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Title: EXPLORING BARRIERS AND CONSEQUENCES RELATED TO NURSES REPORTING CHILD ABUSE.
Creator: Devkota, Asmita, Loerzel, Victoria, University of Central Florida
Abstract / Description: Background: Child abuse is a pervasive and serious problem in the United States. Over 3 million children are the victims of some kind of physical assault by adults. Due to their prolonged contact with children and opportunity to report, nurses should be trained to accurately assess, identify, and manage cases of child abuse. The purpose of this study was to examine student's experiences with Child Protective Services, and explore their confidence and attitudes related to identifying and...
Show moreBackground: Child abuse is a pervasive and serious problem in the United States. Over 3 million children are the victims of some kind of physical assault by adults. Due to their prolonged contact with children and opportunity to report, nurses should be trained to accurately assess, identify, and manage cases of child abuse. The purpose of this study was to examine student's experiences with Child Protective Services, and explore their confidence and attitudes related to identifying and reporting child abuse. Factors associated with non-reporting were identified. Methodology: This was an exploratory, descriptive study. Students enrolled in the online Nursing Research course, NUR 3165, were asked to participate. Forty-four RN to BSN and Concurrent students completed the 27 questions survey on Qualtrics. It included demographic questions, questions regarding the participant's beliefs about child abuse, The Child Abuse Reporting, Attitude and Experience Survey, and two vignettes. Survey data was analyzed using descriptive statistics. Results: There were total of 44 (6 males and 38 females) students who completed the survey; most of them were between the age of 20-24. Fourteen were RN to BSN students who have practiced nursing for more than a year and 30 were concurrent nursing students who are still working on their ASN degree. The results showed that nursing students had positive experiences with CPS and indicated that they had confidence in identifying child abuse. However, students felt that they have not received adequate professional education in this field. Many reported never receiving training regarding child abuse and 84.1% indicated never reporting a suspected case to CPS. When presented with vignettes describing scenarios related to abuse, participants were not able to positively identify cases of abuse versus cases that were ambiguous. Discussion: Nurses are mandatory child abuse reporters in Florida. Many nursing students indicated that they have never reported suspected cases of child abuse to CPS and some of the reasons for this could be the lack of experience, and proper training and education on child abuse. Regardless of the reason, nursing students should be given adequate education to improve their confidence and attitude in identification and reporting of child abuse cases. Nursing schools could focus on including more hands on activity such as case studies and simulation to improve knowledge. Employers could try to utilize protocols to help identify child abuse.
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Date Issued: 2017
Identifier: CFH2000208, ucf:45966
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH2000208

Title: EXPLORING THE RELATIONSHIP BETWEEN SYMPTOM MANAGEMENT AND DISTRESS IN PEDIATRIC ONCOLOGY NURSES.
Creator: Schultz, Amanda M, Loerzel, Victoria, University of Central Florida
Abstract / Description: Pediatric oncology is known to be a stressful work environment due to the difficult aspects regarding patient care. This known stress related to work and caring for pediatric oncology patients can negatively impact nurses, patients, and families. The purpose of this study is to examine: relationships between patient symptom management and nurse distress; strategies used by nurses to manage symptoms in pediatric patients with cancer; nurse perceptions of the effectiveness of non-pharmacologic...
Show morePediatric oncology is known to be a stressful work environment due to the difficult aspects regarding patient care. This known stress related to work and caring for pediatric oncology patients can negatively impact nurses, patients, and families. The purpose of this study is to examine: relationships between patient symptom management and nurse distress; strategies used by nurses to manage symptoms in pediatric patients with cancer; nurse perceptions of the effectiveness of non-pharmacologic or nursing interventions; and nurse distress related to managing symptoms in pediatric patients with cancer. Registered nurses (N=13) at a local children's hospital participated in an online survey. The survey included the Nurses' Distress and Interventions for Symptoms Survey (NDISS) and the Stressor Scale for Pediatric Oncology Nurses (SSPON). Descriptive and correlation statistics were used to analyze data. Results showed that the most commonly managed symptoms were pain (100%), nausea/vomiting (100%), hair loss (100%), fatigue (92.3%), worry (92.3%), mouth sores (84.6%), and trouble sleeping (69.2%). On average, participants reported using at least 10 strategies to manage these symptoms. The most common strategies included: active listening, encouraging family involvement, family support, and reducing sleep interruptions. Most participants felt like they managed the symptoms effectively. Overall, the most common stressors for pediatric oncology nurses were related to co-workers (71.8%) and system demands (68.9%). There was no statistically significant relationship between symptom management and nurse distress. Further research should be conducted on the relationship between nurses and significant stressors other than symptom management. Identifying these significant stressors, especially related to co-workers and system demands, would be the first step in the development of appropriate interventions, such as supportive programs, for decreasing nurses' stress response.
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Date Issued: 2017
Identifier: CFH2000154, ucf:45987
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH2000154

