2013 Abstracts

Home hospice care is a growing area within the health care system. However, because of the difficulty in gaining access to these patients and caregivers in the home, research findings have been slow to keep pace with this growth. While hospice has been at the forefront of family-centered care, explicitly stating that the unit of care is the family, there has been little empirical research to show who is actually involved in this care in the home on a regular basis. Hypothesis: Our goal of this project was to describe who is present at the nurse home visit with the patient. Research Method: This research, part of a larger intervention study, involved reviewing audio recordings of home hospice visits to set up a coding system for future communication coding. During this review, we also identified and documented those present during the visit. Results: In our sample of 115 home hospice visits, 12 nurses caring for 13 patients spent an average of XXX minutes each (SD=XXX) in the home. We have found that caregivers are present 80% of the time. Our data shows that a spouse is present in 28% of visits. In 58.3% of visits, a daughter is present, while sons are present in only 3.1% of visits. Implications: It is important to know who is present at the visit and how long they spent with the patient to increase our understanding of what goes on in home hospice care. This research has implications for improving patient care. For example, in order to promote a more family orientated home care; more family members should participate in nurse visits. This descriptive research can be used in practice for hospices to know who to expect during patient home visits, as well as to incorporate the family members better into the patient care plan.

Background: In November of 2012, a small group from BYU’s College of Nursing returned to Guayaquil, Ecuador to measure anemia indicators post interventions in school age children. In May of 2012 a larger group, including students, from BYU’s College of Nursing had visited Guayaquil for the fourth consecutive year to assess malnutrition and anemia rates in school age children. This multi-phase research project which began in May of 2009 found that nearly 41% of the children in this area suffered from anemia (below 11g/dl as per WHO guidelines). The adverse effects of anemia for these children can include: weakness, fatigue, shortness of breath, and poor concentration. Anemia may result from deficiencies of iron, B12, folic acid, and may also be the result of intestinal parasites. A nutrition survey conducted among these same school children showed that daily intake of iron, B12, and folic acid were below recommended levels. Intervention: In May of 2009 Hogar de Cristo (HDC), a non-profit organization, began distributing 6 to 8 ounce bottles of soy milk as a school snack for each school-aged child at a few of the schools in the area. A local pharmaceutical company who supplied vitamin and iron supplements during the first year of the soy milk distribution, reassessed anemia rates in those children in November of 2009. The BYU College of Nursing continued to assess school- aged children for measures of anemia and growth and development in 2010 and 2011 as directed by Hogar de Cristo. After 2011 it was difficult to correlate anemia and soy milk because of changes in the sample from year to year. In May of 2012 the BYU College of Nursing shifted their focus to four interventions with the aim of determining which one would best lower anemia rates. The study focused on students at four schools in the perimetral area, each school received one of the interventions as an adjunct to soy milk: vitamin supplements, antiparasites, vitamins and antiparasites, and a control group (soy milk only). Growth and development measures along with rates of anemia were reassessed in November 2012. Results: In May of 2012 the BYU College of Nursing tested 1041 school-ages children for growth and development and anemia. growth and development rate results spanning the four years of testing, and a comparison of anemia rates between intervention groups and control groups.

Neurofibromatosis type 1 (NF1) is a common autosomal dominant genetic disorder. It affects 1/3500 individuals worldwide (Friedman, 2002). It is classically characterized as a neurocutaneous disorder, but osseous and spinal abnormalities are clearly associated with NF1. These complications are not well understood and rarely emphasized, even though as high as 38% have been reported to have osseous manifestations (Crawford and Schorry, 1999). In particular, the medical management of scoliosis in NF1 is problematic with no consensus on preferred treatment strategies. More information on the natural history and health-related quality of life are needed before effective therapies can be designed as assessment of treatment efficacy is complex and outcome measures difficult to define. Dr. Stevenson and Dr. Viskochil are part of an NF Consortium focused on developing clinical trials in NF1. However, specific outcome measures are needed for these clinical trials. In particular changes in quality of life are an essential part of clinical trials. Our objective is to determine if specific quality of life instruments can be utilized in the NF1 population for the skeletal manifestations. A battery of these instruments were used given that it was not known which instrument would be most appropriate for the various manifestations of NF1. A total of 129 patients were enrolled in this study, and the relevant questionnaires were administered and recorded. Categorical data of health status will be summarized as frequency distributions and differences among groups will be assessed using chi-square tests of proportions. Frequency distributions for interval-scale variables of health status (e.g., HUI single-attribute utility scores) and HRQL (e.g., HUI multi-attribute utility and PedsQL4.0 summary scores) will be summarized as mean, standard deviation, 95% confidence bounds, median, minimum and maximum. T-tests and analysis of variance techniques (including repeated-measures models) will be used to test differences in means between groups.

