• Experiences Of Registered Nurses Who Encounter Incivility During The Clinical Education Of Nursing Students Within Hospital Settings: A Phenomenological Analysis

      French, Kimberly
      ABSTRACT KIMBERLY M. FRENCH EXPERIENCES OF REGISTERED NURSES WHO ENCOUNTER INCIVILITY DURING THE CLINICAL EDUCATION OF NURSING STUDENTS WITHIN HOSPITAL SETTINGS: A PHENOMENOLOGICAL ANALYSIS Under the direction of SUSAN SWEAT GUNBY, PhD, RN Incivility is disrespectful and unprofessional behavior consisting of negative attitudes with verbal and physical characteristics which negatively affects registered nurses' work environments and nursing students' clinical education. These behaviors are associated with increased healthcare costs (Joint Commission, 2008), negative patient outcomes, and poor patient satisfaction (Joint Commission, 2008; Randle, 2003). Additionally, incivility occurring during the clinical education of nursing students is a problem that can inhibit learning and communication (Institute of Medicine, 2010; Joint Commission, 2008). Research indicates these behaviors persist on nursing units, creating a challenge for stakeholders in both nursing education and patient care (Academy of Medical-Surgical Nurses, n.d.; Hunt & Marini, 2012; Lucian Leape Institute, 2013). Therefore, this descriptive qualitative study was conducted to explore registered nurses' experiences with incivility during the clinical education of nursing students within hospital settings in an effort to identify sources and contributing factors of incivility as well as effective strategies to counter incivility in these settings. A purposive sample of thirteen registered nurses, including staff nurses and clinical faculty, participated in mostly face-to-face, semi-structured interviews. With the support of an integrated conceptual framework utilizing Clark, Olender, Cardoni, and Kenski's (2011) conceptual model for fostering civility in nursing education (adapted for nursing practice) and the reflection-in-action theory by Donald Schön (1983), Giorgi's (1985) descriptive phenomenological method for qualitative research was used to analyze the transcribed verbatim narratives. Analysis of the data revealed three themes and sixteen subthemes. Themes included influences on uncivil actions, experiencing and responding to incivility, and aftermath of incivility. Stress was an underlying factor within all of the registered nurses' encounters with incivility. Most participants were surprised by the incivility they encountered. Some participants were tearful while others became anxious while describing their experiences. Findings revealed a need for educating registered nurses, nursing students, and administrators about incivility. Through participants' reflections on their encounters, strategies for addressing incivility were revealed. Recommendations for further study include examining gender differences regarding perceptions of uncivil and civil behaviors, comparing perpetration of incivility between experienced and less experienced nursing students, and the influence of different levels of nursing education on uncivil actions.
    • Compensatory Hypertrophy Enhances Renal Uptake Of Mercury

      Matta, Kayla Elizabeth
      Approximately 15 % of the adult population in the United States has been diagnosed with some degree of chronic kidney disease (CKD). CKD is characterized by a progressive and permanent loss of functioning nephrons. Following this loss, the remaining functional nephrons undergo compensatory changes including increased renal blood flow, increased single nephron glomerular filtration rate (SNGFR), and cellular hypertrophy. We hypothesize that compensatory hypertrophy of proximal tubules leads to an increase in the uptake and accumulation of xenobiotics and toxicants, such as mercury (Hg). Mercury is a ubiquitous environmental toxicant to which humans are exposed through various routes. Patients with CKD may be more susceptible to Hg and thus, it is important to understand how Hg is handled in the kidneys of these patients. We hypothesize that hypertrophied proximal tubular cells take up more Hg and are also are more sensitive to the toxic effects of Hg. To test this hypothesis, we used New Zealand White rabbits and Wistar rats. Cellular uptake of Hg, as a conjugate of glutathione (GSH; GSH-Hg-GSH), was measured at the basolateral membrane of isolated non-perfused proximal tubules from control and nephrectomized rabbits. Differences in mercury uptake at the cellular level were measured in control and hypertrophied S2 segments of proximal tubules by measuring several biochemical parameters of GSH-Hg-GSH uptake. Expression of selected enzymes was assessed in unexposed control and hypertrophied tubules using quantitative Polymerase Chain Reaction (qPCR). Effects of Hg on the entire kidney were measured in kidneys from rats injected intravenously with HgCl2 (0.5 µmol/kg/2 ml). Specific laboratory techniques utilized were the Glutathione Colorimetric Detection Assay, TBARS (Thiobarbituric acid reactive substances) Assay, qPCR, and Western Blot. Collectively, our findings show that hypertrophied tubules take up and accumulate more Hg than normal tubules. Also, hypertrophied cells appear to be more sensitive to the toxic effects of Hg than normal cells. These data provide important information regarding the altered handling of mercuric ions in patients with renal insufficiency due to chronic kidney disease.
    • Speaking Your Truth : The Unique Experiences That Construct African American Male Counternarratives / By Milanda Alane Curry.

      Curry, Milanda Alane
      The purpose of this qualitative research study was to explore the ways in which family, school, and community environments contribute to the academic success of young African American males. During a three-month period, in-depth individual and focus group interviews were conducted with four African American males between the ages of 25-35 who excelled academically despite adversity and are considered successful. The participants were also asked to identify at least one person in their lives who were considered important sources of support. The perspectives of these male participants on how they overcame adversity and achieved success are essential for identifying and understanding the support structures that facilitate and foster support in young African American males. Ideally, the results of this study may enlighten the development of interventions, programs, and counseling practices focused on creating and enhancing the personal and environmental attributes that promote successful outcomes for other African American males. Findings from the present study revealed that shielding factors across multiple contexts of these males’ lives contributed to their success despite adversity. Four themes emerged from participants responses: principles instilled during adolescence have an impact on success, parental/role model support had an important effect on success, overcoming adversity contributed to success, and society’s negative perception of African American males play a role in challenging and creating successful men. Recommendations for useful applications and future research are included.
    • Fabrication And Evaluation Of Microneedles And Other Enhancement Technologies For Transdermal Delivery Of Anticancer Drugs / By Hiep Xuan Nguyen.

      Nguyen, Hiep Xuan
      Skin (transdermal/topical) delivery offers several advantages over other conventional routes of administration. It helps eliminate first pass metabolism, decrease side effects, enhance patient compliance and decrease frequent dosing. Transdermal delivery has been limited to potent, moderately lipophilic and small molecules. However, the benefits of this route of administration appeal to researchers to expand this limited scope. Multiple physical enhancement techniques have been investigated to increase transdermal drug delivery such as microneedles, laser, electroporation, iontophoresis, and sonophoresis. These methods compromise the barrier function of skin by affecting the skin -stratum corneum and/or epidermis to allow the drug to pass through the treated areas. These approaches facilitate skin delivery of various compounds that includes small molecules, macromolecules, and nano/microparticles. The efficiency of physical enhancement techniques is most useful to deliver hydrophilic large molecules that cannot enter the skin by passive diffusion. In our studies, we used microneedles, fractional ablative laser and ultrasound to treat dermatomed porcine ear and/or cadaver human skin to enhance in vitro transdermal delivery of anticancer drugs, methotrexate, vismodegib, and doxorubicin.