Research indicates that the rate of immunizations of preschool children living in rural areas is lower than 90%. These too-low rates have been attributed to many factorsin the literature. The need was identified for research into what barriers, if any, parents encounter in getting their children the appropriate immunizations. The objective of this study was to discover if parents living in Wattsburg and Corry, in Erie County Pennsylvania, perceived any reasons for difficulty in getting their preschool children the immunizations they need. Interviewers were trained to use the interview questionnaire in order to maximize interviewer consistency, and to protect the subjects' anonymity. The target population was parents or primary caregivers of children under the age of 7 who resided in either Wattsburg or Corry in rural northwestern Erie County, Pennsylvania. The sample was a convenience sample. The 51 subjects were interviewed using a structured script and survey questionnaire, at three grocery stores located in the two areas of interest. Coupons and magnetic coupon holders were given as incentives to the parents to encourage completion of the interview. Subjects consisted of anyone who was the parent or primary caregiver of a preschool child under the age of seven and willing to complete the interview. The survey consisted of 34 questions designed to elicit both qualitative and quantitative data. The use of a small accidental sample was a limitation of this study. Results of this study confirm the hypothesis. Some parents of preschool children in these two areas do report barriers to immunizations and well child care.

Chlamydia infection in the United States has the highest incidence of all infectious diseases tracked by the Centers for Disease Control and Prevention. It is often without symptoms and there is no rapid, cost-effective test method that provides both high sensitivity and specificity. Consequently, the spread of the disease often occurs by patients who are unaware that they are infected. Gram stain is one test which can be performed relatively quickly and inexpensively. Although not able to directly detect chlamydia, it is capable of detecting the presence of white blood cells (WBCs) indicative of infection. This study sought to examine what relationship may exist between either the presence or absence of WBCs on Gram stain and chlamydia infection. It also sought to identify other clinical factors with relationships to chlamydia infection.

The clinic charts from 54 patients of a public health sexually transmitted diseases clinic in northwestern Pennsylvania, were reviewed. A matched groups design comparing the Gram stain WBC results of patients who tested DNA chlamydia-positive and DNA chlamydia-negative was performed. Other clinical factors were also compared between the two groups.

The purpose of this study was to evaluate whether emergency health care practitioners utilize diagnostic laboratory testing consistent with the guidelines promulgated by the American College of Emergency Physicians (ACEP). In 1994, the Clinical Policy for the Initial Approach to Patients Presenting With a Chief Complaint of Nontraumatic Acute Abdominal Pain was approved by the ACEP board. This policy statement provided suggested guidelines for the diagnostic work-up and treatment for patients presenting with acute abdominal pain. The utilization of established medical protocols for diagnostic testing is closely aligned to the general practice of family nurse practitioners (Murphy, 1997).

This non-experimental, retrospective study involved the review of emergency department medical charts for adult patients with a discharge diagnosis related to cholelithiasis, cholecystitis, and/ or pancreatitis. Permission from the medical center nursing research approval committee was obtained prior to the initiation of data collection. Fifty charts were reviewed comparing the laboratory diagnostic evaluation of this sample with the established ACEP guidelines. This study found that diagnostic testing was consistent with the ACEP guide for gallbladder disease 70% of the time and 77% of the time for pancreatic disease, when excluding the requirement for serum calcium for the pancreatic evaluation. Strict adherence to the pancreatic policy produced an outcome of only 12% compliance with recommended testing.

Approximately 50 million adults in the United States either have elevated blood pressure or are taking antihypertensive medications. Unfortunately only 21% of hypertensive patients are being properly treated in the United States. After reviewing the literature the researcher found no studies that compare knowledge level of nonpharmacological treatments of hypertension and actual blood pressures in older adults.

The propose of the research was to assess the relationship between knowledge level about nonpharmacological treatments for hypertension and blood pressure control in older hypertensive adults. Knowledge of nonpharmacological treatments of hypertension was evaluated with the use of a survey. After the subjects completed the survey the researcher measured their blood pressures with a sphygmomanometer. Mean blood pressures were calculated for all the various knowledge levels. The Pearson r test was utilized to test for a correlation between knowledge level of nonpharmacological treatments of hypertension and blood pressure in the subjects.

The targeted convenience sample was approximately 34 middle aged adults ages 45 years and older that can read English. The setting was in the lobby of a northwest Pennsylvania pharmacy. The subjects were responding to a free blood pressure screening and were asked to participate in the study.

The research hypothesis was that persons with an increased knowledge level of nonpharmacological treatments of hypertension will have lower blood pressures. The study found a negative correlation between blood pressure and nonpharmacological treatments of hypertension, but they were not found to be statistically significant.

The purpose of this study was to determine if women with a family history of breast cancer are adhering to the recommended guidelines for mammography use more often than women without a family history of breast cancer. Literature indicates these women are at high risk for contracting breast cancer and compliance with mammography screening is low (Center for Disease Control, 1997). An existing survey authored by Dr. Anna Miller (Miller & Champion, 1996) that examined demographics, compliance, attitudes, beliefs, influencing factors and knowledge of mammography usage was utilized. The sample consisted of 90 women from 2 sites in northwestern Pennsylvania. The results from this study indicate that women with a family history do not adhere to guidelines more than women without a family history. The compliance rate of having at least one mammogram was 80% in the group with a family history and 78% in the group without a family history of breast cancer. This is higher than what is reported in the literature. Having a health care provider recommend a mammogram was the greatest measure of adherence. The results were consistent with Dr. Miller’s study, and indicate that primary care providers are in a valuable position to influence compliance.