The overall goal of our laboratory is to elucidate mechanisms whereby endothelial nitric oxide (NO) synthase (eNOS) enzyme function and NO bioavailability are impaired in individuals with diet-induced obesity (DIO), type 2 diabetes (T2DM), and insulin resistance. This is a clinically relevant issue because all of these conditions are associated with poor vascular function that might be precipitated by disrupted eNOS enzyme function and NO bioavailability. To study this issue we use model systems including cell culture, isolated arteries, and rodents. It is important to have an accurate, reproducible, and sensitive method to detect NO in each of these systems. The purpose of my work was to optimize the technique of electron paramagnetic resonance spectroscopy (EPR) to assess NO in bovine aortic endothelial cells (BAECs). NO contains an unpaired electron. This structural feature facilitates the measurement of NO via EPR. NO is detected with a spin trap of FeSO4 and diethyldithiocarbamate trihydrate (DETC). In the presence of NO, the spin trap forms a NO-Fe(DETC) complex which is detected by EPR. BAECs were grown to 70-80% confluency in six-well plates, and treated with: (i) vehicle (buffer only), (ii) 600 uM of insulin (an NO agonist), (iii) 10 uM of NG-monomethyl-L-arginine acetate salt [LNMMA, an NO synthase (NOS) inhibitor], and (iv) three doses (1, 10, 100 uM) of diethylammonium (DEA) NONOate (an NO donor) to serve as a positive control. All treatments contained L-arginine [the substrate for endothelial NOS (eNOS)] and FeSO4 (the spin trap). After a 60-min incubation with treatments (i) (iv), cells were dislodged from each plate, collected, frozen in liquid nitrogen, and NO was detected using EPR. Relative to vehicle treatment, 1uM, 10uM, and 100uM DEA NONOate increased NO production by 50±8%, 150±2%, and 700±26% (p<0.05) respectively. Insulin increased (p<0.05) NO production by 73±4% vs. vehicle, and this response was prevented in cells treated with insulin + LNMMA. These results indicate EPR is a suitable method to detect cellular NO production. My next project is to optimize this technique for use in isolated arteries from experimental animal models.

Symptoms related to cancer and its treatments are a significant source of distress for children and adolescents with cancer. Although children and adolescents may receive interventions aimed at alleviating symptoms, the hospital care environment itself may be one that adds to the overall symptom burden. The purpose of this study is to investigate relationships between symptoms experienced by hospitalized children and adolescents with cancer and the care environment on an inpatient pediatric oncology unit. This prospective, descriptive study uses use a repeated measure, within-group design to identify relationships between symptoms and the nursing care environment that can be used to guide future interventions. Participants are 50 children and adolescents (7 to 18 years of age) with cancer. Data collection is occurring over a 3-day and 3-night period. Children and adolescents’ symptoms are measured each shift using the Memorial Symptom Assessment Scale for patients aged 7-12 years. Participants also answer two open-ended questions about what has bothered them about the hospital environment and what they perceive could improve the hospital environment. Sound and light levels are measured continuously using a sound pressure level meter and data logger placed approximately 48 inches from the child’s bedside. Nursing care activities are measured through counts of care activities occurring during room entries by nursing staff. Room entries are identified using an Axis pan-tilt-zoom (PTZ) dome camera. A member of the research team reviews the child’s nursing flow sheet, medication administration record, acuity level, laboratory values, and medical orders each day. Data is presently being collected and will be analyzed using hierarchical mixed effects statistical models. Long-term goals of this project include improving symptom management in the inpatient setting, minimizing modifiable factors in the care environment that cause greater symptom burden, and lastly use the findings to inform hypotheses for a larger intervention studies. Hopefully these studies will target structuring the hospital care environment to minimize the symptom burden experienced by hospitalized children and adolescents with cancer and, ultimately, promote their quality of life.

