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



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Military Nursing Research: Bibliographies 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

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Military Nursing Research: Bibliographies 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

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Military Nursing Research: Bibliographies 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

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Military Nursing Research: Bibliographies 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,

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Military Nursing Research: Bibliographies 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

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Military Nursing Research: Bibliographies 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

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Military Nursing Research: Bibliographies 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

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Military Nursing Research: Bibliographies 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

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Military Nursing Research: Bibliographies 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

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Military Nursing Research: Bibliographies 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

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Military Nursing Research: Bibliographies 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.

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Military Nursing Research: Bibliographies 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.

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Military Nursing Research: Bibliographies 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.

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Military Nursing Research: Bibliographies 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.

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Military Nursing Research: Bibliographies 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.

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Military Nursing Research: Bibliographies 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.

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Military Nursing Research: Bibliographies 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

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Military Nursing Research: Bibliographies 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.

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Military Nursing Research: Bibliographies 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.

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Military Nursing Research: Bibliographies 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?

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Military Nursing Research: Bibliographies 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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