Forging professional public health nursing in a southern state: Florida's public health nurses, 1889-1934

From 1889 to 1934, Florida's nurses belonging to a new group of professional women ushered in a pioneering phase of public health nursing in Florida. During this era, the nurses' ability to confront health and professional issues varied a great deal but in quiet and forceful ways they tackled cultural and environmental problems to assist people who were ill or help prevent people from becoming ill. This dissertation places the development of professional public health nursing in its social context by uncovering the relationships public health nurses formed with clubwomen, the medical profession, city leaders, midwives, and others. In 1888, there were few graduate nurses in the state, no state board of health and no organized nursing service to respond to Jacksonville's great yellow fever epidemic. By 1934, national and state leaders of public health nursing had built up the profession to become an essential part of the State Board of Health's service to the community. Between these milestones, in the era of white supremacy and Jim Crow, public health nurses combined their professional training with a pioneer spirit of innovation and risk-taking. In the predominately rural state, the public health nurses' resolve to overcome environmental hazards and cultural obstacles stands out as they attempted to reach those who were unserved or underserved by modern medicine.

Nursing faculty intention to use service learning as pedagogy in higher education

The purpose of this study was to identify the factors that motivate nursing faculty to use service learning. The study was based on the theory of planned behavior (TPB), which implies that the target behavior of intention to use service learning in higher education is influenced by the predictor variables of behavior beliefs (attitude), normative beliefs (peer influence), and control beliefs (confidence and resources). External variables were also considered (years of teaching experience, tenure status, and the type of curriculum). ^ Group interviews and a pilot test were conducted to create the instrument for the study, and Cronbach alpha were calculated for survey item reliability. The participants were full time undergraduate nursing faculty members ( n = 160) in the Southeastern United States who taught in universities with accredited nurse education programs. Demographic data as well as scores on scaled survey responses were used to evaluate the intention of nursing faculty to use service learning in their classes. ^ Pearson product moment correlation coefficient and path analysis were applied to the data. The correlation findings indicated that there were statistically significant relationships between behavior beliefs, normative beliefs, and control beliefs and nursing faculty intention to use service learning. The path analysis also indicated that behavior beliefs and normative beliefs were significant, while control beliefs were not a strong influence on intention to use service learning. Normative beliefs showed the strongest direct influence. The use of a community based curriculum also had a positive influence on intention, and faculty with tenure status were more likely to have positive behavior beliefs (attitude) towards service learning. Finally, as teaching experience increased, positive attitudes towards the intention to use service learning decreased. Seventy-nine percent of the variation in the intention to use service learning was explained by the theory of planned behavior, the type of curriculum, teaching experience, and tenure status. These results will assist nursing administration and faculty to design strategies to facilitate the implementation of service learning pedagogy, as well as a community based curriculum which will help meet the 21st century goals set forth from the American Association of Colleges of Nursing. ^

Nursing faculty intention to use service learning as pedagogy in higher education

The purpose of this study was to identify the factors that motivate nursing faculty to use service learning. The study was based on the theory of planned behavior (TPB), which implies that the target behavior of intention to use service learning in higher education is influenced by the predictor variables of behavior beliefs (attitude), normative beliefs (peer influence), and control beliefs (confidence and resources). External variables were also considered (years of teaching experience, tenure status, and the type of curriculum). Group interviews and a pilot test were conducted to create the instrument for the study, and Cronbach alpha were calculated for survey item reliability. The participants were full time undergraduate nursing faculty members (n=-160) in the Southeastern United States who taught in universities with accredited nurse education programs. Demographic data as well as scores on scaled survey responses were used to evaluate the intention of nursing faculty to use service learning in their classes. Pearson product moment correlation coefficient and path analysis were applied to the data. The correlation findings indicated that there were statistically significant relationships between behavior beliefs, normative beliefs, and control beliefs and nursing faculty intention to use service learning. The path analysis also indicated that behavior beliefs and normative beliefs were significant, while control beliefs were not a strong influence on intention to use service learning. Normative beliefs showed the strongest direct influence. The use of a community based curriculum also had a positive influence on intention, and faculty with tenure status were more likely to have positive behavior beliefs (attitude) towards service learning. Finally, as teaching experience increased, positive attitudes towards the intention to use service learning decreased. Seventy-nine percent of the variation in the intention to use service learning was explained by the theory of planned behavior, the type of curriculum, teaching experience, and tenure status. These results will assist nursing administration and faculty to design strategies to facilitate the implementation of service learning pedagogy, as well as a community based curriculum which will help meet the 21st century goals set forth from the American Association of Colleges of Nursing.

Development of ``HealthServe'': A measure of customer service orientation in healthcare

An assessment tool designed to measure a customer service orientation among RN's and LPN's was developed using a content-oriented approach. Critical incidents were first developed by asking two samples of healthcare managers (n = 52 and 25) to identify various customer-contact situations. The critical incidents were then used to formulate a 121-item instrument. Patient-contact workers from 3 hospitals (n = 102) completed the instrument along with the NEO-FFI, a measure of the Big Five personality factors. Concurrently, managers completed a performance evaluation scale on the employees participating in the study in order to determine the predictive validity of the instrument.^ Through a criterion-keying approach, the instrument was scaled down to 38 items. The correlation between HealthServe and the supervisory ratings of performance evaluation data supported the instrument's criterion-related validity (r =.66, p $<$.0001). Incremental validity of HealthServe over the Big Five was found with HealthServe accounting for 46% of the variance.^ The NEO-FFI was used to assess the correlation between personality traits and HealthServe. A factor analysis of HealthServe suggested 4 factors which were correlated with the NEO-FFI scores. Results indicated that HealthServe was related to Extraversion, Openness to Experience, Agreeableness, Conscientiousness and negatively related to Neuroticism.^ The benefits of the test construction procedure used here over the use of broad-based measures of personality were discussed as well as the limitations of using a concurrent validation strategy. Recommendations for future studies were provided. ^