Purpose: To demonstrate use of a guide to help nursing students increase cultural competency gained during study abroad programs.Background/significance: In a world of increasing globalization, nurses are more likely to care for patients of a cultural background different from their own. To care for increasingly diverse patients, nurses need greater cultural competence to provide the safest and highest quality of care possible. Study abroad programs have been shown to be an excellent way to provide cultural education for students. The number of students choosing to participate in these programs has more than doubled in the last ten years. However, no research is available from a student perspective on how to plan for an optimum learning experience during study abroad. A research-based guide, from a student perspective, will help students take better advantage of experiences abroad to increase cultural competency. Methods: A literature review using online databases (including CINAHL and MEDLINE) was conducted using search terms such as nursing student, student, cultural competency, cultural sensitivity, cultural awareness, study abroad, international experience, and exchange program. Articles from the online search were used to compile a student guide. The guide includes competence-enhancing activities, formulated using brief anecdotal summaries and trending study abroad outcomes found in the articles. The guide’s framework came from Josepha Campinha-Bacote’s 2002 article, “The Process of Cultural Competence in the Delivery of Healthcare Services: A Model of Care,” and its subsequently updated versions (2007 and 2011). With the original version of the guide, there were 16 activities in four categories: cultural awareness, cultural knowledge, cultural skill, and cultural desire. The guide also included 16 blank squares where students could create their own activities. The guide contains a small reflective writing portion where students can think about their experiences as a whole and how they can implement what they learned into practice. A total of 12 students, including the author, used the guide in two different study abroad programs, first while participating in a Global Health and Human Diversity program with the College of Nursing in Tonga in May 2012.

Purpose: To examine how the new policy of Medicare/Medicaid reimbursement being based on HCAHPS scores affects nursing care. Rationale: The Patient Protection and Affordable Care Act (PPACA) mandates that Medicare and Medicaid reimbursement be based on hospital performance and patient satisfaction. Patient satisfaction is measured nationally through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The HCAHPS survey was development in the early 2000’s to create a uniform measure for patient perspectives regarding their inpatient stay; however, with the HCAHPS scores being related to Medicare and Medicaid reimbursement, hospitals are required to reevaluate their quality of care from the patient, not medical, perspective. Van Empel et al. (2011) found that physicians and nurses primarily value medical outcomes of treatment. While, at the same time, patient’s value patient-centeredness, even if it means decreasing the desired outcome of treatment. Undertaking: A literature review was completed by searching in CINAHL and Medline. Preliminary research used HCAHPS and Medicare reimbursement as key words. Second, a search was completed using HCAHPS and nursing as key words. All results were published between 2008 and 2012. Outcomes: Kutney-Lee et al. (2009) reported that patient satisfaction was primarily linked with nurse-to-patient ratio, interdisciplinary collaboration and work environment. Research by Robinson and Watters (2010) found the main factor in patient dissatisfaction was feeling like the nurses were short staffed, task-oriented and rushed, leaving the patient lacking adequately communication to understand their situation. Van Empel et al. (2011) reported patients’ willingness to change providers and facilities to received patient-centered care. Conclusion: Nurses have the greatest potential to effect patient satisfaction. Therefore, with the new regulation of Medicare and Medicaid reimbursement based on patient satisfaction surveys, nurses have a greater responsibility to ensure patient satisfaction. From the research presented, the main nursing implication is to help each patient feel like their care is centered on what is important to that individual. This can most easily be accomplished by the nurse opening a line of communication with the patient, and then advocating for the patient’s wishes.

