Thesis Sounding Board - page 2
Well, the dreaded semester has begun: Intro to the Thesis Project. :eek: I'm early in the stages here and was hoping to bounce off some ideas related to my possible thesis topic. First, I am... Read More
Feb 5, '03I'm actually doing some reading on qualitative studies now, and so far have looked at a few quantitative studies from prior students yes. Our university requires them to be microfiched.
In all actuality, I'm leaning towards the relapse/alcohol question. I know it's totally unrelated to my clinical experience, but I keep going back to that one.
Maureeno, thanks for the suggestion. I think you meant to study a specific populations perception of influence over PTL, such as African Americans' perceptions - these kind of cultural studies are cropping up everywhere and in fact, AWHONN, my professional organization, has culturally competent care as a research priority. But personally, I haven't found any of those particular studies, that I've read, that useful. The most useful was those done on Hispanic/Latino populations - at least for me.
My only concern is if I do the relapse question, that I can make it relevent to nursing.
Feb 5, '03Originally posted by llg
Good question ... but how do we know what the appropriate minority is in this population? Perhaps, white women are the minority in this case ... or women over 35 ... or tall women ... whatever.
If the question has never been studied before and Suzy decides to do qualitative study, what rationale would there be to pick one race (and I assume you mean racial minority) over another? She might want to pick one type of pregnant woman (e.g. adolescents ... or women with other children in the home), but there are lots of different sub-categories to consider in this case. There is no reason to believe at this point that race is a more significant factor to this topic than are some of the other factors I have named. In fact, I would bet that whether or not the woman has other small children in the home is more important than race to this topic.
Premature birth rates rising in state, U.S.
Health officials can't pin down the reason for the increase
By CAROL SMITH
SEATTLE POST-INTELLIGENCER REPORTER
Premature births are on the rise in Washington, making them the biggest and most costly obstetrical problem facing the state, doctors said yesterday.
Prematurity is also the leading cause of death among newborns, accounting for 23 percent of deaths in the first month of life.
In this state, preemie births increased 19 percent between 1990 and 2001, but no one is sure why. Nationally, the rates have risen 27 percent since 1981._
The growing number of multiple births caused by fertility treatments and advancing maternal age both play a role, but can't explain the whole increase, said Dr. Gregory Sorensen, director of pediatrics at Swedish Medical Center.
In this state, about 10 percent of all births, or about 7,500 babies a year, are born before 37 weeks gestation, giving Washington the seventh-lowest rate in the nation. Nationwide, 12 percent of births -- about 476,250 babies -- come early.
The state's large Caucasian and Asian American populations contribute to the lower rates, since both groups on average have fewer preterm births, said Rachel Hien, state program director for March of Dimes in Washington. African American and Native American women have the highest rates of premature deliveries. Despite the state's relatively good ranking, however, the number of premature births is on the rise.
"We're still going in the wrong direction," she said.
Many children born prematurely have lifelong medical problems or disabilities, ranging from lung disorders and brain damage to cerebral palsy and blindness, as a result of their early arrival.
"For every miracle baby, there are 100 more (born prematurely) who have a different story," said Joseph Zavaglia, state chairman of the March of Dimes, and father of three babies born prematurely, one of whom died.
Medical care for a preemie can exceed $500,000 over the child's lifetime, said Zavaglia. The average hospital costs before a preemie goes home run around $58,000, more than 10 times that of a normal birth.
That adds up to a staggering $4.7 billion a year, he said.
In Washington, medical care for premature babies exceeds $500 million a year, said Dr. Arthur Maslow, of Pacific Northwest Maternal-Fetal Medicine Clinic in Tacoma. "That's a lot of health care dollars this state can't afford."
The March of Dimes is hoping to reverse that trend by investing in a 5-year, $75 million campaign to increase research into the causes of prematurity, as well as education to prevent it. The organization is drawing attention to the problem in the hopes more women will recognize the signs of premature labor and get help in time to stop it, or at least delay it long enough to buy the baby time.
Babies born at 24 weeks have only a 10 percent shot at survival. By 28 weeks, survival rates increase to 95 percent. About one in four preemies have disabilities.
Petite, blonde and blue-eyed Morgan was born just a day over 25 weeks at 1 pound 9 ounces. Her ears were just flaps of skin, and her eyes were still fused shut, but she fought to survive, enduring surgery to correct a heart valve problem, and brain bleeding. Now 21 months old, she is barely bigger than a six-month old, but she's walking and her parents couldn't be happier.
"In the midst of all the confused emotion, we always had to find something positive," said her mother, Rhonda Thomas, of all the weeks they spent in the hospital watching their daughter develop outside the womb.
"These babies are the most resilient," she said. "They have to be."