The knowledge and use of critical thinking teaching strategies of faculty in associate degree nursing education programs

The purpose of this study was to determine the knowledge and use of critical thinking teaching strategies by full-time and part-time faculty in Associate Degree Nursing (ADN) programs. ^ Sanders CTI (1992) instrument was adapted for this study and pilot-tested prior to the general administration to ADN faculty in Southeast Florida. This modified instrument, now termed the Burroughs Teaching Strategy Inventory (BTSI), returned reliability estimates (Cronbach alphas of .71, .74, and .82 for the three constructs) comparable to the original instrument. The BTSI was administered to 113 full-time and part-time nursing faculty in three community college nursing programs. The response rate was 92% for full-time faculty (n = 58) and 61% for part-time faculty (n = 55). ^ The majority of participants supported a combined definition of critical thinking in nursing which represented a composite of thinking skills that included reflective thinking, assessing alternative viewpoints, and the use of problem-solving. Full-time and part-time faculty used different teaching strategies. Full-time faculty most often used multiple-choice exams and lecture while part-time faculty most frequently used discussion within their classes. One possible explanation for specific strategy choices and differences might be that full-time faculty taught predominately in theory classes where certain strategies would be more appropriate and part-time faculty taught predominately clinical classes. Both faculty types selected written nursing care plans as the second most effective critical thinking strategy. ^ Faculty identified several strategies as being effective in teaching critical thinking. These strategies included discussion, case studies, higher order questioning, and concept analysis. These however, were not always the strategies that were used in either the classroom or clinical setting. ^ Based on this study, the author recommends that if the profession continues to stress critical thinking as a vital component of practice, nursing faculty should receive education in appropriate critical teaching strategies. Both in-service seminars and workshops could be used to further the knowledge and use of critical thinking strategies by faculty. Qualitative research should be done to determine why nursing faculty use self-selected teaching strategies. ^

Children with special health care needs: Comparison of the effects of home care setting, prescribed pediatric extended care setting, and long-term care setting on child and family health outcomes and health care service use

Technological advances during the past 30 years have dramatically improved survival rates for children with life-threatening conditions (preterm births, congenital anomalies, disease, or injury) resulting in children with special health care needs (CSHCN), children who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who require health and related services beyond that required by children generally. There are approximately 10.2 million of these children in the United States or one in five households with a child with special health care needs. Care for these children is limited to home care, medical day care (Prescribed Pediatric Extended Care; P-PEC) or a long term care (LTC) facility. There is very limited research examining health outcomes of CSHCN and their families. The purpose of this research was to compare the effects of home care settings, P-PEC settings, and LTC settings on child health and functioning, family health and function, and health care service use of families with CSHCN. Eighty four CSHCN ages 2 to 21 years having a medically fragile or complex medical condition that required continual monitoring were enrolled with their parents/guardians. Interviews were conducted monthly for five months using the PedsQL™ Generic Core Module for child health and functioning, PedsQL™ Family Impact Module for family health and functioning, and Access to Care from the NS-CSHCN survey for health care services. Descriptive statistics, chi square, and ANCOVA were conducted to determine differences across care settings. Children in the P-PEC settings had a highest health care quality of life (HRQL) overall including physical and psychosocial functioning. Parents/guardians with CSHCN in LTC had the highest HRQL including having time and energy for a social life and employment. Parents/guardians with CSHCN in home care settings had the poorest HRQL including physical and psychosocial functioning with cognitive difficulties, difficulties with worry, communication, and daily activities. They had the fewest hours of employment and the most hours providing direct care for their children. Overall health care service use was the same across the care settings.

The knowledge and use of critical thinking teaching strategies of faculty in associate degree nursing education programs

The purpose of this study was to determine the knowledge and use of critical thinking teaching strategies by full-time and part-time faculty in Associate Degree Nursing (ADN) programs. Sander's CTI (1992) instrument was adapted for this study and pilottested prior to the general administration to ADN faculty in Southeast Florida. This modified instrument, now termed the Burroughs Teaching Strategy Inventory (BTSI), returned reliability estimates (Cronbach alphas of .71, .74, and .82 for the three constructs) comparable to the original instrument. The BTSI was administered to 113 full-time and part-time nursing faculty in three community college nursing programs. The response rate was 92% for full-time faculty (n = 58) and 61 % for part-time faculty (n = 55). The majority of participants supported a combined definition of critical thinking in nursing which represented a composite of thinking skills that included reflective thinking, assessing alternative viewpoints, and the use of problem-solving. Full-time and part-time faculty used different teaching strategies. Fulltime faculty most often used multiple-choice exams and lecture while part-time faculty most frequently used discussion within their classes. One possible explanation for specific strategy choices and differences might be that full-time faculty taught predominately in theory classes where certain strategies would be more appropriate and part-time faculty taught predominately clinical classes. Both faculty types selected written nursing care plans as the second most effective critical thinking strategy. Faculty identified several strategies as being effective in teaching critical thinking. These strategies included discussion, case studies, higher order questioning, and concept analysis. These however, were not always the strategies that were used in either the classroom or clinical setting. Based on this study, the author recommends that if the profession continues to stress critical thinking as a vital component of practice, nursing faculty should receive education in appropriate critical teaching strategies. Both in-service seminars and workshops could be used to further the knowledge and use of critical thinking strategies by faculty. Qualitative research should be done to determine why nursing faculty use self-selected teaching strategies.