Title: NURSE PRACTITIONER STUDENT KNOWLEDGE AND ATTITUDES TOWARDS SKIN CANCER ASSESSMENTS.
Creator: Woodmansee, Ryan, Loerzel, Victoria, University of Central Florida
Abstract / Description: Background: Skin cancer is the most commonly diagnosed cancer each year in the United States. With skin cancer and the demand for nurse practitioners (NPs) in primary care both on the rise, an accurate assessment of how well NP students are being prepared to perform skin cancer assessments is needed. Patient outcomes are directly linked to early detection and treatment which is essential for all types of skin cancer, especially melanoma. Nurse Practitioners need to be able to recognize the...
Show moreBackground: Skin cancer is the most commonly diagnosed cancer each year in the United States. With skin cancer and the demand for nurse practitioners (NPs) in primary care both on the rise, an accurate assessment of how well NP students are being prepared to perform skin cancer assessments is needed. Patient outcomes are directly linked to early detection and treatment which is essential for all types of skin cancer, especially melanoma. Nurse Practitioners need to be able to recognize the early stages of malignancy versus benign skin lesions and perform accurate skin examinations. The ability to assess practitioners' knowledge while they are still students will give us a better understanding of how well they are being prepared to perform skin cancer assessments in primary practice. This information will inform educators where improvement in skin cancer education is needed. Methodology: Following IRB approval, nurse practitioner students enrolled in a gerontology course fall 2016 were invited to participate in this exploratory, descriptive study. Twenty NP students completed the Knowledge, Attitudes and Practice of Skin Cancer Assessments (KAP-SCA) survey. The survey has 80 questions about lesion identification, knowledge of general skin facts, education in NP Program, and knowledge, attitudes, and confidence levels during skin care assessments. Descriptive statistics (frequencies and percentages) were used to analyze demographics. Total scores and subscale scores for the KAP-SCA instrument were examined with descriptive statistics. Spearman's Rho statistics were used for correlations among knowledge, attitude, training and practice. Results: The typical NP student was female, age 31 years and enrolled in the family nurse practitioner program at UCF. The majority of NP students had an average knowledge score for general skin cancer knowledge and photo lesion identification questions. However, the majority (70%) of NP students did not agree that the dermatology training they received in their NP program prepared them for practice. Discussion: Most NP students do not feel confident performing skin cancer assessments and basic dermatology procedures upon graduation. Most NP students had a difficult time differentiating between benign and malignant lesions, and would refer the patient to a specialist due to their lack of knowledge or confidence in diagnosis. Conclusions: Information obtained from the KAP-SCA survey demonstrated that the majority of NP students lacked confidence performing skin cancer assessments and had difficulty recognizing if a lesion was benign or malignant. This information can be helpful in informing educators on where improvement in skin cancer education is needed in NP programs.
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Date Issued: 2017
Identifier: CFH2000153, ucf:45925
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH2000153

Title: NURSING KNOWLEDGE AND PERCEIVED COMFORT LEVEL IN ACUTE INFUSION REACTIONS FROM ANTINEOPLASTIC AGENTS.
Creator: Maiorini, Andrea L, Loerzel, Victoria, University of Central Florida
Abstract / Description: INTRODUCTION: Acute infusion reactions from antineoplastic agents can include hypersensitivity reactions, anaphylaxis, and cytokine release infusion reactions. Severe acute infusion reactions happen in about 5% of the oncology patient population and nurses are responsible for assessment and management of the reaction. This is a high-stress task for a nurse magnified by the lack of exposure. This project explores nursing knowledge and perceived comfort level of acute infusion reactions caused...
Show moreINTRODUCTION: Acute infusion reactions from antineoplastic agents can include hypersensitivity reactions, anaphylaxis, and cytokine release infusion reactions. Severe acute infusion reactions happen in about 5% of the oncology patient population and nurses are responsible for assessment and management of the reaction. This is a high-stress task for a nurse magnified by the lack of exposure. This project explores nursing knowledge and perceived comfort level of acute infusion reactions caused by antineoplastic agents. METHODOLOGY: An original survey was created to test nursing knowledge and assess comfort level. Nursing knowledge was broken down into six subscales: general knowledge of acute infusion reactions, signs and symptoms of hypersensitivity, anaphylaxis, and cytokine release infusion reaction, and drugs most likely to cause hypersensitivity and anaphylactic reactions and cytokine release infusion reactions. Comfort questions were asked on a 6-point Likert scale from extremely uncomfortable to extremely comfortable. There was an additional section in the survey related to nurses' distress and support in situations with acute infusion reactions. The questions were presented using a 6-point Likert scale ranging from strongly disagree to strongly agree. There were two open-ended questions that were designed to allow the nurses to share any additional information about their experiences with acute infusion reactions. Oncology nurses working with adults and pediatric populations were invited to participate. Descriptive statistics were used to analyze the survey results. T tests were used to compare groups and Pearson R statistics were used to examine relationships between total knowledge, knowledge subscale score, and comfort level. RESULTS: 20 nurses completed the survey. 12 were from the adult nurse population and 8 were from the pediatric nurse population. The typical participant was forty-four years of age, had sixteen years experience as a Registered Nurse, and thirteen years experience in the oncology setting. The average total knowledge score was a 56% based on 84 possible points. The basic knowledge section and the anaphylactic signs and symptoms were the highest scoring subscales, both scoring a 62%. Cytokine release infusion reaction signs and symptoms was the lowest scoring subscale with a 45%. There were no significant differences in knowledge between groups. The nurses chose an overwhelming agree/strongly agree when asked to choose the signs and symptoms related to each type of infusion reaction. The total comfort level score indicated that nurses were very comfortable managing acute reactions. There was no significant difference between the adult and pediatric setting comfort level scores. There was no statistically significant relationship between total knowledge score and total comfort level score. DISCUSSION: The knowledge score showed knowledge deficits while the comfort score indicated confidence in management of acute infusion reactions. The high frequency of agree/strongly agree for all three subscales of signs and symptoms indicates that the nurses at least know what to look for even if they cannot assign the specific sign and symptom to the type of infusion reaction. Knowledge about signs of specific types of drug reactions may not be necessary as long as a basic understanding of what to look for and how to manage a reaction is present.
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Date Issued: 2016
Identifier: CFH2000077, ucf:45564
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH2000077

Title: MENTAL HEALTH INTERVENTIONS FOR ADOLESCENT CANCER PATIENTS.
Creator: Faherty, Kelsey A, Loerzel, Victoria, University of Central Florida
Abstract / Description: Background: According to the National Cancer Institute (2017) approximately 15,270 individuals' ages 0 to 19 years would be diagnosed with cancer in 2017. Although pediatric cancer survival rates continue to rise, there are high rates of anxiety, fear, and depression amongst this population. The purpose of this literature review was to explore mental health interventions for adolescent cancer patients. Methodology: A total of 165 articles were found in a literature search. Databases used...
Show moreBackground: According to the National Cancer Institute (2017) approximately 15,270 individuals' ages 0 to 19 years would be diagnosed with cancer in 2017. Although pediatric cancer survival rates continue to rise, there are high rates of anxiety, fear, and depression amongst this population. The purpose of this literature review was to explore mental health interventions for adolescent cancer patients. Methodology: A total of 165 articles were found in a literature search. Databases used include: CINAHL Plus with Full Text, Cochrane Center Register of Controlled Trials, Cochrane Clinical Answers, MEDLINE, and PsycINFO. As results were further narrowed based on relevance and set limiters a total of 7 articles were used for the purpose of this review. Results: Multiple interventions were used in the purpose of this review including therapeutic play, animal-assisted activities, complementary and alternative medicine interventions, and coping and stress reduction interventions. Interventions used significantly decreased anxiety, fear, and depression amongst adolescent cancer patients. Conclusion: One intervention was not more successful than another. Interventions that included participants in their plan of care, promoted normalcy, and were developmentally appropriate were successful at decreasing anxiety, depression, and fear in adolescent cancer patients.
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Date Issued: 2018
Identifier: CFH2000365, ucf:45791
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH2000365