Purpose/Aims: The purpose of this pilot study was (1) to examine nursing students’ perceptions of their first experience with death in the clinical setting and (2) to determine if curricular changes are necessary to better prepare nursing students effectively cope with their first death experience as a nurse. Background: Death, particularly the unexpected death of a patient, is an emotionally charged, high-stress situation for any nurse. Nursing students encounter scenarios involving death and dying in simulation laboratories, as well as in the clinical setting. In simulation settings debriefing is routinely accomplished and is seen as a critical component of the learning experience. However, Leavy and colleagues (2011) found that even during formal simulation debriefing sessions nursing students were not able to fully process their emotions In real-life clinical settings, the stakes are even higher as nursing students must be able to effectively cope with the death of a patient. Unfortunately, research on students’ first experience with death is limited. Huang and colleagues (2010) found students may not receive adequate support from clinical nursing instructors during the dying process and after a patient’s death. Methods: This was a descriptive mixed methods pilot study. An online anonymous survey was sent to students in the Brigham Young University College of Nursing regarding their first experience with death in the clinical setting (N=306). Students were e-mailed a brief description of the research project and an invitation to participate in the study only if they had experienced the death of a patient. Completion of the online questionnaire implied consent. The participants answered 5 demographic questions and 11 survey questions with the estimated time commitment for each participant being 15 minutes. Results: The online questionnaire was sent to 306 BSN nursing students Approximately 10% initially responded (N=33). A smaller group (N=25) completed the entire survey. Qualitative comments from nursing students who experienced the death of their patient included feeling sad, shocked and uncomfortable. Fifty percent of the nursing students did not receive any debriefing from their clinical instructor following the event.

The Middle Ages and the cultural, political and social coming of age of the European continent produced a corpus of literature and a literary tradition representative of its religious and cultural values that, amazingly, still continues to influence society today. Commonly employed terms such as “a knight in shining armor”, “prince charming”, and parallels occasionally drawn between children and both literary as well historical princes and princesses of yore are evidence of the longevity of the influence of Medieval culture, it’s ideals and the literary genre that most perfectly reflected it: the novel of chivalry. Today, few academics study the genre, it is seldom analyzed in universities, and almost never read outside of academia. In fine, their legacy and their memory has largely been preserved in the endearing pages of Cervantes’ masterpiece, Don Quixote. In this work, the protagonist, don Quixote, goes mad as he credulously devours his extensive private collection of chivalric literature believing all he reads to be not only true but also worthy of imitation. Nevertheless, despite Don Quixote’s wide reading public, few have ever read a novel of chivalry and, as a result, the exact definition of the novel of chivalry can be both obscure and even beyond the grasp of the modern reader who is uninitiated in the field of Medieval and Renaissance chivalric literature. Nevertheless, through a careful analysis of don Quixote’s private collection of novels of chivalry, the mega-genre that they constitute and the sub-genres that comprise it; the chivalric genre can be clearly defined. Additionally, through the comparative analysis of the English term novel of chivalry as opposed to the Spanish term libros de caballerias (book of great deeds done on horseback) the importance of language’s influence on the perception of the world will be demonstrated and Jacques Lacan’s theory regarding language and perception substantiated. Finally, this analysis will elucidate the novel of chivalry’s status both as a continuation of the great classical epic tradition as well as another link in the universal tradition of epic poetry and storytelling. This presentation will be of interest both to Medievalist as well as specialists in the Renaissance, Don Quixote, Spain and Portugal. Power Point Presentation. 20 – 30 minutes.

Range Creek is a small deeply incised canyon located in south central Utah. It is a remote canyon that has experienced minimal impact to its rich archaeological heritage by European-American settlers during the last two hundred years. The canyon contains hundreds of important archaeological sites and thousands of artifacts from the Fremont culture that inhabited the area from around 800 A.D. to 1350 A.D. Though work has been done on the archeological sites in the canyon, a better understanding of the paleoclimate and environment are needed to help understand why the Fremont culture disappeared so abruptly around 1160 A.D.Dendrochronology has been shown to provide excellent data for reconstruction of climatic conditions. Conifer tree species, including Douglas fir (Pseudotsuga mensiezii), are well-suited for studying past climate through the analysis of their tree rings. In this study, I use increment cores from Douglas fir to build a local history of tree-ring growth rates through time and will compare these results to regionally available climate records. By comparing changes in ring widths with weather station data, including monthly and seasonal temperature and precipitation records, I hypothesize that Douglas fir will provide a sensitive indicator of past changes in winter precipitation. Twelve tree cores collected from climatically sensitive locations during the 2012 summer are being analyzed from Range Creek Canyon. Preliminary analyses of the tree ring series suggests this study will provide a climatic history spanning the past ~300 years. Although this analysis cannot provide direct observation on climate conditions during the period of the Freemont occupation and abandonment of Range Creek, it will provide insights into the natural climate variability occurring within the Range Creek Canyon. All tree cores are being analyzed with ARSTAN and COFECHA software, commonly used by dendrochronologists, and results will be made available at the time of presentation.

