husbands or significant others, and from the guardian of the youngest child, concerning the above mentioned issues. Plans will be in place to continue the data collection into a second year of funding and triple the sample size to reach a total of 1300. This extension will allow elaborate and powerful statistical analyses on subgroups and for testing hypotheses and models.

Pierce P. (Air Force Reserve; University of Michigan, Ann Arbor, MI). 1994. Readjustment of Gulf War Veteran Women: A Follow-Up. $247,068.

A total of 40,793 women served in the Gulf War with the Air Force alone deploying 4,246 women, which is more than half the 7,166 women who served during the entire Vietnam era (Kulka, 1990). Women in the military have been an under-served population with respect to health care (Rothman, 1984), veteran's services (Harris, 1985; Page & Stuckford, 1984), and recognition as veterans (Sandrick, 1990) that need to be studied more thoroughly (McVicker, 1985). In our first year, we collected baseline data from representative stratified samples that included 525 women of the active, reserve, and guard who were activated and deployed during operations Desert Shield and Desert Storm. (Women deployed in the theater and those who were parents were oversampled). Thirty-six percent of the women were deployed in the theater and consequently were exposed to more war stressors than the other 64% of the women (our comparison group) who were deployed elsewhere. We propose to extend the study by conducting a longitudinal 2-year follow-up data collection. This extension will provide additional information on the adjustment process of these women and their families over time. In addition, the follow-up data will allow us to perform more powerful statistical analyses for testing hypotheses regarding adjustment and reenlistment behaviors because baseline data are available to be used for statistical control and analysis of change. The data would be collected again with the same successful

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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methods that were used in collecting the baseline data with a mailed self-administered questionnaire to be completed by each woman and her husband or significant other. The data will be used to examine: (1) the effects of deployment and military service in the theater of the war on women's physical and emotional health, (2) the effects of war-induced separation on the marital relationship, parent-child relationships, and family health, (3) the health, social, and psychological problems that are encountered by female veterans as they return to their families, work, and military service, (4) the extent to which job stress spills over and affects family adjustment and/or family stress affects job stress and strain, and (5) how deployment in the theater and war experiences, and job experiences affect both the intention to reenlist and actual reenlistment behavior. Results of the study will have implications for developing interventions to address problematic issues concerning the relationship between military service and deployment, the balancing of marital and parental roles, and mental and physical health.

Puksta N. (Navy Active; Catholic University of America, Washington, DC). 1994. Quality of Life Among Midlife, Female Navy Nurses. $3,680.

With the increased debate regarding women in combat, increased participation in operational assignments, decreased military personnel resources, budgetary constraints, and the possible restructuring of the military system, issues which affect all service members must be addressed. Among the service members who will be affected by these changes are Navy Nurse Corps officers. In order to meet these changes, a study regarding the impact on stress, coping, and social support in Navy Nurse Corps officers will provide invaluable information in ensuring that Navy nurses are physically and psychologically ready to meet any future challenge. The specific aims of this study are to develop a psychosocial profile of the midlife, female Navy Nurse Corps officer by identifying stressful life events and daily hassles, ascertaining what coping and social support resources are used by this population. A second aim is to determine the relationship between quality of life to stressful life events and daily hassles, coping resources, and social support among this population. The broad long-term objective of this study is to identify factors which will assist the Nurse Corps leaders in developing strategies to promote and maintain health among Nurse Corps officers. This study will also assist nurses to identify the stressors in their lives and develop adequate coping and social support networks. A broad research question to be addressed in this study is: What is the relationship between quality of life to stressful life events, daily hassles, coping responses, and social support among female, midlife Navy Nurse Corps officers? Descriptive statistics will be used to analyze demographics and each predictor variable. Pearson “r” correlations between the criterion, demographic, and predictor variables will be calculated. Significant demographics that correlate with the criterion and predict variables will be entered into a stepwise multiple regression. This procedure will allow for the evaluation of the combined effects of the variables on quality of life.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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Ransom V. (Army Active; Walter Reed Army Medical Center, Washington DC). 1994. The Effect of a Nursing Intervention on Birth Weight. $199,075.

Aggressive nursing intervention prenatally can be one of the most effective means of reducing preterm delivery rates and enhancing newborns' quality of life. Moore (1992) reported in her study of 891 women in the Northwest North Carolina Prevention of Prematurity Program (NNCPPP), that 15% of women who received the usual prenatal care offered high risk mothers delivered low birth weight (500–2,499 gram) infants, while 8% of women who received the usual care plus a specific nursing intervention delivered low birth weight infants. The purpose of this multi-site, tri-service replication study is to determine whether the same nursing intervention used by Moore, intensive telephone contact, will be associated with a reduced incidence of low birth weight (LBW) infants in a military population. Secondary objectives of this project include the study of (1) cost effectiveness of the intervention, (2) the correlation of LBW outcomes with specific associated etiologic factors, and (3) the effect of the intervention on state anxiety (STAI). A convenience sample will be recruited from all women receiving prenatal care during the seventh-month period at three military hospitals in the Washington, DC area. Women will be contacted during a prenatal visit between 24 and 28 weeks gestation to ask their permission for a project nurse to discuss the study with them. Women who consent to participate will be randomized to intervention and usual care groups. Both groups will be asked to complete the STAI at 24 and 28 weeks gestation. A sample of at least 730 participants, 365 in the intervention and 365 in the control group, will be obtained to provide the size determined by power analysis necessary to demonstrate a significant difference between groups. Achievement of the primary objective will be approached as a test of the hypothesis that women who receive the usual prenatal care and intensive telephone intervention will experience a lower incidence of LBW deliveries than women who receive only the usual care. Data will be analyzed using Fisher's Exact Test to compare the incidence of LBW between groups. Secondary objectives will be achieved by (1) comparing the cost of inpatient care between groups using the two-sample t-test (2) describing the incidence of specific etiologic factors associated with LBW between groups and (3) using analysis of variance to analyze the mean state anxiety scores as measured by the Spielberger State Anxiety Inventory (Spielberger, Gorsuch, Lushene, Vagg, and Cobbs, 1983) at 28 and 34 weeks gestation. Increased infant morbidity and mortality associated with LBW deliveries represent significant personal and productivity losses to military families, as well as major costs to the military health care system. Military treatment facilities spend more than $60 million annually to deal with the effects of preterm labor. One 25-week gestation infant can incur CHAMPUS costs well over $200,000 during its initial admission. This study proposes a cost-effective intervention which adds to current knowledge of preterm delivery prevention, focusing on improved quality and accessibility of care for military families.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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Ray MA. (Air Force Reserve; Florida Atlantic University, Boca Raton, FL). 1995. Nurse-Patient Relationship Patterns: An Economic Resource. $148,633.

Linking quality and cost effectiveness through an economic theory of managed competition is the central operational goal of the military health care system and the health care reform process. This new form of health care financing based on the ratio of benefits over costs or the “highest quality services at the lowest available costs” challenges old ways of competing for and paying for health care services. Cost saving measures integrating patient and staff outcomes are paramount. Nursing is drawn into the contest by attempting to understand the constitution of nursing in a highly charged economic environment. In the last decade, nursing has firmly established its focus of inquiry and practice as caring in the human health experience. This focus is consistent with recent research studies on quality that locate high quality health care within reciprocal caring actions of the interpersonal relationship. Nursing, however, is not viewed within complex health care organizations as an interpersonal economic resource, but is costed out as a product line or associated with the bed rate, the length of stay for the patient, or the procedures that are performed. The purpose of this study is to utilize a qualitative grounded theory method to study the nurse-patient relationship as an economic interpersonal resource. This study is Study 1 of a program of 3 studies to be conducted over a 3-year time frame. Study 1 consists of 2 phases, qualitative research and instrument (questionnaire) development. In Study 1, a non-profit tax assisted urban hospital and a for-profit corporate hospital will be utilized as the sites for data generation. The aims of this study will be: (a) to describe patterns of interpersonal relationships as an interpersonal economic resource from the perspective of a total population of 28 patients, nurses, and administrators in 2 general hospitals, (b) to generate a substantive theory from the data that determines the patterns of interpersonal interactions as an economic resource, and that will facilitate the development of an instrument (questionnaire) to measure the interpersonal economic resource, (c) to develop an instrument (questionnaire) which will measure in Studies 2 and 3 interpersonal relationships and their effect on outcomes (nurse and patient satisfaction, health, well-being, and costs). The research should provide a foundation for linking quality and cost-effectiveness (nurse-patient interpersonal relationships as an economic resource). In phase 2, a questionnaire will be developed which will be counted later in Study 2 in both military and civilian environments. The research will improve our knowledge of how nursing interaction itself plays a role in outcomes (patient and nurse satisfaction, health, well-being, and cost). It will provide a new understanding of the economics of nursing and health care in the contemporary health care arena of managed competition.

Rea R. (Army Active; Madigan Army Medical Center, Tacoma, WA). 1993. Clinical Information Systems: Impact on Nursing. $14,926.

The purpose of this study is to examine the effects of implementing a clinical information system upon key nursing outputs within an acute surgical nursing

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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unit. In light of the current downsizing of the military coupled with a constrained economic environment, purported computer efficiencies must be empirically validated. Specifically, this study will examine the clinical information system's impact on nursing productivity as measured by proportion of time spent in various direct patient care and indirect care categories and completeness of documentation as defined by JCAHO Nursing Care Standard 1. Using a pre- and post-intervention design, work sampling will be used to collect information regarding time utilization by categorizing nursing behaviors into operationally defined categories and mathematically extracting proportions for each category. Greater than 1,600 data points will be collected from randomly selected days encompassing all days of the week, thereby insuring a 3% accuracy rate. Chart audits using peer review process will be used to quantify the completeness of nursing documentation in the patient record. Power analysis indicates that a review of 53 charts at each data collection time will allow detection of significant differences attributable to implementation of the clinical information system.

Reeder J. (Army Active; Walter Reed Army Medical Center, Washington, DC). 1994. Nurses' Role in Life Sustaining Treatment Decisions. $100,880.

This research will provide baseline data about nurses' role in life-sustaining treatment decisions for critically ill adult patients that will be used (1) in postgraduate education of military nurses to facilitate more effective, efficient, and ethical roles and interventions under combat and field conditions, and (2) in research for continued study of nurses' ethical decision roles during military health care reform. The specific aims of the study are to: (1) Measure the moral reasoning levels, decision-making style, self-perceived levels of nursing practice, and selected demographic characteristics of nurses working in two critical care units in a military hospital. (2) Describe nurses' ethical decision-making processes and their implementation of life-sustaining treatment decisions in the care of critically ill adult patients in a military hospital. (3) Identify the interactions between contextual (patient and institutional) variables, nurse variables, and life-sustaining treatment decisions and their implementations in the care of critically ill adult patients in a military hospital. (4) Develop a model(s) of nurses' ethical decision-making processes and their implementations of life-sustaining treatment decisions. A theoretical model based on Kohlberg (1981), Gilligan (1982), and Benner (1984); and empirical evidence of nurses' decision-making roles in life sustaining treatment decisions guides the descriptive, exploratory research design to answer five research questions. Phase I will involve measurement of levels of moral reasoning, ethical decision-making styles, self-perceived level of nursing practice, and selected demographic variables among nurses working on two critical care units in a large military hospital. Phase II will involve in-depth interviews of a purposeful sample of nurses at different levels of nursing practice for their narrative accounts of caring for critical ill adult patients and how life-sustaining treatment decisions for them were made and implemented. Phase II data will be analyzed for categories and themes related to ethical decision-making and the implementation of life-sustaining treatments.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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Descriptive and non-parametric statistics can be used to analyze the data from Phase I and their relationships to Phase II data.

Renaud MT. (Army Active; Madigan Army Medical Center, Tacoma, WA). 1992. The Effects of Modified Care Environment on the Growth and Development of High Risk Infants. $271,899.

High risk infants are at a greater risk for later neurobehavioral and learning problems. The neonatal intensive care unit (NICU) environment has been suggested as a major contributing factor in the development of these problems, possibly because of a mismatch between the brain expectations and the environment input in the infant in a NICU that leads to overwhelming sensory load, stress and subsequent alterations in development. Research demonstrates that the usual NICU environment (with its high intensity, continuous light, noise and sound levels) is highly arousing, with marked effects on the infants' physiologic and neurobehavioral status and organization and may increase the risk of hearing and vision problems. This research will evaluate the effects of a modified NICU physical environment on physiological and neurobehavioral parameters with two groups of preterm infants (<31 and 32–37 weeks gestational age [GA]) and a group of ill term infants (38–42 weeks GA) during hospitalization and post discharge. One hundred and twenty infants admitted to a tertiary level NICU will be randomly assigned to experimental (n = 60, 20 in each of the 3 GA groups) or control groups (n = 60, 20 in each of the 3 GA groups) once they achieve medical stability. Experimental group will be cared for from entry into the study until discharge in a specially designed NICU with a program of care that includes reduction of sound and light levels and day-night cycling of lighting. Controls will receive routine care in the standard NICU environment. All infants will have dependent measures recorded at the same time intervals. Outcome measures include: weight gain, duration of hospitalization, transition to nipple feeding, duration of organized sleep, amount of quiet sleep, diurnal cycling of heart rate, body temperatures and sleep-wake states, neurobehavioral stress cues, neurobehavioral and neurological assessments, and hearing and vision examinations. Analysis will include descriptive statistics, t-tests, analysis of variance procedures (including repeated measures) and cosinor analysis.

Renaud MT. (Army Active; Madigan Army Medical Center, Tacoma, WA). 1993. Neonatal Outcomes in a Modified NICU Environment. $312,281.

The purpose of the proposed research is to compare the effects of a modified Neonatal Intensive Care Unit (NICU) environment on the neurobehavioral and physiological outcomes of high risk infants and to determine the influence of a modified NICU environment on parental responses and parent infant interaction. Despite the remarkable increase in the survival of high risk infants, the developmental problems experienced by these infants is a pervasive concern. Substantial evidence supports the proposition that the Neonatal Intensive Care environment may be a factor in contributing to developmental outcome. There is little information concerning the effects of a modified NICU environment on

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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parents. Parental behaviors may be influenced directly by the less stressful modified NICU environment or indirectly by the level of their infant's neurobehavioral development. A currently funded study is examining the effects of modifying the NICU physical environment. In this project, three groups of high risk infants (<31 weeks, 32 –37, and 38–42 weeks gestational age) are randomly assigned to either an experimental or control nursery (n = 120). The program of care in the experimental nursery consists of reduction of sound and light levels and day-night cycling of lighting. Infants are admitted to the experimental nursery when medically stable and remain in the experimental nursery until discharge. Data is collected throughout hospitalization, at time of discharge, and at the post-discharge clinic visit. Current outcome data include: weight gain, length of hospital stay, transition to nipple feeding, duration of organized sleep, amount of quiet sleep, diurnal cycling of heart rate, body temperature, sleep-wake states, neurobehavioral stress cues, neurobehavioral and neurological assessments, and hearing and vision examinations. The proposed study extends longitudinal follow-up to include a home visit eight weeks post-discharge and incorporates measures of parental responses. Using the same criteria as the current study, one hundred additional subjects will be included in the continuation. Measures of infant sleep and neurobehavioral development, parent-infant interaction, and parental behaviors will be added to the currently funded project. Analysis will include descriptive statistics, t-tests, and analysis of variance, and cosinor analysis.

Renaud MT. (Army Active; Madigan Army Medical Center, Tacoma, WA). 1994. Fatigue Following Childbirth: Military Family Outcomes. $422,662.

Military readiness and productivity are closely related to home and family life. The birth of an infant is one of the major transition points for any family. During this transition, fatigue following childbirth is constantly reported by mothers and fathers. Research demonstrates that there are three central groups of factors contributing to this fatigue: parent factors (marital satisfaction, stress, depression, physical fitness, anger, sleep, and resources), infant factors (infant characteristics, temperament, neurobehavior and sleep pattern), and environmental factors (child care resources challenges and support). In the childbearing family, fatigue produces effects in three areas: job well-being (job satisfaction, absences, retention in the military, return to duty), parenting ability and infant health/development. The purpose of this study is to determine if an advanced practice nursing intervention to reduce fatigue after birth of an infant will promote job well-being, parenting ability and infant outcomes among military personnel and their spouses. A two group quasi-experimental design with repeated measures will be used. A total of 400 subjects will be entered; 200 during the first year and an additional 200 during the second proposed year. Subjects will be randomly assigned to experimental and control groups and stratified according to the active duty status of their parents into four subgroups: (1) mother active duty, spouse not; (2) father active duty, spouse not; (3) both parents active duty; and (4) single mother who is active duty. Subjects in the control group will receive routine care. The experimental group will be cared for by an advanced practice nurse who will

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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prescribe interventions related to sleep hygiene, sleep environment regulation and sleep consolidation for both the parent(s) and the infant. Outcome measures include marital satisfaction, parenting ability, physical fitness, return to duty, infant temperament, infant development, and life circumstances. The analysis includes cross-sectional and repeated measures to evaluate differences in the dependent variables. The research has benefits for the entire military community. Reduction of fatigue in the military family should improve the function of the active duty soldier and improve infant outcomes.

Rich I. (Army Active; Walter Reed Army Medical Center, Washington, DC). 1993. Psychology of Pregnancy: Peace and Wartime. $74,531.

Rich (1993), in her war-time study of psychological variables in pregnant military beneficiaries, could not determine if the alarmingly high psychological distress levels of respondents were the result of pregnancy or war-time stressors. The purpose of this replication study is to gather peace-time data so that conclusions can be drawn outlining the confounding effect of war-time stressors on pregnant women's ambivalence, attitudes toward pregnancy, and psychological distress. It may also explain why hypothesized differences based on pregnancy trimester were not found. Pregnancy attitudes and ambivalence will be measured using the Rich Pregnancy Attitude and Ambivalence Scales (R-PAAS). Deragotis' Symptom Checklist-90-Revised (SCL-90-R) is a sensitive measure of current psychological status, and will be used to assess psychological distress. An ex post facto, two group design will be employed to make peace- and war-time and soldier versus family member comparisons. Multivariate analysis of variance (MANOVA) will be used for this analysis. A combination of cross-sectional and quota sampling techniques will be used to recruit 675 women to participate with a minimum sample of 100 women per pregnancy trimester. To obtain sufficient data to explore the psychometric properties of the R-PAAS, this sample size exceeds that recommended by power analysis (Cohen & Cohen, 1983). The desired sample size of 450 was further adjusted to allow for 66% mailed survey response rate. A sample of 15 pregnant women will be recruited during the first trimester to participate in a longitudinal pilot project designed to describe changes in women's ambivalence, pregnancy attitudes, and psychological distress as pregnancy progresses. The study will add to what is known about the war-time psychology of pregnancy. The proposed research is a key step in an ongoing program of research which will be focused on improving care and outcomes for pregnant women and their families.

Ryan-Wenger N. (Army Reserve; Ohio State University, Columbus, OH). 1994. Impact of the Threat of War on Military Children. $68,052.

Daily media exposure to the horrors of war-torn Bosnia-Herzogovina has increased speculation about US troop involvement. In the meantime, active duty and reserve personnel constantly train in preparation for war. But how prepared are their children for war? What is it like for children who have parents who could be deployed at any moment? To what extent does living with the threat of

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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war cause fear, anxiety or other emotional responses in children? How do children cope with this pervasive threat to their security and family structure? The overall aim of this tri-service nursing research study is to describe the impact of the threat of war on children of military families. The theoretical framework underlying this study is an integration of Lazarus' stress and coping paradigm and Rachman's theory of fear acquisition. This study will examine the impact of war on three groups: children of active duty, reserve and civilian families. A power analysis for ANOVA with alpha = 0.05, power = 0.80 and a moderate effect size (0.25) indicates that at least 52 subjects per group are needed, for a total of at least 156 subjects. Inclusion criteria for all three groups includes: one child per family (to ensure independent observations); ages 8 to 11; in an age-appropriate grade in school; parental consent, and child assent to participate. The sample will be geographically diverse, and military parents will represent the enlisted and officer ranks of the Army, Navy and Air Force, while civilian parents will represent a range of socioeconomic levels. Triangulation of data collection methods (structured interview, questionnaires, projective techniques) will be used to address the specific aims of this study, which are to compare children of active duty, reserve and civilian families with respect to: (1) their perceptions of war; (2) origins of fears related to war; (3) levels of manifest anxiety; (4) projection of emotional problems in drawings; and (5) ways of coping with the threat of war. Instruments to be used include a structured interview, the Schoolagers ' Coping Strategies Inventory, the Revised Children's Manifest Anxiety Scale, and the Human Figure Drawing Test. Both quantitative and qualitative methods of analysis will be used to answer the research questions, including a computerized contextual content analysis program. Study results may provide direction for anticipatory guidance and nursing interventions for children of military families.

Sarnecky MT. (Army Active; Walter Reed Army Medical Center, Washington, DC). 1993. A History of the Army Nurse Corps. $11,179.

The overall objective of this research study is to produce an accurate, up-to-date, scholarly history of the Army Nurse Corps (ANC) suitable for publication. The specific aims are to describe the major stages of development, to discuss the context which has surrounded the ANC, to identify the influencing factors that have affected the ANC stature and reputation within the gestalt of nursing, to discover the impact exerted by the ANC upon the nursing profession and to provide information about lessons learned from past successes and failures. Other aims seek to characterize the experience of the typical ANC officer in each of the eras included in the study, to illustrate the internal and environmental psychosocial forces which have impacted upon ANC officers in combat, to scrutinize the changes in technology over the years to determine their effect on the basic skills needed by nurses to go to war, and to plot numbers of injuries and illnesses generated by battlefields of the past with a view to projecting future scenarios, expected care needs, and the illness/injury ratio in tomorrow 's mobilization. The design of the study will follow the historical method. The identified problem which drives the study is the dearth of readily available and clearly understandable historical information about the origins and development of the ANC. The theoretical framework utilized will be Bucher's natural history

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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model. Study questions have been developed and will be amended and augmented as the study unfolds. Data relating to the history of the ANC will be collected from sites across the country. It will be assessed for validity and reliability and entered into a database. All data will be organized, integrated, and analyzed. The research report then will be written and published as a volume in the Textbook of Military Medicine series by the Government Printing Office. Finally, the increased understanding of past trends, issues, and events in the history of the ANC will be applied to present and future directions. Additionally, consumers of the research will gain an enhanced sense of cohesion, integrity, pride and inspiration.

Sarnecky MT. (Army Active; Walter Reed Army Medical Center, Washington, DC). 1994. A History of the Army Nurse Corps. $33,639.

The overall objective of this research study is to produce an accurate, up-to-date, scholarly history of the Army Nurse Corps (ANC) suitable for publication. The specific aims are to describe the major stages of ANC development, to discuss the context which has surrounded the ANC, to identify the influencing factors that have affected the ANC stature and reputation within the gestalt of nursing, to discover the impact exerted by the ANC upon the nursing profession, and to provide information about lessons learned from past successes and failures. Other aims seek to characterize the experience of the typical ANC officer in each of the eras included in the study, to illustrate the internal and environmental psychosocial forces which have impacted upon the ANC officers in combat, and to scrutinize the changes in technology over the years to determine their effect on the basic skills needed by nurses to go to war. The design of the study follows the historical method. The identified problem which drives the study is the dearth of readily available and clearly understandable historical information about the origins and development of the ANC. The theoretical framework utilized is Bucher's natural history model. Study questions have been developed and are being amended and augmented as the study unfolds. Data relating to the history of the ANC were collected from sites across the country. It was assessed for validity and reliability and entered into a database. All data were organized, integrated, and analyzed. The research report is currently being written. It will be edited and appropriate photographs will be obtained for inclusion in the finished product. The manuscript will then be published. Finally, the increased understanding of past trends, issues, and events in the history of the ANC will be applied to present and future directions. Additionally, consumers of the research will gain an enhanced sense of cohesion, integrity, pride, and inspiration.