Title: ONLINE SUPPORT GROUP FOR CHINESE WOMEN WITH OVARIAN OR CERVICAL CANCER.
Creator: Xing, Yuan, Loerzel, Victoria, University of Central Florida
Abstract / Description: Women with gynecological (GYN) cancer experience a wide spectrum of physical, emotional and social effects after diagnosis and treatment of their cancer. The insufficient availability of local support groups, limited transportation for the rural Chinese population and a shortage of oncologists make it difficult to have face-to-face support groups for Chinese GYN cancer patients. However, the wide access of Internet has provided an opportunity for people to have online support groups. The...
Show moreWomen with gynecological (GYN) cancer experience a wide spectrum of physical, emotional and social effects after diagnosis and treatment of their cancer. The insufficient availability of local support groups, limited transportation for the rural Chinese population and a shortage of oncologists make it difficult to have face-to-face support groups for Chinese GYN cancer patients. However, the wide access of Internet has provided an opportunity for people to have online support groups. The purpose of this study was to observe and describe the types of support given to and by Chinese GYN cancer survivors in a QQ chat group. This was a qualitative study that used the directed content analysis approach. A QQ group was observed for two weeks between March 10th (12:01am) and March 24st (11:59pm) 2018 Beijing time. Observed online posts were copied and pasted into a WORD ™ document for analysis. There were 4 themes observed: sharing experience, information exchange, emotional support and Guardian Against Cancer group member benefits. The results of the study suggested that women supported each other but little evidence-based support was observed. Healthcare providers should be monitoring and engaging in conversations with group members. Well-planed and organized information sessions should also be beneficial for members. Further research on understanding members' needs on online support groups and the effectiveness of intervention should be conducted.
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Date Issued: 2018
Identifier: CFH2000382, ucf:45808
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH2000382

Title: INTENSIVE CARE IN ONCOLOGY: ADMISSION AND OUTCOMES IN ADULT PATIENTS WITH CANCER.
Creator: John, Surya, Loerzel, Victoria, University of Central Florida
Abstract / Description: Background: Historically, patients with cancer have been perceived as poor candidates for ICU admission. General ICU admission criteria lists cancer patients as low priority in ICU admission depriving them of the care they rightfully deserve. The purpose of this literary synthesis was to examine ICU admission criteria, risk factors, and outcomes of ICU admission in relation to hematological and solid tumor cancers and discuss ways that practitioners and nurses can educate patients with cancer...
Show moreBackground: Historically, patients with cancer have been perceived as poor candidates for ICU admission. General ICU admission criteria lists cancer patients as low priority in ICU admission depriving them of the care they rightfully deserve. The purpose of this literary synthesis was to examine ICU admission criteria, risk factors, and outcomes of ICU admission in relation to hematological and solid tumor cancers and discuss ways that practitioners and nurses can educate patients with cancer and their families on appropriateness of ICU care. Methods: A total of 768 articles were found in a literature search including all literature from 2005 to 2016 from all countries using the databases CINAHL Plus, MEDLINE, PsycINFO, and Academic Search Premier. These were further narrowed down based on relevancy by topic or reading abstracts. A total of 13 articles utilizing the inclusion and exclusion criteria of the literature search were included in the final literature synthesis. Results: In addition to general ICU admission criteria several other criteria and scores can be helpful in admitting patients with cancer to the ICU including cancer specific criteria, mortality predictor tools, performance status, and ICU trials. Mortality predictors, in combination with other patient characteristics, demonstrated effectiveness to predict outcomes in patients with cancer. Survival rates in hematological and solid tumor cancers have improved from the past, and lower prognostic scores can predict who will have better outcomes. Conclusion: Cancer specific criteria, mortality predictor tools, performance status, and ICU trials in addition to general ICU criteria should be used for admission of cancer patients into ICU. Practitioners and nurses should become familiar with the newest outcomes in patients with cancer to make collaborative informed decisions about ICU admission.
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Date Issued: 2016
Identifier: CFH2000093, ucf:45522
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH2000093

Title: YOUNG ONSET DEMENTIA: THE CHILD'S EXPERIENCE WITH COPING.
Creator: Zeher, Jamie, Loerzel, Victoria, University of Central Florida
Abstract / Description: Young onset dementia (YOD) affects not only the person diagnosed, but the family unit as a whole. It is estimated that as many as 500,000 people in the United States have YOD and around 250,000 children are involved in caring for these people. A child of a parent with YOD can begin to experience negative effects when the child begins to take part in caregiving for the person with young onset dementia (PWYOD). Feelings of stress, anger, fear of the future, depression, social isolation, and...
Show moreYoung onset dementia (YOD) affects not only the person diagnosed, but the family unit as a whole. It is estimated that as many as 500,000 people in the United States have YOD and around 250,000 children are involved in caring for these people. A child of a parent with YOD can begin to experience negative effects when the child begins to take part in caregiving for the person with young onset dementia (PWYOD). Feelings of stress, anger, fear of the future, depression, social isolation, and increasing responsibility of caring for the PWYOD can be felt by children as caregivers. Research shows that children of people with YOD have reported an extreme lack of support and decreased communication within the family. The purpose of this thesis was to examine current interventions designed to improve coping for children of parents with YOD. A review of literature using CINAHL, Medline, and PsychINFO was conducted to gather peer-reviewed articles and journals relating to interventions to help children of parents with YOD cope. However, no studies have discussed interventions specifically for the child. Therefore, information was pulled from 5 studies regarding what children of people with YOD feel has helped them, in their respective experiences, to deal with the stresses of a parent with YOD. Research suggests that individualized care should be provided for these children based on: age, developmental stage, and experience. Children have reported that they cope by spending time away from the home, participating in extracurricular activities, and spending time with friends. Clear communication by all members of the family is also reported to be vital in easing the stresses of caring for a parent with YOD. While children have developed these coping mechanisms, interventions need to be formally designed and their effect on improving coping examined. Analyzing the experiences of the children with parents with YOD is necessary for clinicians to gain insight into what interventions worked for this population, and what interventions need to be created for further and more individualized support.
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Date Issued: 2013
Identifier: CFH0004405, ucf:45147
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH0004405