“There is nothing particularly interesting about one’s life story,” Eleanor Roosevelt wrote, “unless people can say as they read it, Why, this is like what I have been through. Perhaps, after all, there is a way to work it out.” Humans throughout time have recognized the need for storytelling and have been preserving oral histories. Narratives supplement our historical memory and offer an in-depth account of personal experience and reflections, which allows another to feel a commonality that often dissolves the barriers of race, class, gender, and even time. During the 19th century, the fight for enfranchisement united Utah’s early settlers with national suffragists. Feminists such as newspaper editor, Emmiline B. Wells and “presidentes” of the women’s organization within the Church of Jesus Christ of Latter-day Saints (LDS), Eliza R. Snow, were in the forefront of this movement. Wells, Snow, along with other women were actively involved in their family responsibilities. However, they also held public and political positions within their communities that were not typical for women of that period. The women’s movement of the seventies recognized that literature wasn’t acknowledging women’s prominent role in society. Not only was there a lack of sources by and about women, but the historiography in general was male dominated. Hence, the LDS church initiated a crusade to collect women’s journals, letters, and other writings of Utah’s pioneers. These sources increased scholarship of Utah’s suffragists, which caused national recognition of the role they played during First Wave Feminism. Nevertheless, there is a trivial amount written about the women in Utah during Second Wave Feminism from the 1970’s to late 1980’s. My research focuses on stories of women in Utah during Second Wave Feminism. I interviewed four women within higher education where they expressed personal experiences that are similar in spirit to Utah’s early settlers. Inadvertently each woman had some connection with the LDS church. My thesis will argue that by extrapolation there were many women, particularly at Utah Valley University who transcended patriarchy to achieve positions of leadership and notoriety. Their personal narratives challenge the feminist theory of patriarchal suppression, which seems paradoxical considering the fact that Utah’s dominant religion, the LDS church, functions as a male governed society.

The study, “Sentimentality Preserves Our Past” focuses on two branches of nostalgia: sentimentality and historical utility and their relationship to cultural relics. Our approach assumes we can recognize similarities and differences between cultural communities by describing the extent to which individuals are sentimental or utilitarian with regard to their possessions. We are currently collecting data from the northern Utah community and Utah Tongan community. We set up a preliminary exercise asking participants to free list the items they have a difficult time throwing away for sentimental reasons. So far we have collected 40 questionnaires and 13 interviews that focus on the five most referenced items. Our target is to conduct about 45 questionnaires and 45 interviews for each community. For the Utahan population we have enough data to identify an S:U RANK – the ratio between a participant’s measure of sentimentality to the measure of utility. For the 25 questions where a respondent’s answer could be classified as appealing to sentimentality (s) or historic utility (h), we summed the totals then divided it by the sum of the answers appealing to utility (u). All totals above 1 indicate that the respondent prefers protecting items for nostalgic purposes; all answers below 1 indicate the respondent prefers items of utility. The S:U RANK gives a general view into a particular population. From this we can discuss the effect of variables such as age, marital status, children, age of children, and years in Utah on an individual’s preference. Currently, the pattern from the S:U RANK suggests that marital status and children are having the greatest effect on the ratio, but this will become clearer as the interviews progress. The research began as an effort to understand the presence of nostalgia as applied to five common relics among a particular diaspora, in light of the incoming data, this question is developing into an attempt to understand nostalgia in a cultural and universal sense as well.