Schmelz JO. (Air Force Active; Boston College, Chestnut Hill, MA). 1995. Lung Sounds as Indicators for Endotracheal Suctioning. $111,666.

The purpose of this study is to extend prior research on the role of lung sounds as an accurate indicator of the need for endotracheal suctioning (ETS) in adult patients requiring mechanical ventilation (MV) and endotracheal intubation. Prior research had demonstrated the usefulness of lung sounds as a sensitive criterion

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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for determining the need for ETS, however use of lung sounds has been somewhat limited in the past because of confusion over terminology, a lack of understanding of the mechanisms that produce such sounds, and the variability among observers. It is this gap in the current research that this study is intended to address. State-of-the-are computerized lung sounds analysis now makes it possible to objectively measure lung sounds. The specific aims of this study are to: (1) analyze adventitious lung sounds immediately prior to ETS using new lung sound recording and analysis technology (Time-Expanded Wave Form Analysis [TEWA]); (2) quantify the differences in the lung sounds observed before and after ETS; and (3) determine the relationship between adventitious lung sounds recorded before suctioning and volume and weight of secretions aspirated from patients' tracheobronchial tree. The following research questions will address these specific aims: (1) What is the pattern of adventitious lung sounds immediately present prior to ETS? (2) How do these lung sounds change in character and number after ETS? (3) What is the relationship between the type and number of adventitious lung sounds and the volume and weight of tracheobronchial secretions aspirated by ETS? Research question #1 will be addressed by visually describing the lung sound patterns recorded. Waveforms will be measured in the time, amplitude and frequency domains of the number of zero crossings prior to the low threshold pause. In addition, the question will be answered using univariate descriptive statistics. Research question #2 will be addressed using a paired t-test to measure the change before and after for each dependent variable (adventitious lung sounds). Finally, research question #3 will be addressed using a multiple correlation technique.

Shaw RJ. (Army Reserve; University of Illinois, College of Nursing, Peoria, IL). 1995. Physical Fitness Compliance in US Army Reservists. $28,347.

Experience during Desert Storm demonstrated that reserve component (RC) soldiers in the US Army did not meet physical standards (Davis, 1992; Department of the Army, 1992). Yet, physical fitness provides the aerobic capacity, muscular strength, and muscle endurance needed for military tasks (Knapik, 1989). Few studies have addressed successful health promotion activities of reservists. Therefore, the overall aim of this study is to examine variables related to health promotion, weight compliance, and exercise compliance in US Army reservists. Pender's Health Promotion Model (HPM) will be the conceptual framework for this study. Questionnaires will be distributed to a convenience sample of reservists in three units (medical, Army school and petroleum supply). Independent variables to be examined include self-efficacy, modifying factors, (age, gender, tobacco history, military rank, and type of reserve unit), and health promotion behaviors. Dependent variables include meeting military weight standards and Army Physical Fitness Test (APFT) pass/fail. Self-Efficacy will be measured with the Exercise Self-Efficacy Scale (Sallis, Pinski, Grossman, Patterson, Ĵ Nader, 1988). Health promotion behaviors will be measured with the Health Promoting Lifestyle Profile (Walker, Sechrist, & Pender, 1987). Follow-up focus groups will be conducted in each unit, using five soldiers who pass and five soldiers who do not pass the weight and APFT standards. The purpose of these focus groups will be to elicit other possible

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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factors related to compliance and noncompliance with physical fitness standards. Specific aims of the study are to: (1) Describe the health promotion behaviors of US Army Reservists. (2) Relate health promotion behaviors to modifying factors (age, gender, tobacco history, rank, type of reserve unit), self-efficacy, Army weight pass/fail and APFT pass/fail. (3) Determine variables that best predict Army weight pass/fail. (4) Determine variables that best predict APFT weight pass/fail. (5) Describe other factors possibly related to weight and exercise compliance in US Army reservists.

Slater V. (Air Force Reserve; University of Tennessee, Knoxville, TN). 1993. The Effect of Healing Touch on Post Operative Pain. $20,539.

The goals of the combined qualitative and quasi-experimental counterbalance study which uses a double Latin Square design are (1) to determine if two healing touch (HT) techniques, magnetic unruffiing and wound filling and sealing, reduce prolonged pain in post-operative patients and, if so (2) to discover which of the three elements believed to be essential to all techniques are required. The three elements are a caring presence, the hand movements of the technique, and the centered/meditative/altered state of consciousness of the practitioner. Another objective of the project is to discover the experience of the three interventions from the perspective of subjects and providers. Thirty patients who have pain at the surgical site lasting longer than one week after surgery will receive the experimental HT intervention, a sham intervention, and a placebo-testing interview. Thus, each subject will act as his own control. All interventions will be given by registered nurses. Healing Touch practitioners who have completed Level IIA of the American Holistic Nurses' Association's Healing Touch for Health Care Professionals certificate program will give the HT intervention. The interview and sham treatment will be done by nurses with no experience with any hand-mediated energetic intervention. The order of the interventions will be determined by random assignment to one of six treatment orders. The null hypotheses are that there will be no differences in post-operative pain between the three techniques as measured by the McGill Pain Questionnaire and, therefore, that none of the three elements lead to more pain relief than either of the other two. The tiny body of literature on the effects of Therapeutic Touch, a treatment which is similar in some respects to HT, suggests that hand-mediated energetic interventions are useful adjuncts to time-honored nursing interventions for relief of pain and stress. If any of the techniques to be studied are found to be useful to reduce long-term post-operative pain, they will be of special value to the military because they can be taught to and used by anyone, even someone in an isolated or highly stressful assignment, such as in space or undersea.

Staggers N. (Army Active; Walter Reed Army Medical Center, Washington, DC). 1993. Factors Influencing Online Nursing Activities. $73,884.

The primary goal of this study is to better understand how nurses interact with computers in the performance of nursing activities. The focus of the study is to

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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examine the relationship of the nurses' demographic and cognitive information processing characteristics during on-line nursing order entry using a graphics-based versus a character-based computer interface at Tripler Army Medical Center. Given the widespread deployment and use of the Composite Health Care System (CHCS) throughout the Department of Defense, the need to develop research outcomes on this character-based system is imperative. Using one of the two interface types during typical on-line nursing activities, nurses may improve their performance speed, accuracy, and subjective interface satisfaction. This, in turn, would enhance the quality-productivity-cost connection in military health care. Also, studying individual differences in computing can help designers build systems that match the way nurses think and perform their work. If designed with nurse characteristics in mind, the computer would effectively disappear, allowing nurses to focus only on the task at hand. The theoretical basis for the study is conceptualized as a task-based information exchange between nurses and computers. Using the Staggers and Parks Nurse-Computer Interaction Framework, this study will examine the outcomes of nurse-computer interactions in two areas: objective (speed and accuracy) and subjective (satisfaction about the computer interface). The nurse characteristics to be investigated are: cognitive nurse characteristics (spatial visualization and spatial memory) and demographic characteristics (age, gender, computer experience). To test the difference in interactions with CHCS and GUI interfaces, the study will use a one group counterbalanced repeated measures design. The data will be analyzed using a two-factor within subjects (interface types and time) repeated measures analysis. The nurse characteristics' relationship to the outcome variables will be a multivariate correlational design; multiple regression will be used during data analysis. Last, the demographic and cognitive characteristics of the TAMC sample will be compared to a representative sample of all Army Nurse Corps officers using profile analysis and a test for comparability of the sample distributions. Nurses are primary information processors in hospitals. As such, the findings of this study will demonstrate whether the present character-based system or the graphics-based system is significantly better on performance measures. This study will also begin to build informatics theory concerning the relationship of nurse characteristics to the performance of on-line nursing activities. Given the tremendous frequency of use of the CHCS system by nurses, the application of these results will significantly enhance military health care for both professionals and consumers.

Stanton M. (Army Reserve; University of Buffalo School of Nursing, Buffalo, NY). 1993. Phenomenological Study of Military Nurse Veterans. $112,640.

The specific aims of this research are (1) to examine the experiences, feelings and perceptions of selected nurses who have served on active military duty for the United States during wartime or during military conflict. (2) Compare the experiences, feelings, and perceptions of selected nurses who served in the United States military in World War II, Vietnam Conflict, and/or Operation Desert Storm. (3) Determine if there are common themes or shared meanings to the experiences, feelings, and perceptions of selected nurses who have served in

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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different wars/conflicts. (4) Using the diagnostic criteria for posttraumatic stress disorder as outlined by the DSM-III-R of 1987 as a framework, determine if there are common behavioral sequelae or behavioral outcomes for selected nurses who served during a period of war/conflict. (5) Determine if there are common themes or shared meanings regarding personal strategies/approaches for integrating the wartime/conflict experience into civilian life experiences. (6) Determine if veteran nurses included in the study indicate common approaches or shared strategies which will enhance a sense of military nursing history and cohesion of military nursing. The specific research methodology is a phenomenological approach based on Heideggerian hermeneutics. This phenomenological approach will utilize an unstructured interview technique. The interview will be audiotaped and then transcribed to typed copy for review by a research review team. Data obtained from the transcribed interviews will be analyzed using a seven stage hermeneutical approach. Each interview will be analyzed by each member of the research review team and then a consensus report on each interview will be compiled during face to face meetings of the research team. At the completion of all analysis, a summary report of the project will be produced by the principal investigator and validated by selected members of the sample and the research review team. The population will be derived from veteran nurses who have attended a continuing education program on military nursing history.

Stanton M. (Army Reserve; University of Buffalo School of Nursing, Buffalo, NY). 1994. Comparative Study of Military Nurse Veterans. $98,636.

The specific aims of this research, using exploratory survey research procedures are: (1) To determine if the common themes and shared meanings identified by nurses serving during a war or conflict in a previous investigation (Stanton, M; Dittmar, S; Jezewski, MA; Dickerson, S; & McCloskey, C 1994) are similar to the feelings, perceptions, and experiences of a broader population of military nurse veterans who served in World War II (WWII), Korea, Vietnam, and Operation Desert Storm (ODS). (2) Compare the experiences, feelings, and perceptions of nurses who served in the United States Military in World War II, the Korean Conflict, the Vietnam Conflict, and/or Operation Desert Storm. (3) Using the diagnostic framework for posttraumatic stress disorder (PTSD) as outlined by the DSM-III-R (9187), determine if military nurse veterans who have served in different wars or conflicts have similar physical, mental, and/or behavioral sequelae. (4) Determine if nurses who have served in the military during war or conflict have similar strategies for integrating the wartime/conflict experience into their postwar life experiences. (5) Identify strategies that military nurse veterans project would assist in the psychological, physical, and clinical preparation of professional nurses who may serve in future wars, conflicts, or humanitarian missions. This study will accomplish these aims using an exploratory survey design. A variety of descriptive statistical procedures will be used to examine the data. Use of several non-parametric tests will also be utilized.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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Stinson JC. (Navy Reserve; NR Naval Hospital, Oakland, 220, San Bruno, CA). 1995. Association of Fatigue and Preterm Birth in Active Duty Military Women. $81,789.

Preterm birth, defined as the birth of a fetus before 37 weeks gestation, occurs in approximately 9% of single births in the United States but accounts for between 50–70% of the total perinatal mortality and morbidity (DeHaas et al., 1991; Hoffman & Bakketeig, 1984). A reduction in complications from preterm births is a national health promotion priority (U.S. Department of Health and Human Services, 1990). Risk reduction efforts have focused on modifiable factors such as malnutrition, substance use, and prenatal care which affect the incidence of preterm birth. Active duty military women are relatively well nourished, have adequate access to prenatal care and have minimal exposure to illegal substance use. Yet the incidence of preterm birth remains high in this population (Adams et al., 1993). This may be due to the fatigue related factors of physical labor and psychological stressors which remain as primary modifiable risk components of concern in relation to preterm birth. This study is timely with consideration of the increased number of active duty women of childbearing age in the military. Research related to fatigue and pregnancy outcome has been limited to a university clinic population with unknown physical activities with non-modifiable risk factors (history of preterm birth and abortions) (Pitzer, 1991). Little is known about the extent of fatigue experienced by women working in occupations with levels of physical and mental stress during pregnancy and perinatal outcome. The purpose of this study is to describe the internal and external environmental demands which influence the fatigue levels of active duty military women. This study will examine the extent of perceived fatigue severity and the incidence of preterm birth in this population aged 18–40 years of age assigned to a variety of occupations in the military, A consecutive sample of 380 women will be selected from three large prenatal clinics of Naval and Army Hospitals. Using the Environmental Demands Fatigue model as the organizing framework, data will be collected between 22–26 weeks gestation using the Profile of Moods State (POMS) short form (30 items), Perception of Fatigue Severity (VAS-F) (18 items), Sleep Disturbance Scale (21 items), Occupational Fatigue Index (OFI) (5 items), Support Behaviors Inventory (SBI) (11 items), Norbeck Life Events Questionnaire (NLE) (82 items), a 3 day fatigue diary, a Health habits survey and demographic form. In addition, a chart review and telephone call to the subject will be made 1–2 weeks after delivery. The data will be analyzed using descriptive statistics, Pearson Product-Moment correlations and logistic regression to test a model of internal and external demands related to fatigue severity and occupational fatigue that predicts preterm birth.

Stotts NA. (Army Active; University of California—San Francisco). 1994. Electrical Stimulation and Diabetic Foot Skin Perfusion. $29,521.

Foot ulcers in diabetic persons are a serious problem. Delayed healing often results in infection and subsequent amputation. The incidence of this problem is particularly high in Black persons. Factors thought to affect healing are blood glucose level, peripheral neuropathy, peripheral vascular disease, severity of

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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ulceration, gender, and ethnicity. Electrical stimulation has been used to promote healing in patients with decubitus ulcers and venous stasis ulcers, but it has not been systematically examined in subjects with diabetic foot ulcers. The primary purpose of this study is to examine the effect of electrical stimulation on foot perfusion of the feet in Caucasian and Black Persons with diabetes who either have, or are at risk for developing, foot ulcers. The secondary purposes are to examine the effects of glucose control, level of neuropathy, level of peripheral vascular disease, Wagner Scale classification (severity), gender, and ethnicity. Electrical stimulation, high voltage pulsed current (HVPC) is applied for 30 minutes. Its effect on perfusion, measured with transcutaneous oxygen, is recorded at baseline, 15 and 30 minutes after electrical stimulation is started, and 30 minutes after electrical stimulation is ended. Purposive sampling will be used to obtain a sample by ethnicity (Black/Caucasian) and gender (male/female) with four groups of 30 each. The primary hypothesis will be answered by a repeated-measures one-way analysis of variance. The secondary hypotheses will be answered by repeated-measures two-way analysis of variance. Results from this study will provide data on an intervention that, if effective, will reduce healing time, infection, and disability in a large US population.

Torrance RJ. (Army Active; Walter Reed Army Medical Center, Washington, DC). 1994. Impact of Perioperative 5–FU on Surgical Wound Healing. $52,532.

This is a descriptive comparative study of surgical wound healing in patients receiving experimental perioperative 5–FU. One of the most critical nursing skills is the accurate and timely detection of impaired wound healing. This skill is particularly significant under conditions in which healing may be compromised. Currently, there is no reliable, valid tool to guide the nursing assessment of these wounds. This study will test such a tool to meet this need. Researchers believe that the best chance of improving long-term survival among colon cancer patients who undergo curative surgery is to administer appropriate adjuvant chemotherapy during the immediate postoperative period. Physicians at Walter Reed Army Medical Center are part of a multi-center group conducting a Phase III drug trial of perioperative 5–Fluorouracil (5–FU). This study is known as CALGB 9395. There is controversy over the impact of 5–FU in wound healing. The purpose of our study is to describe the impact of systemic intravenous administration of 5– FU in abdominal surgical wound healing during the early postoperative period. A second purpose is to establish reliability and validity of a clinically relevant instrument for non-invasive assessment of surgical wound healing. A convenience sample of patients already randomized into experimental and control groups by CALGB 9395 will be used. Researchers will assess the subject's surgical wounds daily during their postoperative hospitalization using the Modified Wound Assessment Inventory (MWAI). Holden (1985) developed a Wound Assessment Inventory (WAI) which evaluated inflammation, exudate, and erythema; this project modifies that tool to include dehiscence. Other variables known to impact on wound healing including underlying medical conditions, nutrition, and smoking history will also be examined. Descriptive

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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statistics and repeated measures analysis of variance will be used to report findings and determine the impact of chemotherapy on wound healing. This study will benefit nursing by objectively documenting information on the impact of 5– FU in wound healing. Additionally, it tests an objective method for clinical assessment of surgical wound healing, potentially contributing to earlier detection of altered wound states.

Torres S. (Navy Reserve; University of North Carolina–Charlotte, College of Nursing). 1995. Intervention to Identify Battering in Ambulatory Care. $300,404.

Ambulatory care settings provide what may be the first opportunity for a battered woman to find support, assistance, or protection, but they are usually not identified as such or given appropriate services. It has become the standard of care over the past few years to identify abused women in emergency departments, but the potential role of primary care in preventing further abuse has only begun to be examined. Serious women's health problems such as depression, chronic pain, chronic irritable bowel syndrome, and pelvic inflammatory disease have been associated with woman abuse. Battered women and their children use significantly more ambulatory clinics than control families. This proposal seeks funding to evaluate the effectiveness of a training intervention to improve staff and institutional responses to battered women. The aims of this research are to: (a) evaluate a comprehensive intervention designed to improve the response of health care providers to battered women in primary care settings, (b) determine the prevalence of currently and formerly abused women in military primary care settings, (c) demonstrate significantly more positive attitudes toward battered women by trained staff, and (d) determine the most frequent correlated medical and mental health diagnosis associated with abuse. The proposed research uses an experimental pre- and post-intervention design. Six Naval Ambulatory care settings have been selected, three randomly assigned as test sites and three randomly assigned as comparison sites. The intervention consists of a six hour training, protocol, and manual for ongoing reference and planning for system changes. Data collection includes pre-intervention and post-intervention measures of identification and documentation of battering in the medical record. As part of the post-intervention data collection, women patients will be asked to complete questionnaires concerning physical and emotional abuse and their general physical and mental health: (a) Abuse Screen, (b) Index of Spouse Abuse, (c) Symptom Checklist 90, (d) Duke Health Profile and (e) Patient Satisfaction Survey. In addition, attitudes of Naval health care providers in the research settings will be surveyed using the Staff Attitudes Scale. In depth interviews will be held with nursing staff from comparison and test sites to determine barriers and facilitators of optimal response to abused women and unique to military primary care settings.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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Turner BS. (Army Active; Madigan Army Medical Center, Tacoma, WA). 1992. Physiologic Responses to Exogoneous Surfactant: Nursing Interventions . $97,406.

The purpose of this pilot study is to extend prior research on exogenous surfactant administration in premature infants by systematically examining two types of exogenous surfactant, two methods of administration and the resulting nursing interventions in response to improved pulmonary compliance. Specific aims are to: (1) Examine the effect of a protein free exogenous surfactant administered without interruption in ventilation. (2) Examine the effect of a bovine preparation exogenous surfactant administered without interruption in ventilation. (3) Examine the effect of a bovine preparation exogenous surfactant administered with interruption in ventilation but based on product guidelines. (4) Examine the nursing interventions instituted during and following exogenous surfactant administration. The sample will consist of 20 intubated and mechanically ventilated infants with radiologic confirmation of RDS. Infants will be randomly assigned to groups. Data from eight physiologic parameters will be collected and recorded simultaneously and continuously for a 2 hour and 25 minute period. Nursing interventions taken in response to improved pulmonary compliance will be annotated. Data will be analyzed for trends based on type of exogenous surfactant, method of administration, and type of nursing interventions instituted. Results from this pilot study will give nurses data on infants response to two types of surfactant and methods of administration as well as nursing intervention response patterns. The data will be used to support a larger multi-site study examining nursing interventions following surfactant administration.

Turner BS. (Army Active; Madigan Army Medical Center, Tacoma, WA). 1992. Piglet Tracheal Epithelial Regeneration After Suctioning. $132,230.

Critical care military nurses care for intubated infants during peace, under armed conflict conditions, and in response to disasters. Maintaining patency of the airway is critical. Endotracheal suctioning (ETS) causes trauma to the tracheal epithelium which disrupts mucociliary transport resulting in retained secretions, compromised ventilation and oxygenation, and tracheal stenosis. The purpose of this study is to build upon our previous work on tracheobronchial trauma by now examining the effect of two methods of endotracheal suctioning (ETS) on the acute tracheal injury and tracheal epithelial regeneration using a piglet model. The questions to be answered are: What is the immediate effect (acute effect) on the tracheal epithelium of six controlled endotracheal suctioning procedures using positive end-expiratory pressure (PEEP) versus six controlled ETS procedures using zero end-expiratory pressure (ZEEP) in newborn piglets? What is the response of the tracheal epithelium (chronic effect) to 6 controlled ETS procedures using PEEP versus 6 controlled ETS procedures using ZEEP over the 21 days immediately following ETS as measured at 3–4 day intervals? Acutely and chronically are there differences in the percentage of tracheal epithelial circumferences that are covered by basal cells, ciliated epithelium and goblet cells

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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based on exposure to suctioning on PEEP versus ZEEP? The sample will consist of ninety-eight newborn Chester-White piglets who will be randomly divided into 4 groups; control (n = 14), sham (n = 14), Group I PEEP (n = 35) and Group II Zeep (n = 35). Groups I and II will be intubated, mechanically ventilated, and receive 6 controlled ETS procedures (1 per hour) during 6 hours of ventilation. Piglets will either be euthanized immediately after the 6th ETS procedure or recovered and then euthanized at 3, 7, 10, 14, or 21 days post ETS. Piglets in the control and sham groups will be euthanized at the same time points. All tracheas will be harvested, sectioned into 13 sections beginning at the second tracheal ring and extending to the 9th tracheal ring. Each section will be graded using video image analysis for determination of the percentage of circumference denuded, the numbers of cells, types of cells and ratio of cell types remaining. Injury score for each piglet in each group at each time period will be determined. It is imperative to determine methods of ETS that are less deleterious to the tracheal epithelium.

Turner JG. (Army Reserve; University of Alabama School of Nursing, Birmingham, AL). 1994. The Effect of Therapeutic Touch on Pain and Infection in Burn Patients . $355,225.