Title: INTERVENTIONS FOR TREATMENT RELATED SIDE EFFECTS IN OLDER WOMEN WITH BREAST CANCER.
Creator: Suarez, Stephanie, Loerzel, Victoria, University of Central Florida
Abstract / Description: Over half (57%) of the women diagnosed with breast cancer are age 65 and older. Treatment for breast cancer may exacerbate current chronic illnesses and/or cause multiple treatment related side effects such as insomnia, fatigue, decreased physical functioning, alterations in body image, poorer quality of life, and changes in psychosocial health. While many women with breast cancer experience these changes, research suggests that older women have different needs than younger women and may not...
Show moreOver half (57%) of the women diagnosed with breast cancer are age 65 and older. Treatment for breast cancer may exacerbate current chronic illnesses and/or cause multiple treatment related side effects such as insomnia, fatigue, decreased physical functioning, alterations in body image, poorer quality of life, and changes in psychosocial health. While many women with breast cancer experience these changes, research suggests that older women have different needs than younger women and may not always benefit from interventions. The purpose of this integrative review of literature was to evaluate interventions designed to improve treatment related side effects in female breast cancer survivors age 65 years and older. This review of literature was conducted using CINAHL, PsycINFO, and MEDLINE databases using various key terms. Inclusion criteria consisted of peer reviewed research articles, women who have experience breast cancer, interventions directed at decreasing side effects, and research articles written in the English language.While using these search criteria, no interventions were found therefore, the age group was lowered to include women 50 and older. Eleven studies met the inclusion criteria. Interventions addressed a variety of treatment related side effects and were delivered in multiple formats. The findings indicate that interventions resulted in a significant improvement in sleep and fatigue, physical function, perception of body image, psychosocial health, and quality of life for older women with breast cancer. While these findings are positive, the literature did not break down results based on developmental stage or "older" age groups. Currently, there is limited literature that examines interventions in women age 65 and older, this may limit nurses' ability to suggest successful interventions to some of our oldest cancer survivors.
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Date Issued: 2013
Identifier: CFH0004393, ucf:44990
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH0004393

Title: NURSING ATTITUDES TOWARD THE USE OF REPROCESSED SINGLE-USE MEDICAL DEVICES.
Creator: Maben-Tenney, Laura, Loerzel, Victoria, University of Central Florida
Abstract / Description: BACKGROUND: Before the implementation of single-use devices (SUD) in health care, medical equipment was sterilized and reused. Now many medical devices are used once and then thrown away, contributing to the 5.9 million tons of medical waste produced yearly. This project explores nursing attitudes toward single-use medical devices, evaluates current recycling practices and examines whether student nurses would be likely to use reprocessed SUDs in their practice if given the option....
Show moreBACKGROUND: Before the implementation of single-use devices (SUD) in health care, medical equipment was sterilized and reused. Now many medical devices are used once and then thrown away, contributing to the 5.9 million tons of medical waste produced yearly. This project explores nursing attitudes toward single-use medical devices, evaluates current recycling practices and examines whether student nurses would be likely to use reprocessed SUDs in their practice if given the option. METHODOLOGY: After obtaining IRB approval, students enrolled in nursing research courses were invited to participate in this exploratory study. 157 undergraduate nursing students completed the 46-question survey. Descriptive statistics were used to analyze the survey results, independent t-tests were used to compare groups and content analysis was used to analyze open-ended responses. RESULTS: The typical student was female, age 30, licensed as a registered nurse and enrolled in the RN to BSN program. Most students (84.7%) viewed themselves as environmentally conscious, and most recycle at home (75.5%) and at work (54.7%). Most agreed (96.8%) that hospitals produce a lot of hazardous waste and that it is the hospitals responsibility for environmentally friendly waste disposal. The majority also agreed (80%) that nurses have the ability to impact waste production at a hospital. More than half (67.7%) agreed that SUD disposal contributes to environmental pollution and many (76.6%) felt that nurses should be responsible for environmental health concepts. Most (81.6%) felt that SUDs should be thrown out after one use and few (28.5%) felt that SUDs can be reused if sterilized. Most (74.0%) also believed that SUD reuse contributes to hospital acquired infections, but a little more than half (56.3%) were willing to reuse a SUD that had only touched intact skin if sterilized for reuse. Additionally, most respondents (79.1%) would consider joining a green team at work. Those who recycle at home were more likely to identify as environmentally conscious than those who do not recycle at home. No generational differences existed when considering environmental consciousness. Generation X was more likely to recycle at home than Generation Y, but no generational differences existed when analyzing work recycling habits. Generation X was also more likely to see single-use device disposal as contributing to environmental pollution than Generation Y. Home recyclers were more likely to agree that nurses have the ability to decrease the amount of hospital trash production, and more likely to join a green team than non-recyclers. They also believed that SUD disposal contributes to environmental pollution, SUDs can be reused if sterilized, and disagreed that SUD reuse contributes to hospital acquired infections when compared to those who do not recycle at home. Discussion: While most students agree that hospitals produce large amounts of waste and should be responsible for the disposal of it in an environmentally friendly manner, most are hesitant to use reprocessed SUDs as a means to make the hospital more environmentally friendly. Student responses indicated the largest perceived barriers to SUD reuse were fears of inadequate sterilization and fears of the spread of disease. CONCLUSIONS: Most students, especially home recyclers, believe themselves to be environmentally conscious and most were willing to consider reusing some SUDs. Translating this belief into action can happen through education in line with the Scope and Standards of practice for nursing, as well as establishing the safety of SUDs through further research.
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Date Issued: 2012
Identifier: CFH0004243, ucf:44939
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH0004243