Literature indicates that secondary conditions are preventable in adults with spina bifida provided they receive appropriate healthcare (Rauen & Aubert, 1992). A telephone survey about adults with spina bifida was conducted to determine the reported frequency with which they received primary and specialty care, the incidence of secondary conditions and surgical interventions they had experienced since turning the age of 21, and their level of satisfaction with their primary care provider’s ability to care for their spina bifida. The tool utilized was a researcher-developed survey and assessed if frequency of care impacted on the incidence of secondary conditions, surgical interventions, and level of satisfaction with spina bifida care.

The sample consisted of 30 male and 16 female adults with spina bifida with a mean age of 29.87. The results from this study indicated that adults with spina bifida received more consistent and frequent care if they were seen in an adult spina bifida clinic and that these patients appear to have a lowered incidence of decubitus ulcers, behavioral issues, osteomyelitis, orthopedic and urological surgical procedures, and reactive surgical procedures. This research also found that adults who received healthcare through a spina bifida clinic had a higher level of satisfaction with their primary care provider’s ability to care for their spina bifida. Because of a limited sample size, not all results were statistically significant. It is recommended that further research in this area utilize a larger sample population and a prospective study approach in order to more accurately determine the incidence of secondary conditions.

This non-experimental research study explored the motivational orientations/reasons and psychological motivational dimensions of life space and life chance of registered nurses participating in adult continuing nursing education. The psychological motivational dimensions were then related to participation/persistence and non-participation/drop out according to Roger Boshier's 1973 model of continuing education. This information is valuable to educators in identifying learning needs, planning, designing, implementing, and evaluating continuing education activities for registered nurses. The Education Participation Scale and a Demographic Survey were the tools utilized to collect data from 50 registered nurses attending three different "all day" (7-8 hours) non-college credit continuing nursing education classes offered by an education center in northwestern Pennsylvania. The characteristics of the total sample and statistical treatment/tests included determining the distribution of scores on the EPS for each of the seven motivational factors, the minimum/maximum score and range for each factor, the central tendency and variability for each factor, the Pearson product-moment correlations and the analysis of variance through the one way ANOVA: F-test. The level of significance utilized throughout was p=0.5. Significant motivational factors included professional advancement followed by cognitive interest and educational preparation. The first two factors identified are life space psychological motivational dimensions and the last factor listed is a life chance psychological dimension. According to Boshier’s model, registered nurses are more likely to participate and persist in continuing nursing education than to not participate or dropout. This prediction is dependent on congruency with self/others, and social, psychological, and subenvironmental variables.

The goal of this research was to compare and contrast the elderly and adolescent populations’ knowledge about cholesterol and their lifestyle choices. Data for this study were gathered via a researcher-written survey that was given to elderly and adolescent sample populations in a rural area of western Pennsylvania. Each group consisted of 36 participants. The survey concerned demographics, lifestyle, and knowledge about cholesterol. Quantitative data were analyzed using descriptive statistics for demographics, level of knowledge, and lifestyle comparison.

A knowledge deficit was found in both sample populations. The elderly were able to answer only an average of 9% of the questions about cholesterol and the adolescents answered an average of 34% of these correctly.

The data also showed that the sample populations had several risk factors for developing high blood cholesterol. For example, 58% of the adolescent’s and 31% of the elderly used tobacco products. Thirty-five percent of the elderly population is overweight. The adolescent population was 8% overweight. The median time the elderly exercised four times per week was only 20 minutes whereas the adolescents exercised a median of 45 minutes six times per week. Of those that smoke and are sedentary only 6% were in the elderly population but 14% of the adolescent population fall into this category. More than 41% of the adolescents and only 14% of the elderly did not want additional education about cholesterol.

Teaching about cholesterol is recommended using an adaptation of the American Heart Association’s “Cardiovascular Risk Factor Education Program”. Smoking cessation also needs to be addressed.

The purpose of this study was to explore the relationship between nursing staff members who have positive or negative attitudes towards the change process and their support or nonsupport for the organizational strategic direction. Differences in attitudes towards the change process and degree of organizational support among nursing staff members with different licensure status were evaluated. This study also identified patterns and trends in relation to nursing staff members’ perceptions concerning factors that helped or hindered the successful change process within their organization. With this information, nursing leaders can better understand employees’ reactions to strategic change and implement steps prior to the change process to gain a more successful outcome. A literature review found little concerning nursing staff attitudes toward the process of change. However, the literature documented the rapid change taking place in healthcare institutions across the nation. The research participants in this study were forty-two nursing staff members in two rural hospitals in northwestern Pennsylvania. The research questionnaire utilized in this study consisted of a demographic section, a seven-point Likert scale that measured attitude and organizational support, one yes or no question with a comment section, and two descriptive questions with comment sections. The attitudinal and organizational support tools used were developed by Dr. Karen Gaertner of Georgetown University. The researcher designed descriptive questions were added to gain further insight into nursing staff attitudes and perceptions about successful or unsuccessful change efforts within their organization. This study concluded that there was no significant correlation between attitude and organizational support. The study did not reach a level of significance when looking at differences between or within the groups. Further research is recommended to verify these results in a larger sample, in more diverse healthcare organizations, and in other geographic locations.

Literature indicates that the majority of primary care providers are not meeting the health care needs of their adolescent patients. A survey of parents of adolescents with Down syndrome was conducted to determine the parents’ perception of the extent to which primary care providers are addressing the unique needs of their adolescent patients with Down syndrome. The tool utilized was a researcher developed survey that assessed the frequency of performance of multiple health care screenings and education as recommended by Guidelines for Adolescent Preventative Services, the American Academy of Pediatrics, and the Down Syndrome Medical Interest Group. The sample consisted of the parents of seven female and six male adolescents with a mean age of 15.77 years. The results from this study indicated that primary care providers were not addressing the unique health care needs of their adolescent patients with Down syndrome.