The goal of this randomized clinical trial with repeated measures is to test the effectiveness of Therapeutic Touch (TT) as an adjunct to narcotic analgesia in reducing pain and anxiety and its effect on nosocomial infection (NI) in burn patients. Pain associated with anxiety and infection are two of the most important nursing problems associated with management of the burn patient. Approximately 100,000 burns occur in the civilian population of the United States each year which require inpatient management. Because the problems of pain management and infection prevention are paramount in nursing management of burn patients, a systematic controlled investigation that tests a nursing intervention strategy is needed. A total of 150 burn subjects who are treated as inpatients in a university burn center will participate on a voluntary basis. A two group repeated measures design will be used with random assignment of subjects to a TT intervention or a single blind placebo intervention (mimic TT). Outcome variables include pain and anxiety as determined by standardized instruments and ongoing surveillance for NI as well as total amount of analgesia used by subjects. General linear models methodology will be utilized to determine if: (1) significant difference in pain and anxiety; (2) differences in total amount of analgesia requested in 24 hours; and (3) NI rate differences exist between study groups. Results of this study can be used to assess the efficacy of TT by lowering pain, anxiety and infection among burn patients and can be applied to civilian and military populations. Additionally, these study results will add to the extant body of knowledge on TT, which may be used on diverse patient populations.

Turner JG. (Army Reserve; University of Alabama School of Nursing, Birmingham, AL). 1995. Quantifying Burn Wound Healing and Inpatient Costs. $283,229.

The objectives of this descriptive correlational study which is conceptually supported by Seyle's General Adaptation Syndrome are to: (1) determine the

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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clinical usefulness and reliability of two methods for measuring burn wound healing during hospitalization, (2) examine the impact of variables that significantly affect wound healing, (3) correlate these variables with the cost of inpatient treatment as well as the rate of wound healing, and (4) recommend a model protocol for quantifying wound healing in future intervention studies. The two methods to be utilized to quantify wound healing are subjecting photographs to computerized image analysis to determine the total wound area and calculating, from photographs and clinical observation, a “burn wound severity score (BWSS). Correlates to wound healing which will be examined in this study include nosocomial infection, pre- and post burn nutritional status, pre- and post-burn psychological stress, demographics, past medical history, adequacy of immediate post-burn care, total body surface burned (TBSA), burn death and anatomical location of burns. A total of 60 burn subjects who are treated as inpatients at a university burn center will participate on a voluntary basis. Facial burn wounds will be utilized to test the burn wound healing measurement. In addition to periodic clinical assessment of facial burns, each subject's facial burns will be photographed using a standard protocol at baseline and thereafter at regular intervals during hospitalization. Physiologic and psychometric methods and clinical observations will be utilized to examine the correlates to wound healing. Post-burn nutritional status will be monitored via periodic body weights, monitoring of food and fluid intake, and repeated urine urea nitrogen levels. Psychological stress will be measured with repeated salivary cortisol levels and the Impact of Event Scale (IES). Pre-burn stress will be measured with an investigator developed questionnaire. Nosocomial infection will be operationalized by Centers for Disease Control guidelines and determined by expert surveillance techniques. Multiple regression procedures will be used to explore the relationship between possible predictors of burn wound healing and (1) change in total wound area, (2) change in BWSS, and (3) cost per patient. Additionally, since the rate of wound healing may impact on cost of care, the relationship between the two measures of wound healing, range in total wound area and change in BWSS score, and cost per patient will be explored using regression techniques. Currently, there is no standardized technique for quantifying wound healing and the role of wound healing correlates and costs attributable to burn wound healing are either controversial or incompletely investigated in the literature. The protocol for measuring wound healing may ultimately be applicable to all types of surgical, traumatic wounds. Examination of wound healing correlates and costs of burn treatment will add to the extant body of knowledge.

Vacchiano CA. (Navy Active; Medical University of South Carolina, Charleston, SC). 1993. Oxygen Modulated, Isoprostane-Induced Pulmonary Edema. $74, 232.

In humans and animals, oxygen exposure of sufficient duration and partial pressure can induce pulmonary edema and associated hypoxemia, both hallmarks of Adult Respiratory Distress Syndrome (ARDS). Patients with pulmonary edema arising from other causes such as inhalation of toxins, multiple trauma, and sepsis

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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are frequently treated with high concentrations of oxygen. Combat casualties and civilian trauma victims are two large populations at risk for this scenario of adding insult to injury by treating pathologies which may manifest themselves as ARDS with an agent known to cause ARDS when applied in high continuous concentrations. The specific cellular and molecular mechanism of oxygen toxicity are unknown. It is possible that a final common pathway exists for ARDS of multiple etiologies. There is evidence to suggest that alveolar macrophages (AM) play an important role in the early exudative phase of hyperoxic lung injury through synthesis of prostaglandins. Macrophages generate free radicals using oxygen as the substrate. Free radicals can catalyze lipid peroxidation of available phospholipids which has recently been associated with the non-enzymatic production of vasoactive isomeric prostaglandin compounds (Isoprostanes). One of these compounds, 8–Isoprostane, can produce severe pulmonary vasoconstriction, the incipient event in ARDS of multiple causes. This activity is coincident with the movement of a proteinaceous exudate into the interstitial and intra-alveolar spaces. This investigation proposes to examine the cellular and molecular mechanisms of oxygen generated pulmonary injury by: (1) quantitating the duration of exposure and oxygen concentration necessary to elaborate Isoprostanes from AMs; (2) determining the relationship between formation of reactive oxygen species and the availability of lipid substrates to production of Isoprostanes by AMs. These specific aims will be examined with the following methods: (1) isolation and primary culture of rat alveolar macrophages; (2) incubation of cell populations in air and incremental concentrations of oxygen for increasing time periods; (3) exposure of cell cultures to various stimulants; (4) superoxide dismutase inhibitable cytochrome c assay for superoxide anion; and (5) enzyme immunoassay for 8–Isoprostane.

Vacchiano CA. (Navy Active; Medical University of South Carolina, Charleston, SC). 1994. The Role of 8–Isoprostane in Oxygen Toxicity in Vivo.$38,734.

Mortality in military casualties following trauma and sepsis is commonly the direct result of Adult Respiratory Distress Syndrome (ARDS). Lung dysfunction is an early and prominent feature of the Multi System Organ Failure (MSOF) seen in this scenario. The major treatment modality for the pulmonary edema and subsequent hypoxemia associated with ARDS is high inspired concentrations of oxygen. However, oxygen exposure of sufficient duration and partial pressure can itself induce the pulmonary edema characteristic of ARDS. Separating oxygen toxicity from established lung injury is all but impossible and has made the study of oxidant induced lung injury extremely difficult. Given the similar clinical manifestations of ARDS from multiple causes, the examination of oxygen toxicity could lead to identification of elements common to all etiologies. Recently a novel group of isomeric prostoglandin compounds has been shown to be produced by oxygen free radical mediated lipid peroxidation. We have observed that one of these compounds, 8–Isoprostane, increases in the media of alveolar macrophages exposed to 90% oxygen for 48 hours. Others have noted the development of pulmonary edema in rabbits when 8–Isoprostane was injected into the pulmonary artery. This investigation proposes to examine the in vivo

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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production of 8–Isoprostane and its effects by: (1) quantifying the synthesis of 8– Isoprostane in the lungs of animals exposed to high oxygen concentrations; (2) determining the ability of exogenously applied 8–Isoprostane to result in altered pulmonary capillary permeability; and (3) assessing the contribution of nitric oxide to free radical mediated production of 8–Isoprostane and lung injury. These specific aims will be studied by: (1) enzyme immunoassay measurement of 8– Isoprostane in the lung lavage fluid of animals exposed to increasing oxygen concentrations for varying time periods; (2) measurement of radiolabeled albumin transfer from the pulmonary vasculature to the interstitial and alveolar space following instillation of 8–Isoprostane in the lungs; and (3) measurement of 8– Isoprostane in the lung lavage fluid of animals pretreated with nitric oxide synthase inhibitors and antioxidants prior to oxygen exposure.

Walizer EM. (Army Active; Walter Reed Army Medical Center, Washington, DC). 1994. A Comparison of Two Therapies for Xerostomia. $40,361.

Virtually every aspect of daily life activity of the irradiated head and neck patient is affected by xerostomia and its associated discomforts. Xerostomia is the subjective feeling of oral dryness and usually indicates major salivary gland dysfunction (Fox, van der Ven, Sonies, Weiffenbach, & Baum, 1985). Irradiated head and neck patients, where total salivary gland destruction has occurred, may be at severe risk for increased infections, dental caries, and cracked or bleeding oral mucosa. Despite the significance of the problem, current therapies for xerostomia are transient, costly, and in some cases unavailable to most patients. The purpose of this original study is to conduct a controlled clinical trial of vegetable oil as an alternative therapy for xerostomia. It may also provide significant information on, not only the efficacy of its use, but also the relationship between clinical oral pathology and subjective reports of dryness. The Oral Assessment Guide (OAG) is a clinically useful tool in assessing oral cavity changes in individuals receiving cancer treatment (Eilers et at., 1992). It will be used to determine severity of oral pathology. The Mouth Dryness Questionnaire (MDQ) which dissects the construct of dryness and will measure the patient's subjective complaint of dryness and its impact on daily life activities and quality of life. A crossover clinical trial design will be employed to compare vegetable oil versus artificial saliva. Repeated measures analysis of variance will be used for this analysis. Both the OAG and MDQ will undergo reliability testing during this study. The study will add to what is already known about the subjective complaint of dryness in the irradiated head and neck patient. The proposed nursing research is the first step in exploring this alternative remedy for a widespread and frustrating complaint that impacts virtually all elements of daily living.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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Walton L. (Army Active; Reynolds Community Army Hospital, Fort Sill, OK). 1994. Cost Analysis and Patient Satisfaction of Health Care Advisor. $18,963.

The purpose of this research study is to determine if a health care advisor program is cost effective while providing satisfactory patient care. This non-experimental research will seek to answer the following research questions: (1) How does the implementation of a health care advisor program affect the cost of delivering outpatient health care to military beneficiaries? (2) To what extent are participants in the health care advisor program satisfied with the health care advice? (3) What is the volume and type of calls by time of day in a 24 hour period seven days a week of a health care advisor program? The sample will consist of 380 adults who call the health care advisor program, and represent the nth caller as defined by a random initial selection using a table of numbers. Each caller of the program who falls in the sample will be informed of the study and asked to complete a 30 item patient satisfaction questionnaire. The questionnaire will then be sent to the caller with a 2 week reminder. Reliability of the questionnaire will be done using internal consistency and Cronbach's alpha. Validity of the questionnaire will be done using a factor analysis. Data analysis will consist of descriptive statistics and correlational analysis. Results from this research will be used to determine the cost benefit ratio of Reynolds Army Community Hospital in implementing a 24 hour seven day a week health care advisor program. Data from this research will seek to determine if the military community is satisfied with this new approach to implementing and accessing health care and to determine the time of day and number of days per week the service should be provided. The results will also serve to guide other Department of Defense health care facilities in the development and implementation of a health care advisor program.

Wesley HL. (Army Active; Walter Reed Army Medical Center, Washington, DC). 1994. Case Managed Telephone Follow-Up of Diabetic Children. $119,122.

The purpose of this study is to determine the effectiveness of a systematic telephone follow-up intervention program for newly diagnosed diabetic children and adolescents using a nurse-managed hospital-to-community-based case management model. It will also describe qualitatively the parents ' expressed satisfaction, concerns, and educational needs over the continuum of the first six months after diagnosis of diabetes. The systematic telephone intervention will consist of a standard follow-up visit protocol, weekly calls for the first 8 weeks after initial hospitalization and then monthly calls until six months after diagnosis to parents and children using a focused interview guide. Knowledge of diabetes will be measured using the Johnson et al. (1982) Knowledge Test. Guided by Cox's (1982) interaction model of client health behavior, outcome variables will include readmissions (measured at 24 weeks), glycosylated hemoglobin (measured at baseline and weeks 2, 6, 12, and 24), length of stay (measured at 24 weeks), management behaviors using the Diabetes Pictorial Scale (weeks 6 and 24), and satisfaction with care obtained through the visit, telephone, and satisfaction with care obtained from an outprocessing interview. This study will

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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employ methodological triangulation using a 2-group experimental pre-test and post-test repeated measures design and a focused interview descriptive design using a stratified random assignment and purposive sampling. A sample of 20–25 subjects will be recruited from newly diagnosed diabetic children between the ages of 4 and 14 and eligible for military care. Demographic data will be presented using descriptive statistics to describe general characteristics of the sample. Content analysis using Ethnograph will be used to analyze qualitative data obtained through the visit, telephone, and satisfaction interviews. The primary quantitative outcome variables are glycosylated hemoglobin (% HgA1C); knowledge test (measured as a numerical score of % correct); management behavior (measured by a four point Likert scale); readmissions (measured in total readmissions); and length of stay (measured in total days). The number of readmissions and length of stay will be compared using the Mann-Whitney U test. The proportion of subjects with HgA1C under 9.0 at the 24 week time point in each group will be compared using Fisher's Exact test. HgA1C, knowledge levels, and management behaviors will be examined using repeated measures analysis of variance with the within-subject factor, time, and the between-subject factor, method of follow-up. Data will be analyzed using SPSS 5.0 for Windows. The results of this study will influence the type, timing, and method of education used for newly diagnosed diabetic children and their families as well as indicate more effective interventions to reinforce means of metabolic control. This study will also lay the foundation for a larger multisite study with possible expansion to outlying populations unable to make follow-up visits. By validating a telephone follow-up intervention, a means of ensuring continuity of care for military families will be identified.

Yoder LH. (Army Active; Brooke Army Medical Center, Fort Sam Houston, TX). 1995. An Exploration of Quality of Life Experienced by People with Cancer . $95,211.

Approximately one million people are diagnosed with cancer each year. Until recently cancer therapies were evaluated solely on the basis of increased survival rates. It is imperative that outcomes for cancer patients move beyond morbidity and mortality statistics to include information about the quality of life. This perspective is consistent with the National Cancer Institute's recommendation that quality of life measurements be included as outcomes in clinical trials. Additionally, oncology nurses have repeatedly ranked quality of life as among the highest priorities in the Oncology Nursing Society Research Priority Survey. The primary aim of this study is to systematically examine quality of life issues experienced by cancer patients treated in the outpatient setting. More specifically, this study will address the following research questions: (1) What is the variation in quality of life experienced by cancer patients who are at least six months post-diagnosis over a period of six months under various treatment conditions? (2) What components of quality of life are rated as most important by the patient? (3) What is the relationship between certain demographic characteristics, such as age or marital status, and quality of life scores? (4) What is the utility of previously described quality of life instruments with demonstrated reliability and validity, in

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
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a military outpatient setting? (5) How is the quality of life of the cancer patients similar to or different from that of other patients experiencing other chronic illnesses (cardiac pulmonary)? The long term goal of this project is to lay the foundation for the development of an exploratory center focusing on quality of life issues experienced by patients with chronic illnesses who are treated in military health care settings. The study will be part of a larger data set examining quality of life for patients experiencing chronic illnesses. DESIGN: A descriptive, prospective, repeated measures design will be used. Several quantitative instruments examining quality of life dimensions will be administered over six months. Instruments will be administered at the time of consent and then at eight week intervals. A total of 200 subjects will be recruited from the Oncology Clinic at the Brooke Army Medical Center. Repeated measures analysis of variance will be used to determine the relationship of patient characteristics, global quality of life scores and quality of life subscale scores.

Young-McCaughan S. (Army Active; Madigan Army Medical Center, Tacoma, WA). 1992. Sexual Functioning in Women with Breast Cancer Comparing Women Treated with Systemic Adjuvant Therapy to Women Treated Without Pharmacological Manipulation. $7,258.

OBJECTIVE: Compare sexual functioning in women treated with systemic adjuvant therapy to sexual functioning in women treated without pharmacological manipulation, that is, with surgery and/or radiation therapy alone. NURSING APPLICATION: While many previous studies have identified sexual dysfunction as a sequela to breast cancer and treatment, no study has looked at adjuvant chemotherapy independently as it relates to sexual function. With this information more clearly defined, effective treatment strategies can be devised. STATUS: Breast cancer is the most frequently occurring cancer in women today. An estimated 180,000 women will be diagnosed with breast cancer during 1992. The incidence of breast cancer is increasing so that now approximately one of every nine women will develop breast cancer sometime during her life (American Cancer Society, 1992). Treatment for breast cancer has become very aggressive using antineoplastic chemotherapy, hormone manipulation, and radiation therapy towards improving women's long-term survival from this disease. Today, most women will be offered systemic adjuvant treatment with chemotherapy and/or hormone manipulation (Henderson, 1988). While the acute toxicities of these drugs are well described and carefully monitored in these patients, the long-term effects these drugs have on sexual functioning has not been extensively explored. Anecdotally, women in breast cancer support groups frequently bring up issues related to sexuality complaining of vaginal dryness, dyspareunia, and frustration with the lack of treatment for these symptoms. Women without a history of breast cancer are given estrogen replacement therapy and/or estrogen creams for similar complaints, which are usually attributed to menopause. However, at the present time, women with breast cancer are not candidates for estrogen replacement for fear of increasing their chance of cancer reoccurrence. So, they live with these uncomfortable symptoms. A number of researchers have looked at the psychosexual adjustment women make after a mastectomy (Craig, Comstock, & Geiser, 1974; Morris, Greer & White, 1977; Jamison, Wellisch, & Pasnau, 1978;

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Morris, 1979; Kiernan, Hubert, Beahrs & Martin, 1981). The focus of this work is on the physical loss of breast and the effect this body change has on sexuality. Jamison, Wellish, and Pasnau (1978) evaluated questionnaire responses from 41 women after mastectomy. The mean time from mastectomy was 22 months. Most women, 83%, reported good or very good overall emotional adjustment. However, when asked specifically about sexual adjustment, the responses were not as positive. In the study, 24% of the women reported a decrease in sexual satisfaction in their relationship, 21% had intercourse less frequently, and 23% found it more difficult or impossible to achieve an orgasm. The role of adjuvant therapy after mastectomy was not evaluated. In an attempt to evaluate the specific effects of adjuvant chemotherapy on women with breast cancer, Meyerowitz, Sparks, and Spears (1979) interviewed 50 women receiving adjuvant chemotherapy for Stage II breast cancer. Forty percent of their sample claimed that their sexual life had been adversely affected. Some women blamed this on psychological distress, while other women attributed the change to a physical cause. The physical causes were not explored. While numerous authors have identified the importance of including sexual functioning in cancer research (Fisher, 1983; Greenberg, 1984; Anderson, 1985; Waterhouse and Metcalfe, 1986; Kaempfer & Fisher, 1988), the measurement of human sexuality has been problematic since the expression of personal sexuality is influenced by various physiologic, psychologic, and interpersonal events (Fisher, 1985; Kaempfer & Fisher, 1988). The Derogatis Sexual Functioning Inventory (DSFI) is a comprehensive tool developed to measure sexuality in ten major areas: information, experience, drives, sexual attitudes, psychologic symptoms, sexual fantasy, body image, and satisfaction (Derogatis & Melisaratos, 1979). The DSFI has been extensively tested in a variety of populations including male and female heterosexuals, homosexuals, transsexuals, and sexually dysfunctional individuals. Test-retest reliabilities for consistency for the ten subscales range from 0.42 to 0.96. Internal consistency reliability coefficients range from 0.56 to 0.97 (Derogatis & Melisaratos, 1979). The DFSI instrument was chosen for this study because it addresses the varied aspects of sexuality. Previous studies of patients with breast cancer have evaluated only very crude measurements of sexuality such as broad evaluations of sexual adjustment with the words “good” or “bad,” frequency of intercourse, and ability to achieve orgasm. Using the DFSI with this study will attempt to sort out more specific aspects of sexuality such as sexual drives subject to neuroendocrine control, psychological symptoms, affect, body image, and sexual satisfaction in women treated with systemic adjuvant treatment as compared to women treated without pharmacological manipulation.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

NATIONAL INSTITUDE OF NURSING RESEARCH

The following annotations were prepared by project staff for studies for which abstracts were available. The listing of current projects was retrieved in November 1995.

Aaronson LS. (University of Kansas Medical Center, Kansas City, Kansas). Care-giver Fatigue and at Risk Infants at Home. National Institute of Nursing Research.

No abstract available. See parent grant.

Aaronson LS. (University of Kansas Medical Center, Kansas City, Kansas). Center for Biobehavioral Studies of Fatigue Management. National Institute of Nursing Research.

This center will conduct studies on the problem of fatigue in a variety of health and illness conditions.

Aaronson LS. (University of Kansas Medical Center, Kansas City, Kansas). Contractile and Biochemical Changes in Diaphragm Fatigue. National Institute of Nursing Research.

No abstract available. See parent grant.

Aaronson LS. (University of Kansas Medical Center, Kansas City, Kansas). Correlates of Fatigue in Rheumatoid Arthritis Clients. National Institute of Nursing Research.

No abstract available. See parent grant.

Aaronson LS. (University of Kansas Medical Center, Kansas City, Kansas). Fatigue and Metabolic Control in Non-Insulin Dependent Diabetes Mellitus. National Institute of Nursing Research.

No abstract available. See parent grant.

Abel PE. (University of Texas at Austin, Austin, Texas). Predicting Sexual Risk Behavior in Rural and Urban Women. National Institute of Nursing Research.

The purpose of this study is to explore factors that influence the choices rural and urban women make that place them at risk for a sexually transmitted disease (STD). The focus is to lay the groundwork for creating prevention programs aimed at reducing risk factors for STD.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Affonso DD. (Emory University, Atlanta, Georgia). Caring for Pregnant Women. National Institute of Nursing Research.

The purpose of this project is to refine, implement, and evaluate an empirically derived community-based nursing practice model for providing prenatal care services to Hawaiian, Filipino, and Japanese women. The goal is to increase access to and retention of these women using culturally sensitive strategies congruent with their Hawaiian origins.

Aiken LH. (University of Pennsylvania, Philadelphia, Pennsylvania). Pilot Study—Functional Assessment in AIDS Care Research. National Institute of Nursing Research.

The aim of this pilot study is (1) to determine the reliability of the four-category global measure of functional status (with respect to activities of daily living), as evaluated by regular staff nurses, in predicting in-hospital mortality of AIDS patients; and (2) to compare it with more complex and expensive clinical staging systems.

Albers LL. (University of New Mexico at Albuquerque, Albuquerque, New Mexico). Low Cost Care Interventions in Labor & Maternal Outcomes. National Institute of Nursing Research.

This is a Shannon Award providing partial support for research projects that fall short of the assigned institute's funding range but are in the margin of excellence.

Allan J. (University of Texas at Austin, Austin, Texas). Cross-Ethnic Nursing Study of Weight Management in Women. National Institute of Nursing Research.

The purposes of this 5-year community based study are (1) to explore weight management experiences among Anglo, black, and Mexican American women; (2) to compare patterns and processes of weight management within and among these three ethnic groups; (3) to examine patterns and processes of successful weight maintainers; and (4) to develop a cross-ethnic nursing model of weight management.

Allen JK. (Johns Hopkins University, Baltimore, Maryland). Nursing Intervention in Women After CABG. National Institute of Nursing Research.

The primary objective of the proposed clinical trial is to investigate the effectiveness of nurse-mediated interventions to improve functional status and adherence to the Step-One Diet to lower blood cholesterol in women following coronary artery bypass surgery.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Ammerman AS. (University of North Carolina at Chapel Hill, Chapel Hill, North Carolina). Rural Nurse Intervention to Lower Cholesterol. National Institute of Nursing Research.

A randomized controlled trial to test the effectiveness and feasibility of a structured dietary assessment and intervention program—the Food for Heart Program—will be conducted to determine if it could serve as a model for a variety of health care interventions in rural areas.