Title: THE ACQUISITION OF STUDENT NURSES' KNOWLEDGE OF GENETICS AND GENOMICS AND ATTITUDES TOWARD THE APPLICATION OF THEIR KNOWLEDGE IN CLINICAL PRACTICE.
Creator: Munroe, Theresa, Loerzel, Victoria, University of Central Florida
Abstract / Description: BACKGROUND: Nurses have the opportunity to bring a unique perspective to genetic and genomic healthcare through their emphasis of health promotion, prevention, screening, caring, and patient, family, and community relationships. Nurses are expected to have genetic and genomic knowledge that can be integrated into clinical practice. However, researchers today are finding nursing students are not competent or comfortable in the clinical applications of genetics and genomics, even though these...
Show moreBACKGROUND: Nurses have the opportunity to bring a unique perspective to genetic and genomic healthcare through their emphasis of health promotion, prevention, screening, caring, and patient, family, and community relationships. Nurses are expected to have genetic and genomic knowledge that can be integrated into clinical practice. However, researchers today are finding nursing students are not competent or comfortable in the clinical applications of genetics and genomics, even though these students will soon be working in healthcare as it advances in these fields. The purpose of this research was to evaluate the genetic and genomic knowledge of nursing undergraduate students and explore their attitudes about using this knowledge in practice. METHOD: A pre- and posttest design was used. Student knowledge was measured online using the Genomic Nursing Concept Inventory (GNCI) in both tests. Demographic questions were included in the pretest and questions regarding attitudes toward comfort and readiness to apply that knowledge were included in the posttest. The pretest was administered at the beginning of the Spring 2014 semester. The posttest was administered at the end of the same semester, after the nursing students received the majority of genetic and genomic instruction from their program's curriculum. Descriptive statistics were used to examine all data. Total and subscale knowledge scores on the GNCI were computed for each test. A paired t-test was used to compare pre- and post-GNCI total and subscale scores. Correlations were calculated at both time points. A Spearman correlation was used to examine the relationship between prior experience with genetic education or exposure to people with a genetic condition and total pre-score knowledge on the pretest. For the posttest, a total attitude score was calculated to examine the relationship between attitude and post total knowledge scores using a Pearson's r correlation. FINDINGS: 109 undergraduate junior nursing students participated. Gains in total and subscale knowledge between the pre- and posttest were statistically significant (p [less than] 0.05), except for the Mutations subscale. For the pretest GNCI, the average mean score was 45%, which improved to 50% at the time of the posttest. Lowest scoring items were in the Genome Basics subscale, whereas highest scoring items were found within the Inheritance subscale for the posttest. Mean total attitude scores were 28.33 (SD = 5.17) indicating students had a relatively positive attitude towards using their knowledge base in practice. The majority of students (87.1%) agreed that it is important for the nurse to incorporate genetic and genomic knowledge into clinical practice although only 34.9% felt ready to do so. DISCUSSION: Genetics and genomic knowledge and preparedness were low among nursing students. This demonstrates a need for more integration of genetic and genomic content within nursing curriculum, including a review of basic concepts. Nurses are expected to perform comprehensive health assessments by incorporating knowledge of genetic, environmental, and genomic influences and risk factors. Lack of a basic understanding could lead to patient consequences related to inadequate risk assessment, referrals for genetic counseling, and patient education.
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Date Issued: 2014
Identifier: CFH0004648, ucf:45290
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH0004648

Title: EDUCATION FOR PEDIATRIC ONCOLOGY NURSES ON FERTILITY PRESERVATION OF PEDIATRIC ONCOLOGY PATIENTS.
Creator: Breit, Elyse, Loerzel, Victoria, University of Central Florida
Abstract / Description: Although the survival rate of childhood cancer is high, nearly two thirds of these survivors experience negative long-term secondary side effects from cancer treatments. Infertility is one such side effect that can have a prominent impact on quality of life as the patient ages. It is important for nurses working with pediatric oncology patients to provide the patient and family with education about risk for infertility and fertility preservation (FP) in order to allow families to make...
Show moreAlthough the survival rate of childhood cancer is high, nearly two thirds of these survivors experience negative long-term secondary side effects from cancer treatments. Infertility is one such side effect that can have a prominent impact on quality of life as the patient ages. It is important for nurses working with pediatric oncology patients to provide the patient and family with education about risk for infertility and fertility preservation (FP) in order to allow families to make decisions about FP before cancer treatment starts. However, pediatric oncology nurses report being uneducated about FP guidelines and are hesitant to broach this subject with families. The purpose of this HIM thesis is to review nurse perceived barriers related to educating patients and their families about the risk for infertility following cancer treatments and FP and to make recommendations for improving communication between nurses and families about FP. A search was performed using CINAHL, PreCINAHL, PsychINFO, PsychARTICLES, and Medline databases and examined peer-reviewed quantitative and qualitative research studies. Key terms used in the database searches were ped* OR child*, onco* OR cancer*, fert*, and nurs*. Findings indicated that there were many barriers for pediatric oncology nurses, which inhibited the discussion of FP with patients and families such as lack of knowledge and resources, provider attitudes toward FP, and patient factors. Based on the findings, the researcher identified several interventions to aid pediatric oncology nurses in overcoming these barriers to FP discussion.
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Date Issued: 2014
Identifier: CFH0004620, ucf:45295
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH0004620