The “American Dream” and the “Working Class Promise” are ubiquitous ideologies in American culture. For this paper, I will argue these ideologies are social constructs which perpetuate and reinforce discrimination, the social hierarchy and the domination of the American working class. First, I will define the key concepts of this paper: ideology, stereotyping, domination, discrimination, the ideologies of the American Dream and the Working Class Promise. Secondly, I will argue these ideologies, as defined by communications professor Kristen Lucas, lead to discrimination and domination of the working class. I will argue the Working Class Promise is an example of philosopher Frederick Nietzsche’s slave morality, where a lower status group attaches positive values to themselves which only serves to perpetuate discrimination against them. Further, I will argue domination arises from such discrimination by examining a study by psychologists Shannon K. McCoy and Brenda Major regarding positive stereotyping, self-stereotyping, discrimination and domination. Next, I will argue, using sociologist Pierre Bourdieu’s concept of habitus, both the Working Class Promise and the American Dream are structured and structuring social concepts which reinforce discrimination and domination through exclusion. In line with Bourdieu, I will use social philosopher Louis Althusser’s arguments to show how the Working Class Promise and the American Dream reproduce the roles of the social hierarchy and domination. I will support this demonstration with evidence from McCoy and Major’s study showing how various forms of discrimination are reproduced in society when individuals believe in the American Dream. Having accepted the social insights of these scholars, I would propose, based on the arguments of philosopher Immanuel Kant regarding the intrinsic worth of rational beings and contrary to elitist or socialist views, the solution is for Americans to reject these ideologies.

Although learning a second language can be difficult, especially for adults, many people believe that once an individual has acquired a second language, it will be easier to learn a third. Individuals may utilize strategies learned from studying a second language (L2) to their study of a third, but this does not necessarily mean that learning a third language (L3) will be easier. As individuals study an L3, their knowledge of both their native language (L1) and their L2 will compete with their developing knowledge of the L3. Previous research has shown that during early stages of L3 acquisition, both L1 and L2 phonology (that is, the underlying sound system of a language) influence the phonology of their L3. This is evident, for example, in learners’ production of some word-initial consonants, such as d, p, and k. Languages differ in the timing between the articulation of the consonant and the beginning of vibration of the vocal folds (voicing) associated with a following vowel sound. This timing is known as Voice Onset Time (VOT). Studies suggest a stronger influence from L2 than from L1 in L3 VOT production. However, learners in these studies had some (if limited) knowledge of the L3, and the influence of this knowledge is unclear. In addition, previous studies have addressed L3 production, but not L3 perception. Research has yet to investigate (i) the influence of L1 and L2 phonology in the very initial stages of L3 acquisition (when the language is totally unfamiliar), and (ii) the influence of L1 and L2 phonology on the perception of VOT boundaries. This study investigates (i) and (ii) by presenting English and Spanish bilinguals with stimuli representing a range of VOT in their L1 and L2, as well as from a third, unfamiliar language in a series of tasks designed to elicit evidence of VOT boundaries in each language. The results of these tasks will be examined to determine whether learners rely more on their L1 or their L2 for processing a third, unfamiliar language. Preliminary results and analyses will be available by February 2013. This research will give important insights into the process of acquisition of a third language.

Within Freshman Composition Studies, little research has been produced on writing conferences between students and teachers since Laurel Johnson Black’s Between Talk and Teaching: Reconsidering the Writing Conference in 1998. Most published research has not included any systematic information about the nature of the writing conference, a consultation between the student and teacher designed to discuss the student’s paper in order to make changes. Student feedback and involvement in this study is of crucial importance because there is no existing data whether teacher-student conferences are working from a student perspective. The major research question is “What is the relationship between types of teacher-student conference interaction and subsequent revision of students’ papers?” The purpose of the research is to discover what the writing conference between teacher and student accomplishes in terms of better writing outcomes, what the expectations of the student are, and what and how the power dynamics between student and teacher affect the quality and quantity of revision from both student and instructor perspectives. We will examine the connection of students’ perceptions about the writing conference to their final scores and other data. During the spring 2012 semester, we drafted three surveys designed to capture students’ perspectives and expectations regarding the conferences (a pre-conference, post conference, and post final grade). The methodology includes transcribing voice recordings of conferences, collecting student surveys before and after conferences, and collecting students’ rough and final drafts for two papers during the semester. This raw data will be coded into usable data, which will then be analyzed to identify behaviors that facilitate or impede the conference and determine its overall effectiveness. We hypothesize that a dialogic conference will occur when the power dynamic between student and teacher is more equitable, resulting in more student-ownership over the revision process. The extent of student ownership within the revision process will be determined by both the quantity and quality of revision. These findings will, in turn, enable teachers to take a closer look at the nature of their own writing conferences in order to develop better consultations with their students.