Anderson RA. (University of Texas at Austin, Austin, Texas). Outcomes of Nursing Management Practice in Nursing Homes. National Institute of Nursing Research.

This study is designed to investigate the impact of nursing management processes on patient outcomes, staff outcomes, and financial outcomes, while also accounting for the influence of case mix and contextual factors.

Aroian KJ. (Boston College, Newton, Massachusetts). Immigrant Stressors and Psycho-Social Adaptation. National Institute of Nursing Research.

The purpose of this proposed research is to develop the theoretical base needed to generate clinical interventions for promoting Soviet immigrants' adaptation and standardized instruments for testing those interventions.

Atwood JR. (University of North Carolina at Chapel Hill, Chapel Hill, North Carolina). Fiber Adherence and Marker Development in Black Churches. National Institute of Nursing Research.

The aim of this community-based, patient outcomes study is to implement a nursing intervention encouraging consumption of dietary fiber among southern black adults, then to assess the adherence outcomes and develop a composite adherence marker.

Auvil-Novak SE. (Case Western Reserve University, Cleveland, Ohio). Efficacy of Chronotherapeutic Versus Traditional Patient Controlled Anesthesia Therapy. National Institute of Nursing Research.

The purpose of this study is to evaluate the efficacy of a chronotherapeutic treatment regimen employing a sinusoidal basal infusion pattern compared to demand-only patient controlled anesthesia therapy to optimize postoperative pain relief.

Averill JB. (University of Colorado Health Sciences Center, Denver, Colorado). Health Care Experiences of Elderly Rural Hispanics. National Institute of Nursing Research.

No abstract available.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Baggs JG. (University of Rochester, Rochester, New York). Interdisciplinary Collaboration in Intensive Care. National Institute of Nursing Research.

This study is designed to improve intensive care unit (ICU) care and decrease hospital costs. It will replicate earlier work in three different ICUs to assess the general amount of collaboration among health care providers in practice and to examine the effects on cost.

Baigis-Smith JA. (Georgetown University, Washington, DC). Nurse-Run-Home Exercise Regimen for HIV-Infected People. National Institute of Nursing Research.

This is a clinical trial to evaluate the effects of a nurse-run home-based exercise intervention for human immumodeficiency virus (HIV) seropositive men and women with CD-4 cell counts between 200 and 500/mm³ on (1) their physical endurance (oxygen consumption); (2) subjects' perceptions of both their functional status and their well-being using validated scales (Sickness Impact Profile, Medical Outcomes Study–HIV Health Survey) and daily diary reports; and (3) their immune status (CD-4 cell count and percentage of CD-4 cells).

Bailey SL. (University of Washington, Seattle, Washington). Diurnal Differences Related to Cortisol, Stress & Sleep. National Institute of Nursing Research.

The purposes of this individual research training program will be (1) to describe the patterns of cortisol secretion, sleep patterns (i.e., electroencephalograms), self-reports of sleep quality, wound healing, and activity levels in a convenience sample of morning-(M) and evening- type (E) individuals (“early birds” and “night owls”); (2) to compare these characteristics between M and E subjects; and (3) to examine the relationships between M and E sleep patterns, activity levels, wound healing, and cortisol values.

Barton JA. (University of Colorado Health Sciences Center, Denver, Colorado). Parental Responses to Adolescent Drug Abuse. National Institute of Nursing Research.

The aims of this research are (1) to identify and describe the coping strategies utilized by parents of drug-abusing adolescents; (2) to explore relationships between parental coping strategies and a number of sociodemographic and structural factors; (3) to develop and pilot-test a Role Formation Interview Guide that is based on Birenbaum's (1970) Role Formation Framework; (4) to describe parental role formation in response to adolescent drug abuse; and (5) to describe the experiences of parents faced with adolescent drug abuse and their evaluation of the efficacy of the ways in which they cope.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Baxendale LM. (Johns Hopkins University, Baltimore, Maryland). Pilot—Biologic Basis of Chronic Fatigue in Cancer Patients. National Institute of Nursing Research.

No abstract available. See parent grant.

Baxendale-Cox LM. (Johns Hopkins University, Baltimore, Maryland). Sodium Entry in Normal and Cystic Fibrosis Airway. National Institute of Nursing Research.

This research will utilize an electrophysiological technique—fluctuation analysis—to study sodium entry in cultured human nasal and guinea pig tracheobronchial epithelia (1) to characterize the components of sodium transport (open probability, channel density, single channel current) in normal and cystic fibrosis epithelia; (2) to examine the effects of amiloride on apical sodium channels of airway epithelia; and (3) to examine the effects of other regulators of sodium entry in absorptive epithelia (cyclic adenosine monophosphate [cAMP], calcium, cytoskeletal elements).

Bearinger LH. (University of Minnesota-Twin Cities, Minneapolis, Minnesota). Impact of Youth Development on American Indian Health. National Institute of Nursing Research.

The intent of the proposed research is to examine the impact of a community-based comprehensive youth development program on risk behaviors and protective factors among American Indians, ages 10–18.

Becker DM. (Johns Hopkins University, Baltimore, Maryland). Nursing Interventions to Reduce Coronary Risk Factors. National Institute of Nursing Research.

This study will examine a nursing intervention based on a problem-solving framework that directs behavior change through repeated problem-solving tasks versus the “usual” care administered through the primary provider system, with the major goal of decreasing cardiovascular risk factors (hyperlipidemia, hypertension, and cigarette smoking) in asymptomatic siblings of people with premature coronary disease.

Becker PT. (University of Wisconsin-Madison, Madison, Wisconsin). Reducing Stress During Handling. National Institute of Nursing Research.

The purpose of this study is to determine whether developmental handling (1) reduces the incidence of physiological (decreases in peripheral and brain oxygenation, respiratory and cardiac instability, and elevated intracranial blood volume) and behavioral (autonomic–visceral, motor, behavioral state) signs of stress (a) during intrusive procedures and (b) during general care-giving and feeding; (2) improves immediate feeding outcomes (feeding distress and feeding efficiency); and (3) is most effective during the early weeks postbirth.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Bevil CA. (Temple University, Philadelphia, Pennsylvania). Managing Chronically Ill Elders—A Trajectory Approach. National Institute of Nursing Research.

This research will compare the effectiveness of a nursing management protocol to the existing system of health and social services. The protocol is based on a trajectory framework of chronic illness and developed specifically for elderly persons who reside in the community.

Beyer JE. (University of Missouri at Kansas City, Kansas City, Missouri). Comfort Measures Used for Children with Sickle Cell Pain. National Institute of Nursing Research.

The aim of this study is (1) to identify and describe the nature and range of comfort measures used for children during vasoocclusive crisis (VOC) of sickle cell disease both in the home and in the hospital; (2) to describe children's and parents' perceptions of the effectiveness of comfort measures; (3) to build a descriptive model of the effectiveness of comfort measures for the pain of VOC in children; and (4) to determine the feasibility of conducting a multidisciplinary, collaborative intervention study designed to examine the effects of specific comfort measures for children during VOC.

Biddle WL. (Dartmouth College, Hanover, New Hampshire). Menstrual Cycle Effects on Ulcerative Colitis. National Institute of Nursing Research.

The purpose of this study is to examine the interrelationships between the menstrual cycle and ulcerative colitis, and to demonstrate the effect of cyclical changes on symptoms and colonic inflammation in women with ulcerative colitis.

Biordi DL. (Kent State University at Kent, Kent, Ohio). In-Home Care and Respite Care as Self-Care. National Institute of Nursing Research.

The purpose of this 3-year, longitudinal, qualitative research is to study the subjective experiences of care providers and their elderly care recipients, by comparing respondents (both providers and receivers) using respite care with those not using respite care.

Bliss DZ. (University of Minnesota Twin Cities, Minneapolis, Minnesota). Dietary Fiber Therapy for Fecal Incontinence. National Institute of Nursing Research.

The objectives of this study are to evaluate dietary fiber therapy for fecal incontinence and to determine a course of fiber supplementation that will reduce fecal incontinence and potentiate the effectiveness of other adjuvant therapies. This study will compare the effects on loose or liquid stools of a conventional, bulking-type fiber supplement that is partially fermented; a fiber supplement that is completely fermented; and a placebo in adults who are incontinent.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Boehm S. (University of Michigan at Ann Arbor, Ann Arbor, Michigan). Tuberculosis—Prevention and Adherence Interventions. National Institute of Nursing Research.

This study will examine the effects of behavioral training for patients alone, behavioral training for nurses alone, and behavioral training for both patients and nurses on patient adherence to tuberculosis interventions.

Bond EF. (University of Washington, Seattle, Washington). Ovarian Hormone Modulation of Smooth Muscle. National Institute of Nursing Research.

The purpose of this study is to compare four different groups (progesterone-estrogen, and vehicle-treated ovariectomized rats and cycling rats in metestrus) with respect to the following characteristics of gastric, intestinal, and uterine smooth muscle: (1) mechanical properties and composition of the contractile apparatus including myosin isoform composition, and (2) content of energy-related phosphate compounds.

Bowers BJ. (University of Wisconsin-Madison, Madison, Wisconsin). Care-giver Perceptions of Caring for Older Adults. National Institute of Nursing Research.

Specific aims of this study are (1) to gain an understanding of how nurses and nurse aides caring for the elderly in the home and the nursing home conceptualize and provide direct care and identify the relationship between conceptualization and practice, (2) to gain an understanding of how nurses in these two settings provide indirect care to the elderly through supervision of nurse aides, and (3) to incorporate these findings into the care-giving theory developed by the applicant's previous studies of family care-giving in the same two settings.

Brennan PF. (Case Western Reserve University, Cleveland, Ohio). Variations in Nursing Practice Models. National Institute of Nursing Research.

No abstract available.

Brooke V. (Washington State University, Pullman, Washington). Involuntary Admissions in a Nursing Home. National Institute of Nursing Research.

No abstract available.

Brooks DL. (University of Arizona, Tucson, Arizona). Process of Decision-making of Dyads—Elder's Perspective. National Institute of Nursing Research.

The aims of this research are (1) to describe the processes of interaction, problem solving, and decision-making between a dyad—the frail elder and her care-giving

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

daughter—from the elder's perspective; (2) to describe factors that may affect the dyadic interaction process; and (3) to identify the critical markers that indicate incipient changes within the dyad and drive problem solving and decision-making in anticipation of these changes.

Broome ME. (University of Wisconsin-Milwaukee, Milwaukee, Wisconsin). Pain Interventions for Children with Sickle Cell Disease. National Institute of Nursing Research.

The specific aims of this study are to examine the effectiveness of (1) an education and a pharmacologic protocol, (2) a cognitive –behavioral pain management program, and (3) an art therapy support program for children and adolescents in reducing pain and to study their effects on the functioning of children and adolescents with sickle cell disease.

Brooten DA. (University of Pennsylvania, Philadelphia, Pennsylvania). High Risk Pregnant Women. National Institute of Nursing Research.

The purpose of this randomized clinical trial is to compare maternal and infant outcomes and cost of care between two groups of women at high risk for delivering low birth weight (LBW) infants: (1) a control group that will receive routine care and (2) an intervention group in which half of the routine prenatal physician care (office or clinic) will be replaced by nurse specialist care delivered via home visits and telephone contact. Both groups will consist of pregnant women with diabetes or diagnosed chronic hypertension, or at high risk of preterm labor.

Brown KC. (University of Alabama at Birmingham, Birmingham, Alabama). Worksite Education/Exercise to Prevent Back Injury. National Institute of Nursing Research.

This study proposes to conduct a randomized, controlled clinical trial of measures to prevent work-related back injury in a group of fire fighters. It will compare no treatment with attendance at back school and interventions to increase back strength and flexibility.

Buckwalter KC. (University of Iowa, Iowa City, Iowa). PLST Model—Effectiveness for Rural ADRD Care-givers. National Institute of Nursing Research.

This study proposes to investigate a nursing approach based on the Progressively Lowered Threshold Model to decrease the adverse effects of care-giving on persons with Alzheimer's disease and related disorders by teaching behavioral management techniques.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Bull MJ. (University of Minnesota Twin Cities, Minneapolis, Minnesota). Testing a Model for Hospital to Home Transition. National Institute of Nursing Research.

The study will provide information about the timing and nature of the risks to care-givers' health during the transition of elderly persons from hospital to home. This information can be used to develop an intervention to reduce risks and promote health and well-being for family care-givers and care recipients.

Burgener SC. (Indiana University–Purdue University at Indianapolis, Indianapolis, Indiana). Factors Predicting Quality of Life in Dementia Patients. National Institute of Nursing Research.

No abstract available.

Burgio LD. (University of Alabama at Birmingham, Birmingham, Alabama). Staff Management System for Behavioral Skills. National Institute of Nursing Research.

The major goal of this study is to utilize a formal staff management system for motivating certified nursing aides to employ behavior management skills on nursing units.

Butz AM. (Johns Hopkins University, Baltimore, Maryland). Home Nursing Intervention for Drug Exposed Infants. National Institute of Nursing Research.

This study is based on the premise that drug-exposed infants are at “double-jeopardy” for developmental problems due to (1) their biological vulnerability as a result of intrauterine exposure to drugs, and (2) the postnatal environmental challenges that may interfere with stimulating and effective parenting. The purpose of this randomized clinical trial is to test the effectiveness of home-based pediatric nurse specialist intervention compared to the usual care given to drug-exposed infants and their mothers.

Cargill VA. (Case Western Reserve University, Cleveland, Ohio). Neighborhood Centered AIDS Education. National Institute of Nursing Research.

The overall objective of this project is to test the effectiveness of the Project SAMM model in reducing HIV/AIDS risk-related behaviors in African American adolescents.

Carrieri-Kohlman V. (University of California, San Francisco, San Francisco, California). Treatments for Dyspnea—Education, Exposure or Training. National Institute of Nursing Research.

The primary aim of this study is to test differences in the effectiveness of three treatments for dyspnea: (1) education about dyspnea and a home walking pre

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

scription; (2) nurse-monitored exposure to dyspnea with education and a home walking prescription; and (3) a model of pulmonary rehabilitation with high-intensity exercise, education, and a home walking prescription.

Cason LC. (University of Arkansas Medical Sciences, Little Rock, Arkansas). Preparatory Information for Cardiac Catheterization. National Institute of Nursing Research.

The long-term goal of this study is to further understanding of how to prepare adults for threatening health care treatments (diagnostic and therapeutic) to minimize their emotional distress before, during, and after treatment. This study will describe how adults with different cognitive informational styles respond before, during, and after cardiac catheterization when they receive preparatory sensory information.

Coates CJ. (University of Colorado Health Sciences Center, Denver, Colorado). Health and Coping—Child Witnesses of Spouse Abuse. National Institute of Nursing Research.

The primary concern of this study is to examine the appraisal processes and coping responses of children who witness spouse abuse.

Cohen FL. (Southern Illinois University at Edwardsville, Edwardsville, Illinois). Sickle Cell Patients' Quality of Life with 3 Therapies. National Institute of Nursing Research.

This is a Shannon Award providing partial support for research projects that fall short of the assigned institute's funding range but are in the margin of excellence.

Conrad KM. (University of Illinois at Chicago, Chicago, Illinois). Nursing Fitness Intervention to Reduce Work Fatigue. National Institute of Nursing Research.

No abstract available.

Cook MR. (Midwest Research Institute, Kansas City, Missouri). Reversal Theory and the Motivations for Health Behavior. National Institute of Nursing Research.

The overall research objective of this continuation effort is to develop biobehavioral, arousal-altering strategies for resisting the urge to smoke that are appropriate for nurse-delivered interventions.

Cook T. (University of Iowa, Iowa City, Iowa). Core—Cognitive/Functional Assessment and Ergonomics. National Institute of Nursing Research.

The purpose of this effort is to enable gerontological nurse researchers and scientists in other disciplines to examine cognitive and functional status and

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

patterns of disability in both institutionalized (acute and long-term care) and community-dwelling elderly and to evaluate the outcomes of specific clinical interventions for older adults by using a state-of-the-art multidimensional approach to functioning.

Covington CY. (Wayne State University, Detroit, Michigan). Anticarcinogenic Factors of Post-Lactation Breast Fluids. National Institute of Nursing Research.

The purpose of this study is to examine the molecular composition of breast fluids for the presence of specific anticarcinogenic factors.

Covington CY. (Wayne State University, Detroit, Michigan). Parent Response to Infant Cry—Abuse Potential. National Institute of Nursing Research.

This 5-year prospective study is designed (1) to examine relationships among factors immediate to the parent–infant ecology, including infant crying propensity, parental physiologic response, social support, family functioning, child abuse potential, and the parent–infant relationship; (2) to evaluate child abuse potential and the adequacy of the parent–infant relationship in families where extremes exist in the parent's response to infant crying or in the crying itself; (3) to assess further the use of the Brazelton Neonatal Behavioral Assessment Scale to predict infant colic in newborns and its association with the parent's physiologic response; (4) to delineate the human and environmental factors that predict infant crying propensity; and (5) to evaluate a model of the causal linkages between and among exogenous, moderating, and endogenous variables.

Cowan MJ. (University of Washington, Seattle, Washington). Self Management Therapy Following Sudden Cardiac Arrest. National Institute of Nursing Research.

The purpose of this study is to compare frequency of complex ventricular ectopy, events of sudden cardiac arrest, and survival rate between randomized treatment and control groups of persons at risk of sudden cardiac arrest before and after self-management/biofeedback therapy over a period of 2 years.

Curry MA. (Oregon Health Sciences University, Portland, Oregon). Biopsychosocial Model to Predict LBW/Pregnancy Outcomes. National Institute of Nursing Research.

The purpose of this prospective study is to determine the relationships of sociodemographic risk factors, biomedical risk factors, and life-style behavior risk factors to each other and to low birth weight and other adverse pregnancy outcomes, including labor and delivery complications and infant complications

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Dalton JA. (University of North Carolina at Chapel Hill, Chapel Hill, North Carolina). Changing Acute Pain Management to Improve Patient Outcomes. National Institute of Nursing Research.

The aim of the research is to evaluate the effectiveness of a pain management educational program designed for nurses, physicians, and pharmacists who provide perioperative care to patients.

Davis AE. (University of Michigan at Ann Arbor, Ann Arbor, Michigan). Auditory Stimulation for Comatose Brain Injury Patients. National Institute of Nursing Research.

This study will examine the effects of a structured auditory sensory stimulation program on traumatically brain-injured patients in coma.

Dejoseph JF. (University of California, San Francisco, San Francisco, California). Women's Work During Pregnancy. National Institute of Nursing Research.

The purpose of this project is to discover, develop, and provisionally verify a theory of women's work during pregnancy. A specific aim is to describe how women themselves define, create, shape, modify, and manage their work during pregnancy.

Dennis KE. (University of Maryland at Baltimore Professional School, Baltimore, Maryland). Self Efficacy, Metabolism and Weight Loss in Older Women. National Institute of Nursing Research.

This research is based on the premise that self-efficacy beliefs and adipose tissue metabolism of postmenopausal women are linked to weight loss (WL) and its maintenance. The hypotheses are (1) that multifaceted interventions that target distinct self-efficacy needs will modify cognitions, emotions, and behavior more effectively to promote WL and adaptations in lipid, glucose, and adipose tissue metabolism than the usual care; and (2) that psychobehavioral as well as metabolic adaptations to WL, and self-efficacy directed WL and relapse prevention treatments, will be necessary to maintain the weight-reduced state.

Denyes MJ. (Wayne State University, Detroit, Michigan). Effect of Nursing Actions to Alleviate Pain in Children. National Institute of Nursing Research.

This project is designed to compare two nursing action protocols with standard nursing practice in a children's hospital to determine the effect of the experimental protocols on the intensity of postoperative pain. Subjects will be 3- to 7-year-old children of diverse racial and ethnic backgrounds.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Dibble S. (University of California, San Francisco, San Francisco, California). Core—Research Support. National Institute of Nursing Research.

The purpose of the research support core of the Research Center for System Management is to provide the affiliated faculty with services for day-to-day management of their respective research grants and methodological support for proposed symptom-related studies.

Dienemann J. (Johns Hopkins University, Baltimore, Maryland). Pain, Fatigue, and Sleep Alterations in Cancer Patients. National Institute of Nursing Research.

The interrelationships of pain, fatigue, and sleep alterations in cancer patients will be studied by using a common conceptual framework emphasizing physiologic, psychologic, behavioral, and sociocultural dimensions. These endeavors will provide information to be used as a basis for developing and implementing multimodal therapeutic interventions aimed at eliminating or mitigating symptoms.

Diiorio CK. (Emory University, Atlanta, Georgia). AIDS Risk Reduction Practices Among College Students. National Institute of Nursing Research.

The long-term objective of this study is to contribute to the knowledge base required for health professionals to develop effective education and intervention programs for promoting the use of AIDS risk reduction practices among college students.

Dodd MJ. (University of California, San Francisco, San Francisco, California). Research Center for Symptom Management. National Institute of Nursing Research.

The goal of the research center is to advance knowledge in the field of symptom management and, thereby, improve health care providers ' practice and individuals' symptom outcomes.

Doswell WM. (University of Pittsburgh at Pittsburgh, Pittsburgh, Pennsylvania). Core—Research Development and Dissemination. National Institute of Nursing Research.

The specific aims of this core of the Center for Nursing Research in Chronic Disorders are (1) to support acquisition and maintenance of state-of-the-art knowledge in chronic disorders and their clinical outcomes assessment; (2) to support the development of skills in clinical outcomes assessment and in methodologic issues in the study of chronic disorders; (3) to provide an environment that stimulates multidisciplinary collaborative interchange; (4) to support the timely dissemination of research findings; and (5) to promote awareness of the center.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Dougherty MC. (University of Florida, Gainesville, Florida). Nursing Model—Urinary Continence for Older Rural Women. National Institute of Nursing Research.

The objective of this project is to implement and evaluate a nursing practice model to assist older, rural women in managing severe urinary incontinence (UI) while living at home. The model is designed to structure the efforts of a nurse, an older woman, and a primary care-giver (where applicable) to establish measurable goals for continence and to develop a plan for managing UI that is sensitive to both the individual needs of the woman and the sociocultural environment within which she resides.

Dowling GA. (University of California, San Francisco, San Francisco, California). Management of Sleep-Activity Disruption in Alzheimer's. National Institute of Nursing Research.

The purpose of this four-group, repeated-measures randomized clinical trial is to test the effects of three sleep-related behavioral interventions on sleep activity disruption and related variables in Alzheimer' s disease patients and their primary care-givers.

Draucker CB. (Kent State University at Kent, Kent, Ohio). Victimization of Sexual Abuse Survivors in Adulthood. National Institute of Nursing Research.

The purpose of this study is to test a causal model designed to identify relationships among abuse situation factors and family-of-origin characteristics, coping tasks, and victimization in adulthood in a sample of female sexual abuse survivors.

Drew BJ. (University of California, San Francisco, San Francisco, California). Nursing Strategy for Cardiac Ischemia Monitoring. National Institute of Nursing Research.

The proposed study seeks to determine the sensitivity and accuracy of continuous bedside cardiac ischemia ST segment monitoring using a “derived” 12-lead electrocardiogram compared to the routinely monitored dual-lead method for detecting recurrent cardiac ischemia following coronary angioplasty.

Duffy ME. (University of Utah, Salt Lake City, Utah). Parenting Practices and Navajo Postneonatal Mortality. National Institute of Nursing Research.