Title: QUALITY OF LIFE IN OLDER BREAST CANCER SURVIVORS.
Creator: Loerzel, Victoria, Meneses, Karen, University of Central Florida
Abstract / Description: Quality of life (QoL) in cancer survivors is an important area of research. While data are available about QoL and breast cancer, there is a paucity of research regarding older breast cancer survivors. The purpose of this research was to examine QoL in older women with early stage breast cancer, within the first year of post-treatment survivorship. The specific aims of this study were to: 1) Describe the changes in overall QoL and the four QoL domains of Physical, Psychological, Social, and...
Show moreQuality of life (QoL) in cancer survivors is an important area of research. While data are available about QoL and breast cancer, there is a paucity of research regarding older breast cancer survivors. The purpose of this research was to examine QoL in older women with early stage breast cancer, within the first year of post-treatment survivorship. The specific aims of this study were to: 1) Describe the changes in overall QoL and the four QoL domains of Physical, Psychological, Social, and Spiritual well-being; 2) Examine the effects of a psychoeducational support intervention on QoL outcomes in older women; and 3) Describe nurses' perceptions of their interactions with older breast cancer survivors. A descriptive, longitudinal design was used to answer the research questions. Data for this study were drawn from the Breast Cancer Education Intervention (BCEI), a longitudinal psychoeducational support intervention for women with early stage breast cancer. Fifty women from the BCEI who were 65 years of age and older were included in this sample, of whom 24 were assigned to the Experimental (EX) Group and 26 were assigned to the Wait Control (WC) Group. Data were collected at three time points: baseline, three months, and six months after study entry. Measurement tools included the BCEI Demographics Form, the Quality of Life-Breast Cancer Survey (QoL-BC), and field notes of the BCEI Research Nurses. The QoL-BC survey is a 50-item scale that measures QoL in women with breast cancer. Descriptive statistics, Generalized Estimating Equation (GEE) methods and t-tests were used to answer research questions #1 and #2. Content analysis was used to answer research question #3. Subjects reported good overall QoL at baseline, but QoL declined over six months. Physical and Psychological well-being declined from baseline to six months later. Social well-being initially improved from baseline to three months but declined at six months. Spiritual well-being initially declined at three months and improved at six months. There was insufficient power to detect a difference in the effects of the BCEI Intervention between the two groups. However, the decline in overall QoL was less in the EX Group. Field notes focusing on nurses' perception of their interactions with older women revealed four themes. These themes include: continuing breast-related health, personal health issues, family health issues, and potential stressors. Results from this study suggest that: 1) changes in overall QoL and within the four QoL domains occur over time; 2) decline in overall QoL was lessened by the BCEI Intervention; and 3) concerns after treatment are both breast cancer and non-breast cancer related. Study findings can direct future research in the following areas: 1) identification of specific concerns within each QoL domain that could lead to an increase or decrease in well-being in older breast cancer survivors; 2) interventions tailored to the needs of older breast cancer survivors to maintain, improve, or lessen decline in QoL after treatment; and 3) reconceptualizing QoL in older breast cancer survivors to include non-cancer related factors.
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Date Issued: 2007
Identifier: CFE0001720, ucf:47298
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0001720

Title: EVALUATING OUTCOMES OF EDUCATION ON WASTE MANAGEMENT IN THE HOSPITAL SETTING.
Creator: Schlather, Taryn N, Decker, Jonathan, Loerzel, Victoria, University of Central Florida
Abstract / Description: With advancements in healthcare, we continue to find new needs that must be addressed. Hospitals generate a substantial amount of medical waste, and proper disposal is important for patient and staff safety, environmental protection, and cost efficiency. A series of studies show there is a need for further education on hospital waste management policies. This thesis aims to evaluate education interventions to improve knowledge and healthcare waste disposal practices. This literature review...
Show moreWith advancements in healthcare, we continue to find new needs that must be addressed. Hospitals generate a substantial amount of medical waste, and proper disposal is important for patient and staff safety, environmental protection, and cost efficiency. A series of studies show there is a need for further education on hospital waste management policies. This thesis aims to evaluate education interventions to improve knowledge and healthcare waste disposal practices. This literature review was conducted using multiple databases, including MedLINE, CINAHL, GreenFILE, Google Scholar, EBSCOhost, and NCBI, to find qualifying research articles in the English language from 2005-2018. Key terms for the searches were: education, training, waste, disposal, healthcare, medical, reduction, hospital, pound, and kilogram. Results demonstrate that further education on hospital waste management has the potential to reduce waste, improve disposal and segregation, and reduce costs. However, the lack of consistency in the research, literature, and educational interventions all pose as limitations. Hospitals have the potential to benefit from improved waste management practices by enhancing patient care, reducing waste, saving costs on waste disposal, and protecting the environment.
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Date Issued: 2018
Identifier: CFH2000377, ucf:45822
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH2000377

Title: EXPLORING WHAT IT IS LIKE TO BE AN UNDOCUMENTED ALIEN IN SEEK OF HEALTHCARE.
Creator: Torrez Pon, Eliany C, Loerzel, Victoria, Chase, Susan, University of Central Florida
Abstract / Description: Currently, there are about 11.8 million undocumented aliens in the United States who are not eligible for public insurance or any type of private coverage obtained through the American Health Care Act of 2017. This creates barriers to healthcare for this large population and has negative implications for the healthcare system. Despite the availability of clinics and low-cost healthcare, this group tends to underuse resources or seek healthcare for emergencies only which leads to increased...
Show moreCurrently, there are about 11.8 million undocumented aliens in the United States who are not eligible for public insurance or any type of private coverage obtained through the American Health Care Act of 2017. This creates barriers to healthcare for this large population and has negative implications for the healthcare system. Despite the availability of clinics and low-cost healthcare, this group tends to underuse resources or seek healthcare for emergencies only which leads to increased cost totaling approximately $1.1 billion a year. The goal of this qualitative study is to better understand what it is like to be an undocumented alien seeking healthcare. Eight semi-structured interviews with Latino undocumented aliens were conducted. Interviews were transcribed into WORD documents and reviewed for accuracy. Data was analyzed using content analysis to code and identify prominent themes. Analysis of data from participants indicate the following themes embody the experience of being an undocumented alien in seek of healthcare: living in the unsure, high costs, system barriers, language and communication incongruences, perceived discrimination, exploitation and deportation, and relief in finally getting care. Undocumented aliens put off getting healthcare as long as possible due to these factors, despite having many needs. Healthcare practitioners must become familiar with these experiences to address and correct these barriers. Advocacy and healthcare changes take on increasing urgency to ensure the well-being of these individuals.
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Date Issued: 2018
Identifier: CFH2000316, ucf:45886
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH2000316

Title: PRE-LICENSURE NURSING STUDENT ATTITUDES TOWARD PHYSICIAN-ASSISTED SUICIDE.
Creator: Cox, Stephanie K, Conner, Norma E., Loerzel, Victoria, University of Central Florida
Abstract / Description: Physician assisted suicide (PAS) has been a legalized presence in the United States since Oregon first passed the Death with Dignity Act in 1994. Now PAS is legalized in six states and it is realistic that nurses may encounter PAS during their career. This project explores pre-licensure nursing student attitudes toward PAS. A mixed method design incorporating descriptive correlation and thematic analysis of an open-ended question was used. Surveys were sent to 550 nursing students enrolled in...
Show morePhysician assisted suicide (PAS) has been a legalized presence in the United States since Oregon first passed the Death with Dignity Act in 1994. Now PAS is legalized in six states and it is realistic that nurses may encounter PAS during their career. This project explores pre-licensure nursing student attitudes toward PAS. A mixed method design incorporating descriptive correlation and thematic analysis of an open-ended question was used. Surveys were sent to 550 nursing students enrolled in the UCF nursing program asking participants to complete the 34-question survey. This survey included a 12 item "Domino scale" on student nursing opinions toward physician-assisted suicide, and a 23-item demographic scale. Complete, usable results were obtained from 231 participants. Demographic data revealed that the typical participant was between 18 and 25 years of age (80%), female (82%), single (87%), white (69%), in their first two semesters of the nursing program (60%), and unemployed (56%). The total scores for the Domino scale indicated a mean of 40. Regression analyses found that participant experience of someone having asked for help with PAS, and participant religiosity were significant predictors (F = 9.82, p = .0019; and F= 160.36, p < .0001) respectively of nursing student opinions on PAS as measured by the Domino scale. Qualitative analysis produced the following themes related to participant opinion on the nurse's role in PAS: ways nurses can help with PAS, nurses should not be involved with PAS, clarification and delineation of the PAS process, the preservation of autonomy, the need for more education and inaccurate assumptions of PAS. This study showed that nursing students are moderately in support of PAS and willing to provide care to patients who are terminally ill regardless of a his or her personal decisions regarding PAS. Participants also comment that they desire additional education. Suggestions for further education, practice enhancements, research and policy development are discussed.
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Date Issued: 2018
Identifier: CFH2000387, ucf:45921
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH2000387

Title: BSN STUDENTS' OPINIONS OF MENTALLY ILL PATIENTS.
Creator: Chugh, Kavika, Dever, Kimberly, Loerzel, Victoria, University of Central Florida
Abstract / Description: Compassionate care, or humanism, should be available to all patients, but the stigma associated with mental illness is a barrier to many people receiving the appropriate care. Views held by Bachelor of Science in Nursing (BSN) students can vary from custodial, or the belief in a traditional medical model which involved a highly controlled setting for all mentally ill patients, to humanistic, or viewing the hospital as a therapeutic community for the human needs of a patient. This study...
Show moreCompassionate care, or humanism, should be available to all patients, but the stigma associated with mental illness is a barrier to many people receiving the appropriate care. Views held by Bachelor of Science in Nursing (BSN) students can vary from custodial, or the belief in a traditional medical model which involved a highly controlled setting for all mentally ill patients, to humanistic, or viewing the hospital as a therapeutic community for the human needs of a patient. This study examines the views of BSN students before their psychiatric clinical experience through a pretest and post-test survey and analyzes for a shift in opinion following the psychiatric clinical experience. This study's aim is to identify the effect of exposure to mentally ill patients on BSN students' opinions of mental illness. A convenience sample of 56 BSN students from the University of Central Florida College of Nursing was used; recruitment happened through an announcement made during the psychiatric mental health lecture. An online survey was distributed before the psychiatric mental health clinical experience, and a post-test survey was done following the conclusion of this clinical experience. Results showed an overall shift toward humanistic views following exposure to mental illness. These results demonstrate the value of the psychiatric mental health clinical experience in developing humanistic views among BSN students. The results of this study complement past research, which has shown that people who have not had experience with mentally ill persons tend to show more negative, custodial views. However, knowledge and experience can shape one�s view in a more humanistic way, opening up nurses to provide compassionate care.
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Date Issued: 2018
Identifier: CFH2000287, ucf:45759
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH2000287

Title: Persistence of Physical Activity Among Veterans.
Creator: Davis, Jean, Edwards, Joellen, Loerzel, Victoria, Weiss, Josie, Kehinde, Julius, University of Central Florida
Abstract / Description: The global burden of disease is staggering in terms of financial costs and human suffering. The general public is aware that physical activity is healthy, although the fact that physical activity can treat and reverse diseases, reduce the risk of cancers, prevent many chronic diseases, stave off cognitive decline, and contribute to quality longevity is less well known. Healthcare practitioners and policymakers are impeded in efforts to support physical activity due to the lack of knowledge of...
Show moreThe global burden of disease is staggering in terms of financial costs and human suffering. The general public is aware that physical activity is healthy, although the fact that physical activity can treat and reverse diseases, reduce the risk of cancers, prevent many chronic diseases, stave off cognitive decline, and contribute to quality longevity is less well known. Healthcare practitioners and policymakers are impeded in efforts to support physical activity due to the lack of knowledge of factors associated with physical activity persistence. The purpose of this dissertation was to determine these factors and identify which predict persistent physical activity among veterans to inform future programs and policies to support physical activity for health. The theorized influence of physical activity habit is addressed in the initial dissertation manuscript. Habits being more difficult to lapse from than to continue made them suitable for investigation to address the knowledge gap identified when no reports of long-term physical activity habits were found. Veterans provided an ideal population to study long-term physical activity habits with, as research indicates that veterans likely formed physical activity habits through recurrent physical activity required to meet the fitness requirements of active duty service. This led to the research reported in the second manuscript. The research was based on theory, literature review, and input from veterans. The integrated theory of health behavior change informed the predictor variables investigated. The explanatory and predictive cross-sectional study of community-dwelling veterans used the web survey method to answer questions of which factors were associated with sufficient or insufficient physical activity among veterans, and which factors were predictive. Recruitment of veterans occurred through Amazon's Mechanical Turk (MTurk(&)#174;) and linked veterans to the survey on Qualtrics(&)#174;. Findings revealed direct associations of exercise self-regulation, social support for exercise, and some service-related and other demographic factors with sufficient or insufficient physical activity. Qualtrics(&)#174; allowed for the presentation of survey questions in a variety of formats. To determine the best format for survey items, a state of the knowledge review was conducted. This review is presented in the final dissertation manuscript. Implications for future research, health education, clinical practice, and health policy are identified. It is expected that the knowledge gained in this study will inform future Veterans Affairs programs, provider practices, public health initiatives, and health care policies to support physical activity practices for healthy longevity.
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Date Issued: 2019
Identifier: CFE0007886, ucf:52783
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0007886