The long-term objective of this proposed research is to develop culturally appropriate interventions that may decrease postneonatal mortality by strengthening parenting skills and community support.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Dunbar SB. (Emory University, Atlanta, Georgia). Adaptation to the Internal Cardioverter Defibrillator. National Institute of Nursing Research.

The primary aims of this project are to examine patient and family member coping with the internal cardioverter/defibrillator (ICD); to describe factors that predict ICD patients' outcomes in terms of functional status and affective state; and to describe their family members' affective outcomes during the first 9 months after ICD insertion.

Dunbar-Jacob J. (University of Pittsburgh at Pittsburgh, Pittsburgh, Pennsylvania). Center for Nursing Research in Chronic Disorders. National Institute of Nursing Research.

The purpose of this center is to provide the infrastructure support for a center of excellence in multidisciplinary, outcomes-based nursing research on chronic disorders among adults.

Eggert LL. (University of Washington, Seattle, Washington). Measuring Adolescent Potential for Suicide. National Institute of Nursing Research.

The purposes of this methodological study are (1) to validate the comprehensive Measure of Adolescent Potential for Suicide, (2) to derive an index for summarizing suicide potential, and (3) to evaluate the Suicide Risk Screening protocol.

Eggert LL. (University of Washington, Seattle, Washington). Promoting Competence and Support to Prevent Suicide Risk. National Institute of Nursing Research.

This prevention trial focuses on two suicide prevention programs: (1) a MAPS (Measure of Adolescent Potential for Suicide) protocol and (2) the addition of CAST (Competence and Support Training) to the MAPS intervention. The goal is to test the efficacy of the two approaches and to compare the effects of varying “dosage levels” of social support and skills training in reducing adolescent suicide potential.

Engler MB. (University of California, San Francisco, San Francisco, California). Omega-3 Fatty Acids and Cardiovascular Risk Factors. National Institute of Nursing Research.

The purpose of this study is to test the hypothesis that vascular relaxation induced by docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), in part, explains the protective or preventive role of omega-3 fatty acids in cardiovascular disease. The study will define and compare the effects of DHA and EPA on rat vascular tissue with increased age, determine the omega-3 fatty acid-induced vascular responses in rats fed a hyperlipidemia-inducing diet, examine the calcium-mediated vascular effects of DHA and EPA in normotensive rats, and

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

compare the calcium-mediated vascular responses of omega-3 fatty acids in hypertensive rats.

Erkel EA. (Medical University of South Carolina, Charleston, South Carolina). Case Management and Maternal-Infant Preventive Care. National Institute of Nursing Research.

The long-term goals of this research are to improve the health of low-income infants and reduce the costs of their medical care by increasing the adequacy of prenatal and preventive child health care. The research purpose is to compare the impact of comprehensive nursing case management with continuity of care and fragmented nursing case management in maternal and infant preventive health care.

Erlen JA. (University of Pittsburgh at Pittsburgh, Pittsburgh, Pennsylvania). AIDS and the Quality of Nursing Care. National Institute of Nursing Research.

The overall purpose of this 3-year study is to describe and measure the quality of nursing care given to persons with AIDS during hospitalization compared to the quality of nursing care given to a general population of hospitalized patients.

Fanurik D. (Arkansas Children's Hospital Research Institute, Little Rock, Arkansas). Pain in Cognitively Impaired Children—What Do We Know? National Institute of Nursing Research.

The goal of the Research Center for Symptom Management is to advance knowledge in the field of symptom management and, thereby, improve health care providers' practice and individuals' symptom outcomes.

Fife BL. (Indiana University–Purdue University at Indianapolis, Indianapolis, Indiana). Model for Understanding Responses to AIDS and Cancer. National Institute of Nursing Research.

The purpose of the proposed longitudinal, prospective study is to test a model of adaptation to life-threatening illness that considers the process from perception of the stressor to social and behavioral outcomes.

Finkelstein SM. (University of Minnesota Twin Cities, Minneapolis, Minnesota). Early Detection—Lung Transplant Rejection/Infection. National Institute of Nursing Research.

This study will develop a home monitoring program based on a nursing assessment framework for patients with transplanted lungs. A decision system will be developed to classify patients automatically as either stable or showing early signs of infection or rejection.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Floyd JA. (Wayne State University, Detroit, Michigan). Aging Related Sleep Changes—A Meta Analysis. National Institute of Nursing Research.

This meta-analytic study will (1) identify the direction and magnitude of relationships between age and sleep continuity, sleep architecture, biological sleep behavior, circadian sleep–wake pattern, and sleep quality variables; (2) test the influence of gender and health variables on the magnitude of aging-related sleep changes; and (3) examine the manner in which research methods influence research findings on sleep and aging.

Foreman MD. (University of Illinois at Chicago, Chicago, Illinois). Confusion—A Three-Wave Longitudinal Causal Model. National Institute of Nursing Research.

The purpose of this proposed study is to test a three-wave, longitudinal, causal model of confusion. The three waves, or time periods, to be examined are time I—admission to the hospital; time 2—onset of acute confusion; and time 3— resolution of acute confusion.

Frantz RA. (University of Iowa, Iowa City, Iowa). Pressure Ulcers in Older Adults—Healing with TENS. National Institute of Nursing Research.

The purpose of this study is to determine the effectiveness of transcutaneous nerve stimulation (TENS) on healing of pressure ulcers in community-based older adults. The study will (1) compare the rate of healing of pressure ulcers treated with conventional therapy and those treated with conventional therapy augmented with TENS, and (2) correlate the rate of wound healing with the presence of specific patient variables and ulcer condition variables within treatment groups.

Friedman RH. (University Hospital (Boston), Boston, Massachusetts). Computer Based Adherence Interventions in Clinical Trials. National Institute of Nursing Research.

This study will evaluate the effectiveness of two medication adherence improvement interventions for clinical trials that are based on computer technology: the Telephone-Linked Computer System and the Medication Event Monitoring System.

Fuller BF. (University of Colorado Health Sciences Center, Denver, Colorado). Model to Improve Nursing Assessment of Infant Pain. National Institute of Nursing Research.

The general purpose of this research is to explicate age-appropriate models of infant pain that can be used as a basis for the development of clinical tools to improve nursing assessment of infant pain.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Funk SG. (University of North Carolina at Chapel Hill, Chapel Hill, North Carolina). Core—Research Support. National Institute of Nursing Research.

The goal of the proposal is to provide core research support services and resources to all center investigators through five subcores: Analytic and Data Services, Methods for Studying Vulnerable Populations, Biobehavioral Support, Cost Analysis, and General Research Support Services.

Gaffney KF. (George Mason University, Fairfax, Virginia). Maternal Role Sufficiency—Predictors and Interventions. National Institute of Nursing Research.

The purposes of this research are (1) to identify prenatal predictors of maternal role sufficiency among low-income, non-Hispanic (nonimmigrant) and low-income, Hispanic mothers of infants; (2) to determine whether prenatal study variables predict low birth weight with the same pattern that they predict maternal role sufficiency; (3) to establish criteria for the selection of at-risk candidates for interventions designed to enhance maternal role sufficiency; (4) to identify intervention methods evaluated as helpful by women who have been determined to be at-risk for problems with maternal role sufficiency; and (5) to design a model for intervention based on findings.

Gallo AM. (University of Illinois at Chicago, Chicago, Illinois). Well Sibling Adjustment in Childhood Chronic Illness. National Institute of Nursing Research.

The purpose of this study is to assess psychological adjustment of well siblings of children with chronic illness, and to explore relationships between sibling adjustment and selected measures of parental functioning, family functioning, and illness characteristics.

Geller G. (Johns Hopkins University, Baltimore, Maryland). Model Informed Consent Process for BRCA1 Testing. National Institute of Nursing Research.

The proposed study will develop, implement, and evaluate a model informed consent process for genetic testing for breast cancer that integrates the perceptions of consumers and providers. The model informed consent process will address both the content and the style of disclosure and counseling

Gennaro S. (University of Pennsylvania, Philadelphia, Pennsylvania). Mothers/VLBW Infants—Anxiety Depression Immune Response. National Institute of Nursing Research.

The purpose of this study is to examine changes in anxiety, depression, and immune function in mothers of very-low-birth-weight (VLBW) infants and to

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

compare these responses to those of mothers of healthy full-term (greater than 37 weeks gestation) infants.

Gillett PA. (University of Utah, Salt Lake City, Utah). Nurse Exercise Intervention for Overweight Older Women. National Institute of Nursing Research.

An experimental design will be used to determine the short- and long-term impact of two nurse-delivered exercise teaching interventions on exercise adherence, physical fitness, self-esteem, and mood of middle-aged and older women.

Given BA. (Michigan State University, East Lansing, Michigan). Family Home Care for Cancer—A Community-Based Model. National Institute of Nursing Research.

This research proposes to describe how a new cancer diagnosis and both initial and continuing treatment begin or add to limitations in self-care, mobility, continence, cognition symptoms, and mental health of elderly patients. It will also examine the effects of these variables on the involvement, reactions, and mental health of family care-givers.

Glazer GL. (Kent State University at Kent, Kent, Ohio). Mid-Life Research. National Institute of Nursing Research.

This research will focus on predictors, moderators, and health outcomes of the transition to midlife for African American and Caucasian women and will develop the principal investigator as a nurse scientist.

Good MP. (Case Western Reserve University, Cleveland, Ohio). Effects of Relaxation and Music on Postoperative Pain. National Institute of Nursing Research.

The proposed study aims to determine if relaxation and music are effective in reducing sensory and affective components of pain in colorectal surgical patients receiving patient-controlled analgesia (PCA) during different activities and postoperative days.

Goodwin JS. (University of Texas Medical Branch at Galveston, Galveston, Texas). Barriers to Breast Cancer Treatment in Older Women. National Institute of Nursing Research.

This study proposes to test whether an intervention combining some of the roles of an oncology nurse with a geriatric case manager will influence favorably the treatment of older breast cancer patients at community hospitals.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Grady C. (National Center for Nursing Research [NCNR], National Institutes of Health). Fatigue Associated with Interleukin 2 Therapy for HIV Infection. National Institute of Nursing Research.

The aims of this study are (1) to identify and describe the frequency, severity, duration, and impact of fatigue reported by HIV-infected individuals during and between cycles of investigational interleukin-2 (IL-2) therapy; (2) to evaluate selected physiologic and psychosocial correlates of fatigue in HIV-infected subjects receiving IL-2 therapy; and (3) to identify self-care strategies used by HIV-infected persons to minimize fatigue.

Grady C. (NCNR, National Institutes of Health). Myopathy During Prolonged Antiretroviral Therapy for HIV Infection. National Institute of Nursing Research.

The aims of this study are (1) to describe and compare the histopathologic characteristics, serum biochemical features, and condition-specific clinical performance, functional status, and health perceptions of patients who have developed myopathy during antiretroviral therapy for HIV infection; and (2) to contrast the changes that occur over time and after such clinically determined interventions as altered antiretroviral doses, steroid administration, or nonsteroidal anti-inflammatory medications.

Grady C. (NCNR, National Institutes of Health). Nutritional Changes During HIV Treatment, Relation to Immune Function. National Institute of Nursing Research.

This study aims (1) to describe the type and extent of changes in nutritional status that develop across the spectrum of HIV infection during its treatment, and (2) to explore the extent to which nutritional status serves as a cofactor to impaired immune function during HIV infection and its treatment.

Grimm PM. (Johns Hopkins University, Baltimore, Maryland). Pilot— Pain, Fatigue, and Emotional Distress in Cancer Patients. National Institute of Nursing Research.

No abstract available. See parent grant.

Hailer KB. (Johns Hopkins University, Baltimore, Maryland). Accuracy of Substituted Judgments in Terminal Illness. National Institute of Nursing Research.

The goal of this study is to explore the degree to which relatives or other surrogates can predict accurately the preferences of patients regarding life-sustaining treatments, when the patients are to make health care decisions for themselves near the end of life.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Hamilton GA. (University of Massachusetts Medical School, Worcester, Massachusetts). Increasing Adherence in a Hypertension Clinical Trial. National Institute of Nursing Research.

The primary objective of this study is to assess the impact and cost-effectiveness of interventions aimed at improving adherence within a clinical trial —in this case a trial of an oral potassium supplement to antihypertensive therapy.

Hamilton PA. (Texas Woman's University, Denton, Texas). Pattern Recognition in Teen Birth Data from 1964 to 1990. National Institute of Nursing Research.

The purpose of the study is to identify patterns in the daily occurrence of births to teens in Texas from 1964 to 1990. The knowledge of the process of change over time will facilitate the development of nursing interventions to reduce the rate of teen pregnancy.

Harrell JS. (University of North Carolina at Chapel Hill, Chapel Hill, North Carolina). Cardiovascular Health in Children and Youth—CHIC II. National Institute of Nursing Research.

This study is a continuation of the CHIC I study, a randomized field trial conducted in 21 rural and urban elementary schools testing the effects of interventions designed to reduce cardiovascular disease. The current study will follow the CHIC I subjects for 4 years to determine the effects over time of the interventions used in CHIC I.

Harrell JS. (University of North Carolina at Chapel Hill, Chapel Hill, North Carolina). Preventing/Managing Chronic Illness in Vulnerable People. National Institute of Nursing Research.

The overall aims of the Center for Research on Preventing and Managing Chronic Illness and Other Chronic Health Conditions are (1) to support ongoing research and initiate multidisciplinary studies of a variety of chronic illnesses and conditions in vulnerable individuals, families, and groups; and (2) to develop a framework for understanding the common and the unique processes involved in both preventing and managing different chronic illnesses and conditions.

Harrison LL. (University of Alabama in Tuscaloosa, Tuscaloosa, Alabama). Effects of Gentle Human Touch on Preterm Infants. National Institute of Nursing Research.

The purposes of the study are (1) to describe the immediate physiological and behavioral responses of preterm infants (27–32 weeks' gestation) to gentle human touch; and (2) to evaluate the long-term effects of gentle human touch on morbidity status, motor activity levels, levels of behavioral distress, and developmental outcomes.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Hathaway DK. (University of Tennessee at Memphis, Memphis, Tennessee). Autonomic Function and Posttransplant Quality of Life. National Institute of Nursing Research.

The purpose of this study is to explicate the biobehavioral linkages among changes in autonomic function and the profound improvement in posttransplant quality of life that occur following kidney and pancreas–kidney transplantation.

Heacock PE. (University of Arkansas Medical Sciences, Little Rock, Arkansas). Intervention for Care-giver Dementia Client Dyads. National Institute of Nursing Research.

The primary aim of this study is to evaluate an educational intervention program for the care-giver and dementia client dyad to determine if it can improve the dressing ability of the cognitivety impaired individual and increase the self-efficacy of the care-giver.

Hedlund NL. (University of Hawaii at Manoa, Honolulu, Hawaii). Cancer Control Strategies in Hawaii's Minority Women. National Institute of Nursing Research.

The purpose of this Academic Investigator Award is to support the candidate's career transition into nursing research in cancer control. Aims of this proposal are to conduct community-based research to test culturally appropriate nursing interventions targeting multiethnic low-income older women and to receive training in community-based cancer control research.

Heitkemper M. (University of Washington, Seattle, Washington). Core—Biobehavioral Research Support. National Institute of Nursing Research.

The goals of this core effort are to develop the capacity to measure immune function indicators; to expand and refine altered autonomic nervous system, hypothalamic–pituitary–adrenal, and hypothalamic–pituitary–ovarian axis measures; and to perform assays for the purpose of supporting studies in which interaction among these systems is relevant.

Heitkemper MM. (University of Washington, Seattle, Washington). Nursing Study of Gut Function in Menstruating Women. National Institute of Nursing Research.

This study is designed to characterize the patterning of gastrointestinal (GI) symptoms with respect to menstrual cycle function, autonomic nervous system adrenal arousal, psychological and somatic distress, and GI function in menstruating women between 20 and 40 years of age.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Heitkemper MM. (University of Washington, Seattle, Washington). Ovarian Hormone Modulation of Serotonin Levels. National Institute of Nursing Research.

This study proposes to examine the link between serotonin, which is present in both enteric neurons and mucosal enterochromaffin cells, and gastrointestinal function.

Henry SB. (University of California, San Francisco, San Francisco, California). Representing Nursing Concepts for Computer-Based Systems. National Institute of Nursing Research.

The aim of this study is to compare selected classification systems for their ability to represent the terms used to describe patient problems or nursing diagnoses and nursing interventions in the patient record. The study findings have the potential to refine and extend the Unified Nursing Language System proposed by the American Nurses Association and the International Council of Nurses and to influence the inclusion of data elements related to nursing care in federal databases and computer-based patient records.

Herr KA. (University of Iowa, Iowa City, Iowa). Elder Pain—Assessment of Intensity. National Institute of Nursing Research.

The specific aims of the current research are to establish the psychometric properties of pain intensity measures for the elderly, to identify difficulties in responding correctly to selected measures, and to identify factors useful for selecting an appropriate tool for the elderly based on cognitive, psychomotor, and visual capabilities.

Hester NO. (University of Colorado Health Sciences Center, Denver, Colorado). Effects of a Policy for Managing Children's Pain. National Institute of Nursing Research.

The specific aims of this study are (1) to refine the pain management policy; (2) to evaluate the effectiveness of policy implementation on four outcome variables: provider attitudes about pain, provider behaviors related to pain, pain-related patient-centered outcomes, and cost factors related to recovery; (3) to describe relevant contextual factors; and (4) to evaluate the feasibility and cost– benefits of policy implementation.

Hoffman LA. (University of Pittsburgh at Pittsburgh, Pittsburgh, Pennsylvania). Transtracheal Assist—Effect on Ventilatory Efficiency. National Institute of Nursing Research.

The objectives of this research are to compare the efficacy and cost –benefit of transtracheal (TT) and concealed nasal oxygen delivery to that of nasal cannula delivery and to determine if the initial benefits of TT delivery are maintained with long-term (4 years or more) use.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Hogue CC. (University of North Carolina at Chapel Hill, Chapel Hill, North Carolina). Reducing Frailty in Older Adults with Arthritis. National Institute of Nursing Research.

The purpose of this study is to determine whether a 16-week training program designed to increase muscle strength, flexibility, aerobic capacity, and speed of task completion, as well as knowledge about, acceptability of, and support for exercise will lead to continued exercise and will improve the functional status, physical activity, and self-esteem of rural sedentary older adults with arthritis.

Holder B. (New York University, New York, New York). Elderly Black Diabetics—A Family Centered Intervention. National Institute of Nursing Research.

This 4-year, randomized clinical trial will test the effect of two interventions on the quality of family relationships, treatment adherence, and metabolic control in 150 elderly black individuals with diabetes mellitus who reside in the community.

Holtzclaw BJ. (University of Texas Health Science Center, San Antonio, Texas). Febrile Symptom Management in Persons with AIDS. National Institute of Nursing Research.

This study tests a protocol for febrile symptom management in persons living with AIDS, centered on the heightened sensitivity and lowered threshold to shivering caused by the elevated hypothalamic set point range in fever.

Holzemer W. (University of California, San Francisco, San Francisco, California). Core—Research Development and Dissemination. National Institute of Nursing Research.

The objectives of the Research Development and Dissemination Core are (1) to coordinate special research training among affiliated Research Center for Symptom Management (RCSM) faculty; (2) to facilitate the exchange of scientific information related to symptom management; (3) to disseminate scientific information to communities of scientists, clinicians, and consumers; and (4) to develop culturally competent interventions and methods for specified minority groups.

Holzemer WL. (University of California, San Francisco, San Francisco, California). Quality of Nursing Care of People with AIDS. National Institute of Nursing Research.

This study will examine the quality of nursing care provided to people with AIDS by utilizing a quality-of-care framework to conceptualize patient problems (inputs), nursing activities (processes), and patient status (outcomes). The findings from this study will provide descriptions of those nursing care activities found to be effective in improving outcomes for persons with AIDS.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Hopp LJ. (Purdue University, West Lafayette, Indiana). Incremental Threshold Loading in Healthy Subjects. National Institute of Nursing Research.

This research aims to define the limits of normal inspiratory muscle endurance as tested by the incremental threshold loading (ITL) test and to determine the extent to which age, gender, body size, and physical activity contribute to the prediction of outcomes of the ITL test.

Houck GM. (Oregon Health Sciences University, Portland, Oregon). Mother and Child Interactions and Adaptation of Toddlers. National Institute of Nursing Research.

This 5-year project has three specific aims: (1) to describe the nature and quality of mother–child control-salient interactions during the transition to toddlerhood; (2) to examine the relationship of individual maternal and child characteristics to the quality of mother –child control-salient interactions; and (3) to examine the relationship between the quality of mother–child interactional behavior and the child's sociobehavioral competence and sense of control.

Hoyer PJ. (Wayne State University, Detroit, Michigan). Health Promotion of the Pregnant Adolescent. National Institute of Nursing Research.

The purpose of this study is to examine the effects of a mastery modeling peer support group nursing intervention for pregnant adolescents that is designed to increase self-efficacy and improve self-concept and to affect both short- and long-term perinatal outcomes.

Hurn PD. (Johns Hopkins University, Baltimore, Maryland). pH-Mediated Mechanisms of Injury in Cerebral Ischemia. National Institute of Nursing Research.

This study will provide critical tests of two different molecular mechanisms of reperfusion injury associated with severe acidosis during cerebral ischemia. The investigators will then determine if metabolic alkalosis also exacerbates ischemic injury and if excitotoxic mechanisms play a role in recovery deficits when acidosis is minimized.

Hutchinson SA. (Jacksonville State University, Jacksonville, Alabama). Observational Study of Alzheimer's Behavioral Symptoms. National Institute of Nursing Research.

The purpose of this observational study is to describe and categorize the full range of behavioral symptoms among patients diagnosed with Alzheimer's dementia (AD). The goal of this research is to generate basic knowledge for developing a controlled clinical trial of nursing interventions to manage symptoms and preserve functioning in AD patients.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Irvine AB. (Oregon Center for Applied Science, Eugene, Oregon). Worksite HRA Intervention to Reduce Cardiovascular Risk. National Institute of Nursing Research.

No abstract available.

Jacobson SF. (University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma). Diabetes Representations and Signs of Mvskoke Indians. National Institute of Nursing Research.

The aims of this study are (1) to elicit the representations of diabetes mellitus, arthritis, and health-for-age from traditional Mvskoke Creek Indians with and without diabetes; (2) to learn their views of traditional and Western helping systems and of culturally appropriate and inappropriate behavior for Anglo health professionals; (3) to assess signs of diabetes and state of health among the Mvskoke; and (4) to identify culturally appropriate nursing interventions for diabetes among the Mvskoke.

Jansen DA. (University of Wisconsin-Madison, Madison, Wisconsin). Factors Influencing Attentional Capacity in the Elderly. National Institute of Nursing Research.

No abstract available.

Jemmott LS. (University of Pennsylvania, Philadelphia, Pennsylvania). AIDS—Testing Risk Behavior Interventions. National Institute of Nursing Research.

The objective of this proposal is to identify effective culturally sensitive behavioral interventions by nurses to reduce the risk of sexually transmitted HIV infection and AIDS among inner-city black women.

Jensen KA. (University of California, Los Angeles, Los Angeles, California). Patterns of Adaptation & Coping in Alzheimers Caregivers. National Institute of Nursing Research.