Title: Evaluation of a Mind-Body Website by Women with Breast Cancer.
Creator: Beck, Laura, Loerzel, Victoria, Sole, Mary, Morrison, Kimberly, University of Central Florida
Abstract / Description: Despite having access to volumes of information, women newly diagnosed with breast cancer report a moderate level of distress related to their diagnosis, treatment, life expectancy, threat to current roles, and life-changing surgery and treatment choices. Web sites designed to teach people strategies to reduce distress are readily available online. The online format may be useful and practical for women who can access the site at their convenience, learn the components of the interventions at...
Show moreDespite having access to volumes of information, women newly diagnosed with breast cancer report a moderate level of distress related to their diagnosis, treatment, life expectancy, threat to current roles, and life-changing surgery and treatment choices. Web sites designed to teach people strategies to reduce distress are readily available online. The online format may be useful and practical for women who can access the site at their convenience, learn the components of the interventions at their own pace, and practice the strategies in the comfort of their home. The purpose of this study was to evaluate an online Mind-Body web site (http://www.www.preparingforyoursurgery.com) designed to reduce distress related to surgery for its usability, practicality, and appropriateness for women newly diagnosed with breast cancer. Results of this study will be used to either adopt use of the web site into standard of care at our cancer center or explore development of a similar web site to meet the needs of women newly diagnosed with breast cancer. Women recently diagnosed with breast cancer, who had breast cancer surgery in the past 60 days, were asked to evaluate an online Mind-Body web site and then respond to an online questionnaire measuring the web site usability, practicality, and appropriateness. Thirty-one women evaluated the web site and completed the online survey. The majority of women agreed the web site is useful, practical, appropriate, and would recommend to others. There was no significant relationship between age, income, level of education, frequency of Internet use, or experience with Mind-Body techniques and women who agreed the web site is useful, appropriate, or practical compared to women who were neutral or disagreed the web siteis useful, appropriate, or practical. The results of this study suggest the web site could be introduced to women newly diagnosed with breast cancer at our cancer center regardless of age, income, education, frequency of Internet use, or experience with Mind-Body techniques.
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Date Issued: 2013
Identifier: CFE0005085, ucf:50752
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0005085

Title: Evaluating Moral Distress, Moral Distress Residue and Moral Courage in Oncology Nurses.
Creator: Melhado, Lolita, Chase, Susan, Conner, Norma, Loerzel, Victoria, Uddin, Nizam, Haley, William, University of Central Florida
Abstract / Description: Purpose: To examine relationships between moral distress, moral distress residue, and moral courage and to determine which nurse characteristics are predictive of moral distress and moral courage.Methods: The study used a mixed methods cross-sectional correlation design and qualitative content analysis to investigate oncology nurses' characteristics and relationships between moral distress, moral distress residue, and moral courage. A convenience sample of 187 oncology nurses working in...
Show morePurpose: To examine relationships between moral distress, moral distress residue, and moral courage and to determine which nurse characteristics are predictive of moral distress and moral courage.Methods: The study used a mixed methods cross-sectional correlation design and qualitative content analysis to investigate oncology nurses' characteristics and relationships between moral distress, moral distress residue, and moral courage. A convenience sample of 187 oncology nurses working in inpatient and outpatient settings was recruited through the national Oncology Nursing Society in the Southeastern United States. Hamric's 21-item Moral Distress Scale-Revised (MDS-R) and Sekerka et al. 15-item Professional Moral Courage Scale (PMCS) supplemented with written examples of moral courage were used for data collection. Descriptive statistics, independent-samples t test, Pearson correlation, ANOVA, and multiple regressions analyses were used to evaluate data.Findings: MDS-R scores were not predictive of PMCS scores. No statistically significant differences were found between nurses' characteristics (age, education level, certification, ELNEC training) and MDS-R. Though nurses with BSN had higher Moral Distress scores compared with other levels of education, none were predictors of MDS-R. ANOVA results indicate a marginal but not significant difference of the MDS-R score among the nurses with different basic ethics education (p = .067). Nurses working in adult inpatient settings had significantly higher MDS-R than those in outpatient settings. Nurses who had moral distress residue by virtue of leaving a previous job (26%) and those who considered leaving (28%) reported statistically significantly higher mean Moral Distress levels than those who had not considered leaving. Nurses (17%) currently considering leaving their jobs due to the way patient care was handled at their institutions had the highest Moral Distress mean scores and the lowest Professional Moral Courage scores. Work setting and having left a previous job were weak predictors of MDS-R, accounting for 11.6% of the moral distress score variance (p = .013) compared with 4.4% when work setting was a single predictor (p = .014). Total years' oncology experience was a weak predictor of PMCS, accounting for 2.5% or an inconsequential amount of the variance (p = .043). Moral courage was displayed in major areas of supporting the patient, risk taking, advocacy, enlarging the circle for decision-making, putting aside personal beliefs, respecting patient autonomy, empowering the patient, fighting for the patient in face of consequences in a complex system, sharing information, getting to the meaning, handling tricky situations, protecting the patient and truth-telling.Discussion/Implication: Despite experiencing levels of moral distress, oncology nurses demonstrate support and respect for patients' decision-making and autonomy. Ethics education derived from clinical practice can provide an opportunity for open discussion for nurses to create and maintain morally acceptable work environments that enable them to be morally courageous. This research underscores the presence of moral distress and moral distress residue among oncology nurses and the importance of finding ways to lessen moral distress and strengthen moral courage in nurses.
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Date Issued: 2016
Identifier: CFE0006142, ucf:51175
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0006142

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child (2)	+ -
education (2)	+ -
nurse (2)	+ -
pediatric (2)	+ -
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Advance Care Planning (1)	+ -
Attitudes (1)	+ -
Biotherapy (1)	+ -
Cervical (1)	+ -
Chemotherapy (1)	+ -
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Congruence (1)	+ -
Death with Dignity (1)	+ -
Evaluation of web site (1)	+ -
Family Care Giver (1)	+ -
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Genomics (1)	+ -
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