This study uses an adaptation paradigm to formulate and test a casual model for explaining satisfaction of those in the care-giving role for Alzheimer's disease. Factors studied include age, education, years in the care-giving role, physical health, hardiness, social support, and coping mechanisms.

Jirovec MM. (Wayne State University, Detroit, Michigan). Nursing Care of Incontinent Dementia Patients at Home. National Institute of Nursing Research.

The research will explore urine control problems in people with some type of dementia living at home. The long-term objective is to identify nursing strategies

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

that will lessen the burden on care-givers and prolong the time that care-givers are able to maintain patients at home.

Johnson JE. (University of Rochester, Rochester, New York). Nursing Care and Coping with Cancer Treatment. National Institute of Nursing Research.

The purpose of the proposed research is to demonstrate the direct application of a research-based theory of coping to the clinical practice of nursing. An informational intervention based on traditional teaching–learning guidelines will be contrasted with an informational intervention guided by research and theory on coping.

Johnson MR. (University of Iowa, Iowa City, Iowa). Classification of Nursing-Sensitive Patient Outcomes. National Institute of Nursing Research.

The purposes of the research are (1) to identify, label, validate, and classify nursing-sensitive patient outcomes and indicators; (2) to evaluate the validity and usefulness of the classification in clinical field testing; and (3) to define and test measurement procedures for the outcomes and indicators.

Jordan PL. (University of Washington, Seattle, Washington). Expectant/New Fathers at Risk. National Institute of Nursing Research.

The overall purpose of the proposed research is to broaden the understanding of the male experience of expectant and new fatherhood for men deemed at risk in their transition to parenthood.

Kasper CE. (Univeristy of California, Los Angeles, Los Angeles, California). Control of Muscle Fiber Size in Adaptation. National Institute of Nursing Research.

The proposal is designed to address how the volume or cross-sectional area of a muscle fiber is regulated. The hypothesis being tested is that the size of a muscle fiber is determined by the total number of myonuclei in a fiber, the type of myosin expressed, and the mitochondria concentration.

Kauder DR. (University of Pennsylvania, Philadelphia, Pennsylvania). Pilot Study—Influences on Injury Outcome After Massive Transfusion. National Institute of Nursing Research.

This prospective study is designed to explore the relationship between injury-related physical, immunological, or psychological variables and specific injury-related outcomes.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Kearney ML. (University of Maryland Baltimore Professional School, Baltimore, Maryland). Post Ischemic Platelet Function—Young vs Adult. National Institute of Nursing Research.

The overall goal of this project is to examine platelet reactivity in a clinically relevant model of intracranial hypertension and to determine if the response of neonatal lamb platelets differs from that of mature sheep.

Keithley JK. (Rush-Presbyterian-St Lukes Medical Center, Chicago, Illinois). Nutritional Supplementation in Early HIV Infection. National Institute of Nursing Research.

The purpose of this pilot study is to evaluate the feasibility of administering nutritional supplements in early HIV infection and to explore the effects of this supplementation on selected measures of nutritional status and HIV disease progression.

Kerr ME. (University of Pittsburgh at Pittsburgh, Pittsburgh, Pennsylvania). Comparison of CSF Drainage Protocols in Intracranial Pressure Management. National Institute of Nursing Research.

The purpose of this study is to determine if cerebrospinal fluid (CSF) drainage decreases intracranial pressure and improves cerebral perfusion in head-injured patients. It will compare the cerebrovascular responses of head-injured patients to three CSF drainage protocols using both traditional and advanced neurophysiologic methods available to nurse clinicians.

Kerr ME. (University of Pittsburgh at Pittsburgh, Pittsburgh, Pennsylvania). Endotracheal Suctioning in Head Injuries. National Institute of Nursing Research.

The purpose of this study is to extend prior research on the effects of endotracheal suctioning (ETS) in head-injured adults by comparing two hyperoxygenation protocols. The protocols will be administered between ETS passes as a means of controlling increases in intracranial pressure and preventing compromised cerebral perfusion pressure.

Kerr ME. (University of Pittsburgh at Pittsburgh, Pittsburgh, Pennsylvania). Suctioning Effect of Cerebral Perfusion. National Institute of Nursing Research.

This project proposes to interface advanced neurophysiologic methods with nursing research to answer the question of whether endotracheal suctioning (ETS) puts the patient at risk for cerebral ischemia or hyperemia. The purpose of this study is to evaluate changes in transcranial blood flow velocity and cerebral oxygenation and their relationship to cerebral perfusion pressure (CPP) during ETS in head-injured patients.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Killen JD. (Stanford University, Stanford, California). Computer Education and Community Participation on CVD. National Institute of Nursing Research.

This study is designed to develop an effective, generalizable school-and community-based intervention to reduce tobacco use, increase heart-healthy food consumption, and increase aerobic exercise among ninth grade youth in East San Jose, California. Both a school-based and a community participation intervention are proposed.

Killien MG. (University of Washington, Seattle, Washington). Returning to Work—Impact on Mothers' Postpartum Health. National Institute of Nursing Research.

No abstract available.

King RB. (Rehabilitation Institute Research Corporation, Chicago, Illinois). Adaptation After Stroke—Patient and Support Person. National Institute of Nursing Research.

The primary purposes of this 4-year multisite longitudinal descriptive study are (1) to describe the process of adaptation of patients with stroke and their primary support persons, and (2) to assess the relationship between selected variables and psychosocial adaptation

Kneipp SM. (University of Washington, Seattle, Washington). Health Outcomes in Women Affected by Welfare-to-Work Programs. National Institute of Nursing Research.

No abstract available.

Koenig BA. (University of California, San Francisco, San Francisco, California). Cultural Pluralism & Ethical Decision-Making in Nursing. National Institute of Nursing Research.

The objective of this research is to conduct an empirical investigation of cultural pluralism and ethical decision-making with a sample of patients with life-threatening cancer, their families, and their care providers.

Kohout F. (University of Iowa, Iowa City, Iowa). Core—Nursing Research Support. National Institute of Nursing Research.

The research support core's (RSC) major thrust will be toward establishing long-term collaborations between nurse researchers and RSC consultants. The core will bring together a team of four senior statisticians, who have extensive experience in developing and implementing funded studies, in consulting and teaching.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Koniak-Griffin D. (Univeristy of California, Los Angeles, Los Angeles, California). Early Intervention Program for Adolescent Mothers. National Institute of Nursing Research.

The purpose of this study is to determine if an early intervention program (EIP) improves social and health outcomes and mother–infant interactions of adolescent mothers and their children.

Lamontagne LL. (Vanderbilt University, Nashville, Tennessee). Children's Preoperative Coping and Postoperative Outcome. National Institute of Nursing Research.

The purpose of the proposed research is to expand and extend previous research related to children's preoperative coping. In the proposed study, the ways children cope with major orthopedic surgery will be examined in relation to their age, locus of control beliefs, and the amount of preoperative information given them by various sources.

Lappe JM. (Creighton University, Omaha, Nebraska). Development of Bone Quality in Healthy Children. National Institute of Nursing Research.

This proposal focuses on the problem of osteoporosis early in life. The aims are (1) to characterize changes in bone quality in children from 9 to 18 years of age, and (2) to determine whether variations in self-chosen levels of calcium intake and physical activity are associated with variation in bone quality.

Larson JL. (University of Illinois at Chicago, Chicago, Illinois). Nurse Managed Inspiratory Muscle Training of COPD Patients. National Institute of Nursing Research.

This study aims to compare the effects of inspiratory muscle training (IMT) with those of general exercise therapy (GET) and the combination of IMT and GET in patients with moderate to very severe chronic obstructive pulmonary disease (COPD).

Lee JL. (University of Michigan at Ann Arbor, Ann Arbor, Michigan). Self-Management of Diabetes. National Institute of Nursing Research.

The overall aim of this 3-year investigation is to generate a substantive grounded theory of self-management of diabetes mellitus.

Lee KA. (University of California, San Francisco, San Francisco, California). Sleep Disturbances in Ethnically Diverse Women With HIV. National Institute of Nursing Research.

The aims of this study are (1) to describe significant environmental and physiological correlates of disturbed sleep for ethnically diverse women who are

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

HIV seropositive; (2) to describe and contrast strategies used by these women to manage their daily activities within the context of their complex environment; and (3) to develop and pilot-test an educational intervention to enhance sleep efficiency and daily activities.

Lentz MJ. (University of Washington, Seattle, Washington). Measuring Sleep Changes—Accuracy of Alternatives to PSG. National Institute of Nursing Research.

This project proposes to look at the accuracy of self-report and motion sensor measures of sleep quantity (total nighttime sleep time and awakenings) compared to polysomnography (PSG).

Levine JD. (University of California, San Francisco, San Francisco, California). GABA/Opioid Treatment of Acute Postsurgical Pain. National Institute of Nursing Research.

This study will employ the standardized model of outpatient surgery —surgical removal of bony impacted mandibular third molars—to evaluate the effect of the combination of baclofen or flumazenil with morphine on postoperative pain.

Lewis FM. (University of Washington, Seattle, Washington). Promoting Adjustment in Single Women with Breast Cancer. National Institute of Nursing Research.

This study will test the effectiveness of a home-based counseling intervention for single women with early-stage breast cancer who have dependent children. The goal of the intervention is to improve psychosocial adjustment in single women with early-stage breast cancer and their dependent children, as well as to improve the women's quality of life.

Lewis LL. (University of Washington, Seattle, Washington). Nursing Appraisal, Stress and Endocrine Dynamics in PMS. National Institute of Nursing Research.

The purpose of this study is to provide evidence for a significantly greater responsiveness to an applied stress challenge in the luteal phase of the menstrual cycle in women with premenstrual syndrome (PMS), compared to rest conditions and normal controls, by using a repeated-measures, between-group design.

Lindenberg CS. (Emory University, Atlanta, Georgia). Drug Abuse Prevention in Hispanic Women. National Institute of Nursing Research.

The specific aims of this proposal are two: (1) to select, modify, and pilot-test existing data collection instruments that measure the Social Stress Model for Substance Abuse Prevention's key psychosocial constructs (stress, competence, social support, and community resources) for use with Hispanic women of childbearing age; and (2) to prepare four to six case studies consistent with the social and cultural context in which Hispanic inner-city childbearing women live.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Lobel M (State University New York at Stony Brook, Stony Brook, New York). Prenatal Maternal Stress Effects on Birth Outcomes. National Institute of Nursing Research.

No abstract available.

Lobert SA (University of Mississippi Medical Center, Jackson, Mississippi). Interactions of Antimitotics with Tubulin Isotypes. National Institute of Nursing Research.

This study investigates the interactions of tubulin with antimitotic agents.

Lorig KR. (Stanford University, Stanford, California). Spanish Arthritis Self Management Program Evaluation. National Institute of Nursing Research.

The proposed study will examine the applicability and effectiveness of an efficacy-enhancing arthritis self-management program for Spanish-speaking populations. The specific aims of the study are fourfold: (1) to translate and revalidate Spanish arthritis-specific scales, as well as scales to determine general health status in five diverse Spanish-speaking arthritis patient populations; (2) to determine the most effective and efficient means of collecting data from Spanish-speaking patients; (3) to study the effectiveness of the arthritis self-management program with Spanish-speaking arthritis patients; and (4) to determine the applicability of self-efficacy theory to Spanish-speaking patients.

Ludington SM. (Univeristy of California, Los Angeles, Los Angeles, California). Skin to Skin Contact for Preterm Infants and Their Mothers. National Institute of Nursing Research.

The purpose of this study is to determine the cardiorespiratory, thermal, and state behavior effects of multiple skin-to-skin sessions occurring over 3 to 5 consecutive days on stable, continuing-care premature infants who are of appropriate size for gestation and greater than 32 weeks' gestational age. A pretest–posttest control group design with randomization by the Zellen technique will be used.

Lynn MR. (University of North Carolina at Chapel Hill, Chapel Hill, North Carolina). Clinical Outcome—Patient's Perception of Nursing Care. National Institute of Nursing Research.

The primary goal of the proposed study is to further test a measure of the patient's perspective on quality nursing care to provide documentation of its utility as a quality-of-care measure. The long-term goal of this project is to make available to acute care administrators, researchers, and clinicians a measure of the patient's perspective on quality nursing care. This measure is intended to provide a means for assessing the quality of care delivered and to identify how variations or changes in the delivery of care affect the quality of that care.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Maas ML. (University of Iowa, Iowa City, Iowa). Nursing Intervention for Alzheimer's—Family Role Trials. National Institute of Nursing Research.

This proposal represents the third part (Phase III) of a program of research to evaluate the special units approach to the care of institutionalized patients with Alzheimer's disease (AD). The purpose of this nonequivalent group, repeated-measures, quasi experiment is to test the effects of a specific nursing intervention (family involvement in care) on family members, staff, and AD patients in six settings.

Magilvy JK. (University of Colorado Health Sciences Center, Denver, Colorado). Health Care Transitions for Rural Older Adults. National Institute of Nursing Research.

The purpose of this revised ethnographic competing continuation study is to describe and analyze health care transitions of rural older adults, from a multidimensional perspective, in several selected counties in rural Colorado, with greater emphasis placed on the Hispanic population residing in the study areas.

Marion LN. (University of Illinois at Chicago, Chicago, Illinois). Risk-Related Sexual Behavior—Low Income Separated Women. National Institute of Nursing Research.

The purpose of this retrospective, cross sectional study is to describe the risk-related sexual practices of a representative sample of low-income women who were separated or divorced from a partner or spouse. The study will use a tested nursing theoretical framework—the Interaction Model of Client Health Behavior—to explore sexual risks after separation from regular partner or spouse.

McCarthy-Beckett D. (University of Wisconsin-Madison, Madison, Wisconsin). Cytokine Activity and Anorexia in Tumor-Bearing Rats. National Institute of Nursing Research.

The objectives of the study are to determine whether immunoregulatory cytokines such as IL-1, IL-6 or tumor necrosis factor (TNF) are involved in the onset of anorexia with tumor growth.

McCloskey JC. (University of Iowa, Iowa City, Iowa). Nursing Interventions Classification—Expansion and Use. National Institute of Nursing Research.

The purpose of this competing continuation grant is twofold: (1) to refine and expand the Nursing Interventions Classification (NIC) and (2) to field-test the classification for clinical usefulness.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

McCool WF. (Yale University, New Haven, Connecticut). Biobehavioral Indices of Stress Reactivity in Pregnancy. National Institute of Nursing Research.

This study represents the third phase of a five-phase research agenda whose overall objectives are (1) to explore biobehavioral influences on labor and delivery outcomes of pregnant women and their infants and (2) to test antepartal interventions that will improve pregnancy outcomes by focusing on these potentially influential biobehavioral factors. The specific aim of this phase is to examine, by use of a longitudinal, prospective design, the relation of certain biological and emotional changes during pregnancy to intrapartal outcomes for both the women and their children.

McCorkle R. (University of Pennsylvania, Philadelphia, Pennsylvania). Advancing Care in Serious Illness. National Institute of Nursing Research.

The Serious Illness Center has three cores: administrative, research support, and research development and dissemination. Pilot funds are used to support innovative research related to serious illness.

McCorkle R. (University of Pennsylvania, Philadelphia, Pennsylvania). Core—Research Development and Dissemination Facility. National Institute of Nursing Research.

The Research Development and Dissemination Core of the Center for Advancing Care in Serious Illness is comprised of two units: the research training unit and the research dissemination unit.

McCorkle R. (University of Pennsylvania, Philadelphia, Pennsylvania). Core—Research Support Facility. National Institute of Nursing Research.

Two units will provide support to investigators—the biopsychological unit and the biostatistics unit—at the Center for Advancing Care in Serious Illness.

McCorkle R. (University of Pennsylvania, Philadelphia, Pennsylvania). Nursing Impact on Quality of Life Outcomes in Elders. National Institute of Nursing Research.

The specific aims of the study are (1) to examine the effects of a standardized nursing intervention protocol on quality of life and outcomes for postsurgery older cancer patients after 3 and 6 months; and (2) to examine the effects of a standardized nursing intervention protocol on the family care-givers' perceived burden after 3 and 6 months.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

McCubbin MA. (University of Wisconsin-Madison, Madison, Wisconsin). Children's Chronic Illness—Parent and Family Adaptation. National Institute of Nursing Research.

The overall purpose of this two-phased program of research is to examine parent and family system adaptation to the care of a chronically ill child by using a family stress and coping framework.

McDowell BJ. (University of Pittsburgh at Pittsburgh, Pittsburgh, Pennsylvania). Behavior Treatment of Incontinence in Homebound Elderly. National Institute of Nursing Research.

The main purpose of the project is to study the effects of individualized programs of prompted voiding and biofeedback-assisted behavioral training implemented by nurse practitioners in the home care setting.

McGrath MM. (University of Rhode Island, Kingston, Rhode Island). Competency of School Age Term and Preterm Children. National Institute of Nursing Research.

The study proposes to investigate specific risk and protective factors that can serve as a framework for reevaluating models of development of preterm children in order to improve the precision with which the prediction of developmental outcomes can be made.

McGrath MM. (University of Rhode Island, Kingston, Rhode Island). Developmental Outcome—4-Year-Old Children Born at Risk. National Institute of Nursing Research.

The objective of this proposal is to examine the interplay between biobehavioral risk status and the social context of parental care-giving variables on the developmental competencies of 4-year-old children who were born with varying degrees of medical risk.

McGuire DB. (Emory University, Atlanta, Georgia). Nursing Interventions for Acute Oral Pain and Mucositis. National Institute of Nursing Research.

The hypothesis to be tested is that a nurse-administered psychoeducational intervention used in conjunction with pain and oral care practice standards will decrease the severity and duration of acute oral pain and mucositis, decrease emotional distress, and increase the use of cognitive and behavioral coping strategies.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

McNees MP. (North Rim Systems, Issaquah, Washington). Computer Detection of At-Risk Nursing Home Residents. National Institute of Nursing Research.

This project reflects the next steps in developing an automated system for detecting changes in nursing home residents' nutritional intake and body weight—changes assumed to be associated with health status. It is directed toward (1) establishing operational definitions of and criteria for significance of change from a broad group of experts and practitioners; (2) validating efficient data capture and analytic protocols; (3) establishing the efficacy of the system in three nursing homes; (4) establishing the relationship of detected changes to clinical implications; and (5) establishing the end-user interface characteristics for the automated system.

Medoff-Cooper BS. (University of Pennsylvania, Philadelphia, Pennsylvania). Nutritive Sucking—Physiologic and Behavioral Correlates. National Institute of Nursing Research.

This study proposes to continue work to develop a clinically useful tool for evaluating central nervous system organization in preterm infants who weigh less than 1,500 grams at birth.

Melvin N. (Arizona State University, Tempe, Arizona). Children's Temperament—Nursing Intervention for Parents. National Institute of Nursing Research.

This study is intended to expand existing knowledge of the relationship of temperament to potential social–emotional problem behaviors in preschool-age children, as viewed by parents, and to refine and test interventions with parents by pediatric nurses.

Merkle CJ. (University of Arizona, Tucson, Arizona). Nuclear Architecture and Calcium Transients. National Institute of Nursing Research.

The long-term objective of this study is to understand how endothelial cells change shape to form gaps during inflammation.

Merritt SL. (University of Illinois at Chicago, Chicago, Illinois). Pupil Staging and PSG/EEG Measures of Sleeplessness. National Institute of Nursing Research.

No abstract available.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Miles MS. (University of North Carolina at Chapel Hill, Chapel Hill, North Carolina). Core—Research Development and Dissemination. National Institute of Nursing Research.

The development arm of this core will help develop a variety of skills among all the center's investigators. The dissemination arm will use many dissemination methods, including a focus on increased utilization of research findings.

Miles MS. (University of North Carolina at Chapel Hill, Chapel Hill, North Carolina). Parental Role Attainment with Medically Fragile Infants. National Institute of Nursing Research.

The overall aims of this longitudinal study are (1) to investigate systematically the process of parental role attainment with medically fragile infants in the context of the highly technological health care environment; (2) to examine the influence of the infant and selected parent, family, and health care factors on parental role attainment; and (3) to explore the influence of parental role attainment on mother–child relationships through the second year of life. Subjects will be 105 medically fragile infants and their parents.

Misener TR. (University of South Carolina at Columbia, Columbia, South Carolina). Behavioral Change Variables in Men's Reproductive Health. National Institute of Nursing Research.

The overall purpose of this exploratory descriptive correlational study is to establish the basis for a program of health promotion research emphasizing male reproductive health.

Mishel M. (University of North Carolina at Chapel Hill, Chapel Hill, North Carolina). Core—Conceptualization. National Institute of Nursing Research.

The conceptualization core will establish a mechanism for critiquing and further developing the current state of knowledge surrounding the prevention and management of chronic illness. Through engaging in strategies to challenge ideas and stimulate debate, the investigators will generate a group of conceptual themes and develop these into frameworks to guide investigations conducted through the center.

Mishel MH. (University of North Carolina at Chapel Hill, Chapel Hill, North Carolina). Managing Uncertainty in Stage B Prostate Cancer. National Institute of Nursing Research.

The proposed study extends a successful nursing intervention for breast cancer patients to Caucasian and African American men with Stage B prostate cancer and to their family care providers.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Mitchell PH. (University of Washington, Seattle, Washington). Critical Care Nursing Systems, Retention and Outcomes. National Institute of Nursing Research.

This study proposes to expand on the findings of two recent studies suggesting that the organization of nursing care and the collaboration between nurses and physicians are as important as the organization of medical care and technology in determining compelling clinical outcomes such as excess mortality.

Mitchell PH. (University of Washington, Seattle, Washington). Transcranial Doppler Ultrasonography and Intracranial Pressure Waveform —Predicting Response to NSG Care. National Institute of Nursing Research.

The specific aims of this study are (1) to determine the relationship of a transcranial Doppler ultrasonography indicator of autoregulation and an intracranial pressures waveform analysis indicator of cerebral compliance to the number of episodes of untoward physiological responses to nursing care; and (2) to describe the temporal relationship of transcranial Doppler ultrasonography evidence of decreased cerebral autoregulation, altered intracranial pressure waveform, and elevated intracranial pressure.

Mobily PR. (University of Iowa, Iowa City, Iowa). Elder Pain in LTC— Prevalence, Impact, and Management. National Institute of Nursing Research.

The specific aims of this project are (1) to determine the prevalence and characteristics of pain in the elderly in long-term care setting; (2) to evaluate the relationship of pain to functional status, interference with life activities, and mood/depression; (3) to determine the range and perceived effectiveness of residents' coping strategies for dealing with pain; and (4) to determine the range and effectiveness of staff-initiated pharmacologic and nonpharmacologic pain management strategies used in the long-term care setting.

Montgomery CL. (University of Colorado Health Sciences Center, Denver, Colorado). Homeless Women: Strengths and Nursing Strategies. National Institute of Nursing Research.

The aims of this proposed investigation are (1) to discover the sources of personal strength and meaning that enable women to overcome homelessness; (2) to discover the sources of possibility and hope available to women living with extreme disadvantage; and (3) to identify strategies for nurses and other health professionals to help clients who are in homeless conditions.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Moore IM. (University of Arizona, Tucson, Arizona). CNS Tissue Damage and Cognitive Deficits—Nursing Model. National Institute of Nursing Research.

The overall goal of this project is to test and refine a preliminary nursing model of central nervous system tissue damage and cognitive impairments following whole brain radiation (WB RTX) and intrathecal chemotherapy (IT CTX) in children.

Moore IM. (University of Arizona, Tucson, Arizona). FABMS/MS of CNS Phospholipids in Children with Cancer. National Institute of Nursing Research.

The purpose of the proposed study is to develop a method based on fast atom bombardment mass spectrometry and tandem mass spectrometry for measuring cell membrane damage in the central nervous system.

Moore ML. (Wake Forest University, Winston-Salem, North Carolina). Reduce Low Birth Weight—Intensive Nursing Intervention. National Institute of Nursing Research.

The primary objective of the project is to determine whether a nursing intervention, intensive telephone contact, will reduce the incidence of low birth weight (LBW) deliveries in women at high risk for delivering LBW infants. Specific aims include the study of the effect of the intervention on specific types of LBW outcomes, the correlation of LBW with specific associated etiologic factors, the cost-effectiveness of the intervention, and the effect of the intervention on state anxiety.

Morisky DE. (Univeristy of California, Los Angeles, Los Angeles, California). Tuberculosis—Prevention and Adherence Interventions. National Institute of Nursing Research.

The long-term objective of this research is to identify cost-effective educational approaches that can be incorporated easily into the management and treatment of patients diagnosed as having active tuberculosis. Short-term objectives include (1) the identification of psychosocial and environmental determinants of adherence behavior and completion of therapy, and (2) the development and testing of innovative educational strategies that enable health care professionals to target personal, social, and cultural barriers to adherence.

Morrison-Beedy DC. (Niagara University, Niagara University, New York). HIV Risk Appraisal in Single Urban Women. National Institute of Nursing Research.

No abstract available.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Morrow GR. (University of Rochester, Rochester, New York). Predicting Side Effects of Cancer Treatment. National Institute of Nursing Research.

Chemotherapy has the maximum opportunity for cancer cure or control when maximum drug doses can be administered to patients. The proposed research related to antiemetic treatment will expand and examine the generalizability of current findings by studying 200 patients of both genders with a variety of diagnoses given a variety of chemotherapeutic drugs.

Morse JM. (Pennsylvania State University, University Park, Pennsylvania). Defining Comfort for the Improvement of Nursing Care. National Institute of Nursing Research.

The aims of this 5-year continuation grant are to continue research on the components of comfort by identifying the construct of comfort and to continue developing a clinical nursing model of providing comfort.

Murdaugh CL. (NCNR, National Institutes of Health). Burden, Quality of Life of Elderly Care-givers in Alzheimer's Disease. National Institute of Nursing Research.

The purpose of this study is to describe predictors of care-giver burden and quality of life in elderly care-givers of persons with Alzheimer's disease in the Honolulu Asian Aging Study of the Honolulu Heart Program. The care-givers are elderly spouses or siblings of Japanese American men between the ages of 70 and 90 who have been diagnosed with dementia.

Murdaugh CL. (NCNR, National Institutes of Health). A Study of Quality of Life in Persons with HIV Disease. National Institute of Nursing Research.

The purpose of this research is to describe physical and psychological predictors of quality of life and changes in these predictors with the course of the illness in persons with HIV disease.

Murphy SA. (University of Washington, Seattle, Washington). Parent Bereavement Stress and Nursing Intervention. National Institute of Nursing Research.

The goal of this study is to test the effectiveness of a 10-week preventive intervention for bereaved parents following the sudden accidental deaths of their adolescent and young adult children.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Mutran EJ. (University of North Carolina at Chapel Hill, Chapel Hill, North Carolina). Domiciliary Care—Homelike Care or Access Problem. National Institute of Nursing Research.

This study will compare the residents of domiciliary care homes in terms of demography, health characteristics, and care needs in order to address questions of discrimination or cultural preference.

Nacion KW. (University of Illinois at Chicago, Chicago, Illinois). Validating the Safety of Nurse-Health Advocate Services. National Institute of Nursing Research.

This research addresses whether or not maternal child health advocates (MCHA), working with a professional nurse, can provide health screening, self- and infant care information, and referrals in a safe manner.

Naylor MD. (University of Pennsylvania, Philadelphia, Pennsylvania). Comprehensive Discharge Planning. National Institute of Nursing Research.

This randomized clinical trial will add a home care component implemented by nurse specialists to the current study, which involves comprehensive discharge planning for the elderly. It will target the clinical intervention at high-risk elderly, measure its effectiveness at a large teaching hospital and a smaller community hospital, and examine the nurse specialists' interventions.

Norman S. (University of Pennsylvania, Philadelphia, Pennsylvania). Pilot Study—Lymphedema Questionnare for Breast Cancer Patients. National Institute of Nursing Research.

The objective of the proposed research is to develop and pilot-test a questionnaire to measure the occurrence of lymphedema in breast cancer patients.

Norris JF. (Creighton University, Omaha, Nebraska). Situational Self-Esteem and Body-Image Changes. National Institute of Nursing Research.

The proposed study is an initial effort to develop a theory of situational low self-esteem particularly as related to body image alterations following the loss of a body part and/or functioning or after experiencing disfigurement.

Nusbaum JL. (Pima County Health Department, Tucson, Arizona). Nursing Intervention for Homeless Infected with M Tb. National Institute of Nursing Research.

The goal of this study is to examine the effectiveness of an aggressive follow-up nursing intervention for homeless persons receiving prophylactic treatment for infection with Mycobacterium tuberculosis.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

O'Connell KA. (University of Kansas Medical Center, Kansas City, Kansas). Behaviors and Cognitions for Resisting the Urge to Smoke. National Institute of Nursing Research.

The long-term objective of this project is to develop effective nurse-delivered interventions that help clients quit smoking. This project investigates the occurrence of resistive responses, which are defined as both intentional coping strategies and unintentional cognitions that the subject perceives as helpful in resisting the urge to smoke.

Ostwald SK. (University of Texas Health Sciences Center Houston, Houston, Texas). Randomized Intervention for Families of Persons with DAT. National Institute of Nursing Research.

This 3-year project proposes to test the effectiveness of a randomized interdisciplinary, family systems-based, nonpharmacological and psychoeducational intervention on 140 families of persons with dementia of the Alzheimer 's type (DAT). The goal of the program is to decrease the care-givers ' perceptions of behavior problems in persons with DAT and to decrease the depression experienced by care-givers.

Page GG. (Ohio State University, Columbus, Ohio). Perioperative Pain Immune Function and Metastasis. National Institute of Nursing Research.

The objective of this research is to explore the immunosuppressive and tumor-enhancing effects of surgery and the attenuation of these consequences by managing perioperative pain.

Page GG. (Ohio State University, Columbus, Ohio). Perioperative Pain and Immunity—Sex and Estrous Effects. National Institute of Nursing Research.

The objective of this research is to assess the importance of sex-and estrous-related differences in immunity when considering surgery and pain management options for women with breast cancer.

Painter PL. (University of California, San Francisco, San Francisco, California). Exercise Intervention After Kidney Transplant. National Institute of Nursing Research.

This randomized clinical trial of kidney transplant recipients will determine the effects of a 1-year program of exercise training on physical fitness, quality of life, and well-being.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Palmer MH. (NCNR, National Institutes of Health). Role of Estrogen in Urinary Incontinence and Symptoms in Post-Menopausal Women. National Institute of Nursing Research.

This project is designed to evaluate the effectiveness of topical estrogen in the behavioral treatment of urinary symptoms and incontinence.

Palmer MH. (NCNR, National Institutes of Health). Urinary Continence Status and Treatment of Incontinence in Nursing Home Residence. National Institute of Nursing Research.

This project was designed to test the effectiveness of staff performance feedback in conjunction with the behavioral treatment of incontinence.

Pate RR. (University of South Carolina at Columbia, Columbia, South Carolina). Physical Activity Promotion in Adolescent Youth. National Institute of Nursing Research.

This investigation examines the effects of an after-school/summer physical activity promotion program on physical activity, behavioral determinants of physical activity participation, physical fitness, and tobacco and alcohol use in adolescent youth.

Pett MA. (University of Utah, Salt Lake City, Utah). Measurement Characteristics of the Clinical Rating Scale. National Institute of Nursing Research.

This family assessment rating tool, the Circumflex Model's Clinical Rating Scale, utilizes independent observers to evaluate family system functioning on three dimensions: family adaptability, cohesion, and communication. The major objective of this research is to examine the measurement characteristics of the clinical rating scale when used to evaluate distressed and nondistressed married and divorced families of preschool children.

Philbin MK. (University of Texas Health Sciences Center Houston, Houston, Texas). Development of an Avian Model of Prematurity. National Institute of Nursing Research.

This proposal expands on a larger program of research by providing the equipment necessary (1) to refine an avian model of prematurity; (2) to improve the validity of investigations of the effects of neonatal intensive care unit sounds on the development of auditory perception; and (3) to increase the productivity of the investigators by providing state-of-the-science psychoacoustic instrumentation for the research program.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Phipps SA. (University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma). Couples' Infertility—Racial and Socioeconomic Context. National Institute of Nursing Research.

No abstract available.

Pierce JD. (University of Kansas Medical Center, Kansas City, Kansas). Direct Measurement of Diaphragm Fatigue. National Institute of Nursing Research.

The objectives are to measure diaphragm contractility directly in animals with respiratory alterations and to describe how pressure support ventilation affects diaphragm contractility. The overall research objective of the proposal is to use a miniaturized ultrasound device to measure diaphragm contractile movements directly in an animal model as an index of the work of breathing.

Piessens PW. (Education Development Center, Inc., Newton, Massachusetts). Nursing Initiatives in Health and Community Youth Service. National Institute of Nursing Research.

This study proposes to design, implement, and evaluate a health education – community service program aimed at helping inner-city young adolescents in Brooklyn's school District 19 to adopt and maintain health-promoting cognitive and behavioral patterns.

Popkess-Vawter SA. (University of Kansas Medical Center, Kansas City, Kansas). Reversal Theory and Motivations for Overeating. National Institute of Nursing Research.

The long-term objectives are to conduct studies that contribute to the knowledge and treatment of overweight women.

Potempa K. (University of Illinois at Chicago, Chicago, Illinois). Functional Benefits of Aerobic Training After Stroke. National Institute of Nursing Research.

No abstract available.

Pressler JL. (Vanderbilt University, Nashville, Tennessee). Methodological Issues in Preterm Infant Outcomes. National Institute of Nursing Research.

This study will investigate methodological issues in examining preterm infant outcomes. It will apply time series techniques to the analysis of longitudinal data collected in the neonatal ICU environment and integrate these single-subject results for generalization across individuals.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Puskar KR. (University of Pittsburgh at Pittsburgh, Pittsburgh, Pennsylvania). Intervention to Promote Mental Health in Rural Youth. National Institute of Nursing Research.

This study is a longitudinal assessment of adolescent mental health and the development of effective nursing interventions to promote adolescent mental health and enhance coping.

Quayhagen MP. (University of San Diego, San Diego, California). Chronic Memory Loss—Home vs Community Interventions. National Institute of Nursing Research.

This study will compare and contrast the effect of four interventions targeted (two home-based, two community-based) to both care-givers and care receivers on family outcomes.

Rainey C. (Clemson University, Clemson, South Carolina). Beliefs of African American Mothers About Child Health. National Institute of Nursing Research.

The long-term specific aim of the proposed project is to develop the database necessary for planning, implementing, and evaluating a culturally relevant prevention program to strengthen health behaviors and prevent or change unhealthy behaviors of African American children in the low-income communities of Pickens, Oconee, and Anderson Counties in upstate South Carolina.

Reame NE. (University of Michigan at Ann Arbor, Ann Arbor, Michigan). Nursing Assessment—Menstrual Cycle Clinical Models. National Institute of Nursing Research.

The overall goal of this project is to test the hypothesis that the hypothalamic– pituitary–ovarian axis plays a permissive but necessary role in the etiology of psychoemotional and physical symptoms trained to the menstrual cycle.

Reed KS. (University of Akron, Akron, Ohio). Parental Psychosocial Responses to Perinatal Loss. National Institute of Nursing Research.

This panel study has two specific aims: (1) to provide information regarding the effect of race and gender on specific psychosocial responses (grief response, self-esteem, and relationship adjustment) to perinatal loss over time; and (2) to provide information regarding the impact of certain subject attribute variables (parental age, marital status, income level, pregnancy planning status, and parity status) on specific psychosocial responses (grief response, self-esteem, and relationship adjustment) to perinatal loss over time.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Roberts BL. (Case Western Reserve University, Cleveland, Ohio). Falls—A Predictive Model of Risk. National Institute of Nursing Research.

Adults transferred from an ICU to a general medical or surgical unit had 2.5 times the incidence of falls compared with patients never treated in the intensive care unit. This proposal focuses on a high-risk group after its transfer from the ICU.

Roberts BL. (Case Western Reserve University, Cleveland, Ohio). Walking—A Nursing Intervention. National Institute of Nursing Research.

The purpose of this study is to determine the effects of walking, as a nursing intervention, on some functional capacities (postural stability, muscle strength, flexibility, and reaction or movement times), which are thought to be required for functional health.

Robinson EM. (Boston College, Newton, Massachusetts). Surrogate Experience—Last Decision for Alzheimer Patient. National Institute of Nursing Research.

The goal of this dissertation research is to describe what it is like for a surrogate decision maker (SDM) to live through the implementation of an advance proxy plan (APP) treatment decision made by the SDM for a loved one with advanced dementia of the Alzheimer's type.

Rogers BP. (University of Mississippi Medical Center, Jackson, Mississippi). Diabetes Mellitus Effect on Keratinocyte Function. National Institute of Nursing Research.

The long-term objective of this study is to determine if signal transduction defects associated with diabetes and insulin resistance are expressed in the epidermal keratinocyte and whether the defects alter functioning of the keratinocyte in wound healing. This study compares glucose transport and intracellular phosphotyrosine following insulin stimulation of cultured epidermal kertinocytes.

Rogers BP. (University of Mississippi Medical Center, Jackson, Mississippi). Insulin Resistance Effect on Skin Cell Function. National Institute of Nursing Research.

The long-term objective of this study is to determine if signal transduction defects associated with diabetes and insulin resistance are expressed in the epidermal keratinocyte and whether the defects alter functioning of the keratinocyte in wound healing. This study compares insulin binding and intracellular phosphotyrosine following insulin stimulation of cultural epidermal keratinocytes.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Rogers JC. (University of Pittsburgh at Pittsburgh, Pittsburgh, Pennsylvania). ADL Intervention for Nursing Home Residents with DAT. National Institute of Nursing Research.

The goal of this 3-year study is to devise and test a model activities of daily living (ADL) intervention, using graduated prompts and social reinforcement, to achieve and maintain functional independence in nursing home residents with Alzheimer's dementia.

Rogers JC. (University of Pittsburgh at Pittsburgh, Pittsburgh, Pennsylvania). Functional Outcomes of Treatment for Depression. National Institute of Nursing Research.

The primary aims of the proposed methodologic study are to examine the outcomes of four common methods of assessing personal ADLs and instrumental activities of daily living (IADLs) in the elderly. The study will assess their level of agreement, compare their criterion-related validity, examine their relative sensitivity for documenting change in functional status, identify factors that account for differences among outcomes, and compare their ability to predict performance postdischarge.

Rowley PT. (University of Rochester, Rochester, New York). Testing and Counseling for Cystic Fibrosis Mutations. National Institute of Nursing Research.

This is a pilot study to determine the best method of incorporating population-based cystic fibrosis (CF) carrier screening into the health care system. The project will offer CF carrier screening to persons of reproductive age and will assess quantitatively the resulting benefits and burdens to patient, provider, and society.

Roy JF. (University of Rhode Island, Kingston, Rhode Island). Self-Efficacy in Postmyocardial Infarction. National Institute of Nursing Research.

No abstract available.

Rubenstein LV. (Rand Corporation, Santa Monica, California). Quality of Nursing Care as Measured by Implicit Review. National Institute of Nursing Research.

The purpose of this application is to develop, implement, and evaluate an implicit review method for measuring the quality of nursing care delivered to acutely ill, hospitalized Medicare patients.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Ryden MB. (University of Minnesota Twin Cities, Minneapolis, Minnesota). Cost-Effective Quality-Improving Client Outcomes. National Institute of Nursing Research.

The long-term goal of this 4-year project is to improve the quality of care and therefore the quality of life of nursing home residents in a cost-effective manner. The focus will be on changes in four resident outcomes: incontinence, pressure sores, depression, and disruptive behavior.

Sampselle CM. (University of Michigan at Ann Arbor, Ann Arbor, Michigan). Nursing Intervention/Pelvic Floor Exercise in Pregnancy. National Institute of Nursing Research.

This study aims to assess the validity of preventive pelvic floor exercise for pregnancy-related stress urinary incontinence and for the restoration of postpartum pelvic floor muscle strength.

Sampselle CM. (University of Michigan at Ann Arbor, Ann Arbor, Michigan). Urinary Incontinence Prevention—Reducing Birthing Risk. National Institute of Nursing Research.

The impact of birthing events on urinary continence mechanisms is not well understood. An experimental pretest–posttest design will be used with one experimental and one control group to study prospectively the effect of maternal pushing during the second stage of labor on the function of urinary continence mechanisms.

Saunders JM. (City of Hope National Medical Center, Duarte, California). Nursing—Self-Care and HIV Disease. National Institute of Nursing Research.

The purpose of this project is to broaden the understanding of the trajectory of self-care among people at four different levels of HIV disease: at risk, mild, moderate, and severe.

Schnelle JF. (University of California, Los Angeles, Los Angeles, California). Nighttime Incontinence Care in Nursing Homes. National Institute of Nursing Research.

The purpose of this research is to extend into the nighttime period a prompted voiding incontinence management system that has been validated during daytime hours. The nighttime incontinence management intervention is designed to consider a resident's sleep pattern, severity of incontinence, and risk for pressure sore development.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Schraeder BD. (Thomas Jefferson University, Philadelphia, Pennsylvania). Development, Temperament, and Very Low Birth Weight. National Institute of Nursing Research.

The purpose of this study is to extend into the middle and high school years (ages 11 through 15; grades 5 though 9) a prospective longitudinal research project describing the developmental and behavioral progress of very low birth weight children (weight less than 1,500 grams at birth).

Schwarz DF. (Children's Hospital of Philadelphia, Philadelphia, Pennsylvania). Health Promotion with Teenage Mothers. National Institute of Nursing Research.

This study is a randomized, controlled trial of practice and community-based interventions modeled on Ajzen's Theory of Planned Behaviors and aimed at improving health outcomes of African American adolescent mothers ages 15–18 years. The key outcomes of interest include complete adolescent immunizations (physical health), not carrying lethal weapons or smoking cigarettes (mental health), and regular use of condoms and effective hormonal contraception (sexual health).

Schwertz DW. (University of Illinois at Chicago, Chicago, Illinois). Ischemic Preconditioning and Phospholipase Activity. National Institute of Nursing Research.

The major objective of the proposed study is to examine the relationship between PKC activation and the activity of PLA2 and PLC on the process of ischemic preconditioning.

Schwertz DW. (University of Illinois at Chicago, Chicago, Illinois). Mechanism of Sex Differences in Myocardial Function. National Institute of Nursing Research.

No abstract available.

Sereika SM. (University of Pittsburgh at Pittsburgh, Pittsburgh, Pennsylvania). Core—Research Support. National Institute of Nursing Research.

The Data Center of the Center for Nursing Research in Chronic Disorders provides centralized services to faculty to expand clinical outcome assessment in chronic disorders.

Shaver JL. (University of Washington, Seattle, Washington). Nursing Study of Perimenopausal Insomnia. National Institute of Nursing Research.

The purposes of this study are to assess objective sleep patterns over six nights at home, to determine the effect of removing women with insomnia to the laboratory

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

for one night of sleep, and to assess general stress arousal and reaction to laboratory stress application as a basis for determining subtypes.

Sheidler VR. (Johns Hopkins University, Baltimore, Maryland). Pilot—Pain Experience in Bone Marrow Transplantation. National Institute of Nursing Research.

No abstract available. See parent grant.

Sherwood S. (Hebrew Rehabilitation Center for Aged, Boston, Massachusetts). Managing Symptom Distress in ADRD Nursing Home Residents. National Institute of Nursing Research.

The goal of this preliminary longitudinal study is to increase the knowledge of nursing processes used in the nonpharmacologic management of secondary symptoms exhibited by Alzheimer's disease and related disorders–cognitively impaired residents in nursing homes.

Siler WM. (Southern Dynamic Systems, Birmingham, Alabama). Development of Fuzzy Logic Decision Support Tool. National Institute of Nursing Research.

No abstract available.

Smith BA. (Ohio State University, Columbus, Ohio). Aerobic Exercise—Effects on Physical Symptoms of HIV. National Institute of Nursing Research.

This study proposes to examine the effects of a 12-week low- to moderate-intensity aerobic exercise program on selected disease-related outcomes in patients with HIV but without AIDS as defined by the Centers for Disease Control and Prevention.

Smith BA. (Ohio State University, Columbus, Ohio). Reducing CVD Risk Factors. National Institute of Nursing Research.

The primary aim of this study is to evaluate the effectiveness of an aerobic exercise training intervention as a strategy to reduce cardiovascular disease (CVD) risk in African American children with at least one CVD risk factor.

Smith CE. (University of Kansas Medical Center, Kansas City, Kansas). Adaptation in Families with Technological Care at Home. National Institute of Nursing Research.

No abstract available.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Smith CE. (University of Kansas Medical Center, Kansas City, Kansas). Technological Home Care—Costs and Quality of Life. National Institute of Nursing Research.

No abstract available.

Souder E. (University of Arkansas Medical Sciences, Little Rock, Arkansas). SPECT and Spatial Neurocognitive Predictors of IADLS in Alzheimers Disease. National Institute of Nursing Research.

This prospective pilot study will address the following question: What is the predictive value of right parietal lobe perfusion as measured by single-photon emission computed tomography (SPECT) and performance on selected neurocognitive tests on instrumental activities of daily living (IADL) performance in patients with Alzheimer's disease? The sample will consist of 24 patients with possible or probable Alzheimer's disease.

Sowers MF. (University of Michigan at Ann Arbor, Ann Arbor, Michigan). Perimenopause, Bone and Arthritis in African Americans. National Institute of Nursing Research.

This study will determine if menopausal-related changes in hormones or menstrual cycle patterns are associated with changes in joints that are indicative of arthritis development, loss of bone density, and change in body composition.

Stefanek M. (Johns Hopkins University, Baltimore, Maryland). Pilot—Sleep Alterations in Cancer Patients. National Institute of Nursing Research.

No abstract available. See parent grant.

Stein KF. (University of Michigan at Ann Arbor, Ann Arbor, Michigan). Self-Concept and Eating Disorders. National Institute of Nursing Research.

This project is based on the schema approach to the study of the self-concept. A model suggesting that anorexia nervosa and bulimia nervosa are the results of a unique combination of self-concept deviations is tested. More specifically, the model posits that the availability in memory of an overweight body self-conception serves as the cognitive foundation that gives rise to weight concerns and dysregulated eating behaviors.

Stember ML. (University of Colorado Health Sciences Center, Denver, Colorado). Infant Growth Failure and Nursing Care. National Institute of Nursing Research.

The focus of this prospective, longitudinal study is on nonorganic infant growth failure: developing standards for growth failure, investigating variables that are related to infant growth, and developing a framework for a risk assessment tool.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Stevens BJ. (University of Toronto, Toronto, Canada). Management of Procedural Pain in Premature Infants. National Institute of Nursing Research.

No abstract available.

Stone KS. (Ohio State University, Columbus, Ohio). Endotracheal Suctioning in Acutely Ill Adults. National Institute of Nursing Research.

The purpose of this study is to determine the effect of two endotracheal suctioning techniques—off- versus on-ventilator ETS (Ballard Trach Care System)—on cardiopulmonary status in acutely ill adults.

Stone PL. (University of Rochester, Rochester, New York). Models of Delivery of Prenatal and Childbirth Care. National Institute of Nursing Research.

No abstract available.

Strickland OL. (Emory University, Atlanta, Georgia). Nursing Assessment of PMS—Neurometric Indices. National Institute of Nursing Research.

The purposes of this research are (1) to describe, compare, and contrast patterns of brain function through the use of neurometric analyses in women with perimenstrual turmoil symptoms and in women with no or mild perimenstrual symptoms; and (2) to determine the association of patterns of brain function with perimenstrual symptoms, anxiety, depression, and cortisol levels during postmenstrual and perimenstrual phases among symptomatic and asymptomatic women.

Strumpf NE. (University of Pennsylvania, Philadelphia, Pennsylvania). Refugees, Minority Status and Long-term Care. National Institute of Nursing Research.

The proposed 36-month study is designed to examine the influence of the refugee experience on awareness, expectations, and access regarding long-term care services for the aged living in the community. In particular, it will examine the experiences of two minority refugee populations from Southeast Asia (Cambodian and Vietnamese) and contrast them with the experiences of two nonminority refugee groups from the former Soviet Union (Jews and Ukrainians).

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Stuifbergen AK. (University of Texas at Austin, Austin, Texas). Health Promotion and Quality of Life in Chronic Illness. National Institute of Nursing Research.

The purpose of this 5-year nursing study is to refine and confirm an explanatory model that can guide the development of health-related interventions for promoting quality of life in individuals with multiple sclerosis.

Swanson EA. (University of Iowa, Iowa City, Iowa). Music Therapy—Effect on Elders' Agitation in Long-term Care Facilities. National Institute of Nursing Research.

The proposed study will test Gerdner's Explanatory Theory in an investigation of individualized music as a nursing intervention for agitation in the elderly.

Swigart V. (University of Pittsburgh at Pittsburgh, Pittsburgh, Pennsylvania). Prospective Study of Family Life Support Decision-making. National Institute of Nursing Research.

This study will examine the impact of participation in life support decisions on family members and factors related to the decision making process.

Talashek ML. (University of Illinois at Chicago, Chicago, Illinois).Nursing Model of Adolescent Maturity and Pregnancy. National Institute of Nursing Research.

The primary purpose of this study is to test a model relating physiological, psychological, and cognitive maturity and sociocultural and demographic variables to teen pregnancy for inner-city adolescents. This case-control study will include four cohorts of high school freshmen who are tested routinely as freshmen on ego identity and knowledge of human reproduction.

Tappen RM. (Florida Atlantic University, Boca Raton, Florida). Activity Vs Discourse to Improve Communication in AD. National Institute of Nursing Research.

The broad, long-term objective of this research is to use nonpharmacological intervention to assist the individual in the middle and later stages of Alzheimer's disease to improve his or her ability to communicate.

Taylor D. (University of California, San Francisco, San Francisco, California). Nursing Strategies for Perimenstrual Symptom Management. National Institute of Nursing Research.

In this study, a randomized clinical trial design will be used to determine the effectiveness of an experimental treatment aimed at relieving the symptom and stress experience associated with premenstrual syndrome (PMS).

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Teresi JA. (Hebrew Home for the Aged at Riverdale, New York, New York). Depression Recognition Program for Nursing Home Staff. National Institute of Nursing Research.

The central aims of this study are to examine the degree to which staff in nursing homes recognize and respond to depression among elderly residents and to evaluate a program aimed at enhancing depression recognition.

Therrien BA. (University of Michigan at Ann Arbor, Ann Arbor, Michigan). Disorientation—Model for Nursing Therapy. National Institute of Nursing Research.

This study uses an established animal model of human disorientation to examine the ability of male and female rats with left, right, or bilateral hippocampal lesions and controls to acquire and use spatial information in a new environment.

Thomas KA. (University of Washington, Seattle, Washington). Temperature Effect on Preterm Infant Sleep-Wake State. National Institute of Nursing Research.

Specific aims of the study are to examine the development of temperature biorhythm in hospitalized infants born prematurely; to determine the relationship between preterm infant sleep–wake state and both infant body and incubator temperature; to compare body temperature biorhythm and sleep–wake state and both infant body and incubator temperature; and to compare body temperature biorhythm and sleep –wake patterns in preterm and term infants in the home environment.

Thompson CL. (University of Tennessee at Memphis, Memphis, Tennessee). Dyspnea, Airway Resistance and Pressure with Suctioning. National Institute of Nursing Research.

The purpose of this study is to determine the pattern of dyspnea after tracheal suction and to determine how well the amount of mucus removed by suctioning, airway resistance, and positive and expiratory pressure predict the reduction in dyspnea.

Thorpe DM. (University of Texas MD Anderson Cancer Center, Houston, Texas). Post-Operative Pain in Anglo and Hispanic Women. National Institute of Nursing Research.

This project addresses the efficacy of two interventions for pain and other symptom relief within the purview of nursing practice: relaxation training and sensory information preparation. These interventions are compared with standard procedural preoperative preparation in Anglo and Hispanic women undergoing unilateral mastectomy or abdominal hysterectomy and/or salpingo-oophorectomy.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Tilden VP. (Oregon Health Sciences University, Portland, Oregon). Family Decision-making for Incapacitated Patients. National Institute of Nursing Research.

No abstract available.

Titler M. (University of Iowa, Iowa City, Iowa). Core—Research Development and Dissemination. National Institute of Nursing Research.

The major purposes of this Research Development and Dissemination Core are (1) to coordinate the research training of doctoral students and junior scientists in functional and cognitive health status measurements, gerontological nursing interventions, and the use of biostatistical methods in measuring the efficacy of gerontological nursing interventions; and (2) to disseminate scientific knowledge of functional and cognitive assessment and interventions for geriatric patients.

Tkacs NC. (University of Medicine and Dentistry of New Jersey, Newark, New Jersey). Limbic Activation and Opiate Expression in Sepsis. National Institute of Nursing Research.

The long-term goal of this research is to determine effects of physical illness on brain regions and transmitters involved in emotion and behavior.

Tripp-Reimer T. (University of Iowa, Iowa City, Iowa). Gerontological Nursing Interventions Research Center. National Institute of Nursing Research.

The broad objective of this research center is to provide an environment that will strengthen and expand intervention-focused research in nursing and related disciplines regarding the health of elders in a variety of care settings.

Uman GC. (Comp-U-Stat, Los Angeles, California). Long-term Care Customer Satisfaction Methodology. National Institute of Nursing Research.

No abstract available.

Vallerand AH. (University of Pennsylvania, Philadelphia, Pennsylvania). Functional Status in Chronic Facial Pain. National Institute of Nursing Research.

The goal of the proposed study is to expand the knowledge base utilized in assessing and treating patients with chronic facial pain. Specific aims are (1) to describe the functional status of patients with chronic facial pain, and (2) to identify variables that affect functional status in patients with chronic facial pain.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Varvaro FF. (University of Pittsburgh at Pittsburgh, Pittsburgh, Pennsylvania). Postcoronary Adaptation in Women—Nursing Intervention. National Institute of Nursing Research.

The purpose of this research is to compare the efficacy of the Patient Evaluation System of Sequential Instruction versus regular or usual instruction in promoting role and physiological adaptation in women patients postmyocardial infarction. Adaptation is defined according to the Roy model of nursing.

Verran JA. (University of Arizona, Tucson, Arizona). Joint Analysis of Innovative Practice Model Effects. National Institute of Nursing Research.

The purpose of this continuation study is to conduct secondary analysis of data obtained in two projects funded under the Research and Demonstration of Innovative Nursing Care Delivery Models RFA (RFA No. 88-NR-01).

Vessey JA. (University of Arkansas at Little Rock, Little Rock, Arkansas). Children, Chronicity, and Concepts of the Body Interior. National Institute of Nursing Research.

This descriptive study will explore how concepts of the body interior held by children with chronic conditions are associated with their ability to cope with their disease, adhere to therapeutic regimens, and develop age-appropriate self-care behaviors.

Walker BL. (University of Utah, Salt Lake City, Utah). Facilitating Adjustment After Radiation Treatment. National Institute of Nursing Research.

The purpose of this pilot study is to test the effect of a theoretically based intervention (provision of concrete objective information) on the psychosocial adjustment of breast and prostate cancer patients following completion of radiation therapy.

Wallston KA. (Vanderbilt University, Nashville, Tennessee). Behavioral Aspects of Rheumatoid Arthritis. National Institute of Nursing Research.

This is a continuation of a longitudinal panel study of persons with rheumatoid arthritis (RA). Several types of data are being collected for use in helping to design nursing interventions to help patients with RA and their families to cope with this chronic condition.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Ward SE. (University of Wisconsin-Madison, Madison, Wisconsin). Overcoming Patient Related Barriers to Pain Management. National Institute of Nursing Research.

No abstract available.

Webster-Stratton CH. (University of Washington, Seattle, Washington). Improving Treatment Programs for Conduct Disorders. National Institute of Nursing Research.

The long-term objective of this research program is to develop, evaluate, and improve cost-effective, widely applicable, and sustaining early intervention programs of treatment for families with young children with oppositional defiant and conduct disorder.

Weiler K. (University of Iowa, Iowa City, Iowa). Patient's Knowledge and Use of Legal Advance Directives. National Institute of Nursing Research.

The objective of this research is to develop and pilot-test instruments that assess the patient's knowledge and use of a living will and durable power of attorney for health care.

Weinert CL. (Montana State University, Bozeman, Montana). Families Living with Long-Term Illness—National Study. National Institute of Nursing Research.

No abstract available.

Weiss SJ. (University of California, San Francisco, San Francisco, California). Care-giver Touch and Health Outcomes for High Risk Infants. National Institute of Nursing Research.

The long-range goal of this research program is to promote the healthy development of low-birth-weight infants. It will examine the extent to which nursing interventions will assist families to provide care-giving that is congruent with the neurobehavioral vulnerabilities of their high-risk infants.

Westfall UE. (Oregon Health Sciences University, Portland, Oregon). Nursing Study of Responses to Enteral Feeding Options. National Institute of Nursing Research.

This multiphase study will first use a well-established rat model to study delivery times for enteral feeding; then the subjects will be human oncology patients with enteral feeding or enteral feeding plus an antineoplastic chemotherapy regimen.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Westfall UE. (Oregon Health Sciences University, Portland, Oregon). Selected Physiologic Responses to Dietetic Manipulations. National Institute of Nursing Research.

The specific experimental aims of the randomized study are to characterize and compare daily temporal patterns for the systematic responses of plasma corticosterone and insulin levels and to examine gut structural and functional integrity among adult rats. Two different food consistencies, two times for access to food, two caloric levels, two fiber contents, and specific antineoplasic chemotherapy regimens will be studied.

Wewers ME. (Ohio State University, Columbus, Ohio). Cigarette Smoking, Opioid Peptides and Mood States. National Institute of Nursing Research.

The goals of this study are to examine the relationships of nicotine, endogenous opioid peptides, antinociception, dysphoric states, and exercise and their influence on smoking behavior through a logical sequence of human and animal studies. The proposed inpatient human study is a 6-day repeated-measures experimental design.

White-Traut RC. (University of Illinois at Chicago, Chicago, Illinois). Intervention for Preterm Infants Diagnosed with PVL. National Institute of Nursing Research.

This research will evaluate selected physiological, behavioral, and developmental responses of preterm infants with periventricular leukomalacia to multisensory stimulation in the neonatal intensive care unit and at home through 2 months' corrected age.

Whitney JD. (University of Washington, Seattle, Washington). Nursing Study of Physical Activity and Wound Healing. National Institute of Nursing Research.

The specific aims of this study are (1) to determine if augmented postoperative activity enhances wound healing as measured by cellular and subcellular markers of healing; (2) to describe the effect of augmented activity on subcutaneous oxygen (PscO2) and blood flow; and (3) to describe the relationships between subcutaneous perfusion/oxygen and cellular markers of healing.

Williams AB. (Yale University, New Haven, Connecticut). Primary Care Nursing & HIV Gynecologic Manifestations. National Institute of Nursing Research.

This study is a randomized, double-blind, placebo-controlled trial of three primary care nursing strategies for prophylaxis of vulvovaginal candidiasis, in which HIV-infected women who are not receiving systemic antifungal therapy will be stratified according to their baseline CD-4 count.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Williams JK. (University of Iowa, Iowa City, Iowa). Genetic Knowledge— Psychosocial Impact. National Institute of Nursing Research.

The purpose of this research is to identify the psychosocial impact of providing genetic information to people who have received carrier testing for serious autosomal recessive X-linked disorders.

Wilson JR.(American Biorobotics, Inc., Tacoma, Washington). Automation of Drug Distribution in Federal Hospitals. National Institute of Nursing Research.

This study describes the automation of drug distribution systems for hospitals and nursing homes.

Wolf JL. (Medtrac Technologies, Inc., Lakewood, Colorado). Single Pill Delivery with Compliance Monitoring/Reminding. National Institute of Nursing Research.

This project involves the development of a hand-held, microelectronics-based unit that dispenses individual medication doses in pill, tablet, or capsule form and records such dispensing for subsequent data retrieval.

Woods NF. (University of Washington, Seattle, Washington). Center for Women's Health Research. National Institute of Nursing Research.

The goal of this center is to continue to support research on women 's health across the life span and, in particular, on midlife and older women's health. The center focuses (1) on women's health in the context of diverse sociocultural environments and (2) on relationships between symptoms and stress physiology and immune system function.

Woods NF. (University of Washington, Seattle, Washington). Core—Research Development and Dissemination. National Institute of Nursing Research.

No abstract available. See parent grant.

Woods NF. (University of Washington, Seattle, Washington). Core—Sociocultural Environments. National Institute of Nursing Research.

The goals of this core effort are (1) to support investigators in extending and refining research related to sociocultural environments and women's health begun during the first years of the Center for Women's Health Research activities; and (2) to enhance center investigators ' capacity to study diverse populations of women in culturally competent ways, including the development of community partnerships for research.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Wykle ML. (Case Western Reserve University, Cleveland, Ohio). Care-givers Formal/Informal Service Use. National Institute of Nursing Research.

In this study, data will be collected to answer research questions on the issues of assets, obligations, and attitudes implicated in family decisions to provide formal or informal care for aged relatives who have heart disease or who have experienced a stroke.

Wyman JF. (Virginia Commonwealth University, Richmond, Virginia). Balance Assessment Intervention in the Elderly. National Institute of Nursing Research.

The broad, long-term objective of this proposal is the development of strategies for prevention of falls in the community-dwelling elderly population.

Wysocki AB. (New York University, New York, New York). Chronic Wound Environment in Spinal Cord Injury. National Institute of Nursing Research.

The long-term objective of this 5-year project is to develop more effective therapies to prevent and treat pressure sores in those with spinal cord injury. The proposed study will focus on the cellular and biochemical features of wound fluid and tissue samples collected from pressure sores of the injured.

Wysocki AB. (New York University, New York, New York). Chronic Wound Fluids—Effect on Matrix and Cells. National Institute of Nursing Research.

The long-term objective of this study is to determine and characterize the cellular and biochemical mechanisms resulting in defective reepithelialization and proteolytic degradation of extracellular matrix in chronic wounds.

Yeo S. (University of Michigan at Ann Arbor, Ann Arbor, Michigan). Maternal/Fetal Hemodynamics Responses to Exercise. National Institute of Nursing Research.

The focus of this program is to examine the maternal and fetal hemodynamic repercussions of medically accepted levels of acute, non-weight-bearing exercise.

Youngblut JM. (Case Western Reserve University, Cleveland, Ohio). Nursing—Maternal Employment and LBW Infant Outcomes. National Institute of Nursing Research.

The purposes of this study are (1) to identify the effects of maternal employment status on developmental outcomes for low-birth-weight (LBW) children and a comparison group of full-term children; (2) to compare LBW and full-term children in terms of these effects at two time points and across time; and (3) to

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

identify the effects of different types of child care arrangements on developmental outcomes.

Yucha CB. (University of Colorado Health Sciences Center, Denver, Colorado). Nursing Outcome Measures of SNS Activity in Hypertension. National Institute of Nursing Research.

No abstract available.

Zahr LK. (Univeristy of California, Los Angeles, Los Angeles, California). Efficacy of Home Visits on Families of Premature Infants. National Institute of Nursing Research.

The purpose of this study is to investigate the efficacy of a home-based intervention program by public health nurses on very low-birth-weight infants from Hispanic families with low socioeconomic status.

NURSING RESEARCH INITIATIVE OF THE DEPARTMENT OF VETERANS AFFAIRS

The following annotations were prepared by project staff, based on abstracts. The listing of projects was retrieved in November 1995.

Campbell DH. (Department of Veterans Affairs, Medical Center, Washington, DC). 1995. Perception of Family Stress in Families Having Members with Dual Mental Diagnoses Versus Single Mental Diagnosis.

This will be a descriptive correlational study to compare the stress levels perceived by (1) families of a person who has mental and coexisting chemical dependency diagnoses (dual diagnosis) and (2) families of a person who has a single mental diagnosis.

Cannella KS. (Department of Veterans Affairs, Medical Center, Washington, DC). 1993. Addicted Patients' Beliefs, Attitudes, and Responses to Touch.

The overall purpose of this study is to further develop the measures of patients' attitudes, beliefs, and responses to touch both in general and within the context of nursing care, with addicted patients in an inpatient treatment program.

Cannella KS. (Department of Veterans Affairs, Medical Center, Washington, DC). 1993. Beliefs, Attitudes and Responses to Touch.

The objective of this study is to assess the reliability and validity of a set of instruments (the Touch Inventory, Patient Touch Inventory, and Patient Personal Space Inventory) in a group of addicted patients.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Fehlauer CS. (Department of Veterans Affairs, Medical Center, Washington, DC). 1993. Implementation of Pen-Based Computers as Nursing Information Processing Devices.

The study is a prospective controlled trial of pen-based computers to determine their effectiveness as a nursing information management device.

Felver LRN. (Department of Veterans Affairs, Medical Center, Washington, DC). 1992. Biological Rhythms and Nursing Research.

The purpose of this study is (1) to describe the patterns over time of body temperature, heart rate, and occurrence of cardiac arrhythmias in intensive care unit (ICU) patients while concurrently describing ICU environmental stimuli; and (2) to examine potential predictors of body temperature patterns and explore patient outcomes related to altered body temperature rhythms in these ICU patients.

Georgette GM. (Department of Veterans Affairs, Medical Center, Washington, DC). 1995. Nurse Manager Competencies.

The purpose of this study is to delineate and identify specific behavioral competencies that are considered important for hospital-based nurse manager effectiveness.

Gilbert C. (Department of Veterans Affairs, Medical Center, Washington, DC). 1993. Comparative Effectiveness of Two Dressing Techniques for Post-CABG Saphenous Vein Harvest Site Wound Healing.

The purpose of this study is to compare two dressing techniques used to manage leg incisions in the postcoronary artery bypass graft patient. This project was transferred to V. Van Valkenburg.

Hall JD. (Department of Veterans Affairs, Medical Center, Washington, DC). 1992. Review of Role Functions of the Psychiatric Nursing Staff.

The purpose of this descriptive review of the role functions of the psychiatric nursing staff is to address staff concerns related to occurrences, issues, and observations on the unit.

Jacobs MD. (Department of Veterans Affairs, Medical Center, Washington, DC). 1993. Geriatric Nursing Research and Education Project.

This project involves patient care, educational, and research activities with a major emphasis on staff development.

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Jensen LA. (Department of Veterans Affairs, Medical Center, Washington, DC). 1993. Nursing Research Project.

This project was established to facilitate nursing research projects being planned and conducted at the Veterans' Administration Medical Center in Salt Lake City, Utah.

Kundrat MA. (Department of Veterans Affairs, Medical Center, Washington, DC). 1993. Modified Neecham Confusion Scale Assessment.

The purpose of this study is to evaluate clinically the modified Neecham Confusion Scale

Kundrat MA. (Department of Veterans Affairs, Medical Center, Washington, DC). 1994. Acute Confusion in Hospitalized Elderly Veterans.

The aim of this project is to study acute confusion in hospitalized elderly veterans. This study will establish estimates of the prevalence, incidence, and risk factors for acute confusion, as well as the differences in outcomes between patients with and without acute confusion during hospitalization.

Matijevich KJ. (Department of Veterans Affairs, Medical Center, Washington, DC). 1988. Nursing Activity for Patients in the VA Ambulatory Care Settings.

The purposes of this study are (1) to identify the patient-related nursing activities in ambulatory care settings; (2) to examine the roles of advanced practice nurses compared to those of general practice nurses; and (3) to explore how these two nursing groups functioned with regard to the nursing activities identified.

Pennington MS. (Department of Veterans Affairs, Medical Center, Washington, DC). 1994. Instrument Development for Boundaries.

The purpose of the study was to pilot-test an instrument to examine the professional nurse's cognitive beliefs about the nurse-patient relationship.

Rosser DL. (Department of Veterans Affairs, Medical Center, Washington, DC). 1993. Nurse Managers' Participation in Decision-Making Relationships with Assertiveness, Perceived Power and Cultural Background.

The purpose of this study is to answer two research questions: (1) To what extent do nurse managers at selected Veterans Affairs medical centers participate in decision-making? (2) What is the relationship of decision-making participation to assertiveness, perceived power, and cultural background?

Suggested Citation:"6 Research in Progress." Institute of Medicine. 1996. Military Nursing Research: Bibliographies. Washington, DC: The National Academies Press. doi: 10.17226/9180.
×

Shively M. (Department of Veterans Affairs, Medical Center, Washington, DC). 1994. Research Utilization: Changing from Heparin to Saline for Intermittent Intravenous Devices.

The purpose of this pilot study was to describe the hemodynamic and oxygenation responses to fluid volume replacement with Pentaspan or Plasmanate in postcardiac surgery patients who are monitored with the Explorer TM system and are at risk for right ventricular dysfunction.

Tappen RM. (Department of Veterans Affairs, Medical Center, Washington, DC). 1993. Activity vs Discourse to Improve Communication in AD.

The specific aims of this study are (1) to test the effects of three interventions (planned walking, conversation treatment, and a combination of the two) on the communication performance of individuals with Alzheimer's disease; and (2) to test the direct and indirect effects of the constructs of mental status.

Van Valkenburg V. (Department of Veterans Affairs, Medical Center, Washington, DC). 1993. Comparative Effectiveness of Two Dressing Techniques for Post-CABG Saphenous Vein Harvest Site Wound Healing.

The purpose of this study is to compare two dressing techniques used to manage leg incisions in the postcoronary artery bypass graft patient.

Wheeler L. (Department of Veterans Affairs, Medical Center, Washington, DC). 1989. Comparing Intermittent Catheterization Methods in Long-term Care.

Research will include the use of bar code technology for data collection.

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