Rhonda and her husband, John, count themselves among the lucky ones -- those for whom the outcome appears positive.
The reasons for the increase in preemie birth rates continue to confound doctors.
"They've gone up a half to 1 percent a year, every year for the last two decades," Maslow said.
Half of all premature births have no known cause. Risk factors for premature birth include diabetes, high blood pressure or other chronic disease, smoking, and infections during pregnancy. Very young, or much older moms are also at risk.<<
Susy I wish you luck no matter what you decide to study, my suggestion was based on my perception of your interests [from reading your health care posts] and my belief nurses can help with the documented higher prematurity and lower birth weights of black and native american women.
Feb 6, '03There has been studies that correlate the incidence of PTL and birth to low educational level. Strange, isn't it?
Feb 6, '03To maureeno: I didn't mean to imply that we shouldn't ever study racial minorities. I know that there are more premature births in that population (which actually makes them the majority of that patient patient population). Anyway ... what I was trying to say was that to the phenomenological question of "what is the experience like to ..." the racial variable may not be the key variable. Other variables might be much more significant and might be better to use to focus the question for a student project.
If Suzy were to do a phenomenological study of patients discharged after PTL, teenager might make a nice choice for a study group. So would mothers with other children at home. Another group would be working mothers. All these goups would be quite legitimate choices. I just didn't want her to feel compelled to jump to the standard "race" variable.
Feb 6, '03hey susy, I know you are joking! we all know the correlation is not strange! With your love of children, experience with at-risk groups and strong belief in preventative care I'm still thinking you could maybe find some effective nsg. interventions or teaching strategies.
Feb 6, '03Suzy: If you choose the alcohol topic, would you have good access to a suitable population from which to draw your participants? Would you have access to faculty with expertise in this area? It sounds like a good topic, but be sure you have the resources you need to complete the project before you invest too much of yourself in it.
Feb 6, '03I think a lit review would be helpful first. Do any of the topics sound more interesting than the others?
Feb 6, '03Originally posted by llg
Suzy: If you choose the alcohol topic, would you have good access to a suitable population from which to draw your participants? Would you have access to faculty with expertise in this area? It sounds like a good topic, but be sure you have the resources you need to complete the project before you invest too much of yourself in it.
I've gotten a few PMs from people with input and suggestions, and I didn't thank them personally, but would like to say thanks to them now. I really like the feedback and exchange of ideas. It's very helpful.
Feb 15, '03WashYaHand, llg, or any other post-graduates out there or anyone else good at critiquing these things, I need your best critique!
After all this time, I've finally written my problem statement. Here goes:
Alcoholism is a complex disease that has individual, familial and societal implications, as well as manifestations of physiologic and psychological in nature. A 1998 paper estimated alcoholism to effect at least 19.7 million Americans. (Bufe, C., 1998). Societal impacts of alcoholism are quite profound. Alcoholics have a higher incidence of unemployment, domestic violence and legal problems. Recent statistics state that there were over 19,000 alcohol-induced deaths, not including motor vehicle accidents, each year (National Vital Statistics Reports, (50)15). The significant financial impact of alcoholism has been estimated at $148 billion in 1992 alone (Galanter, M., 1998). It is clear that alcoholism is a significant public health concern.
Only 15% of all alcoholics seek treatment (National Vital Statistics Reports, (50)15); even with treatment, relapse is quite common and is a significant problem for recovering alcoholics. Relapse affects both the individual and their family with feelings of guilt and anger, as well as continued health problems for the alcoholic, including but not limited to, alcoholic hepatitis, cirrhosis and liver failure. Several research studies on curbing relapse have focused on a combination of counseling and medications (Morris, P., Hopwood, M., Whelan, G., Gardiner, J., & Drummond. E., 2001) as well as understanding the role of alcohol cravings (National Institute on Alcohol Abuse and Alcoholism, 2001). But despite these investigations, relatively few studies have examined why alcoholics themselves feel the need to return to alcohol use. With relapse continuing to be a real threat to a complete recovery, the need for further exploration into the meaning of relapse is warranted. Alcoholic relapse is a significant health concern affecting recovering alcoholics and their families, and little is known about what may cause relapse from the alcoholic's perspective, therefore it is essential that the meaning of relapse and the alcoholic's perception of the experience is explored.
Feb 15, '03Oh, and while it isn't directly stated, it's a phenomenological study. Or so it should be.
Feb 15, '03REading your posts again I am glad I am done with my graduate program......PHEW
Feb 15, '03relatively few studies have examined why alcoholics themselves feel the need to return to alcohol use.
In terms of financial impact, is there more recent data than 1992 since health care costs have risen in the last decade?
Feb 15, '03Linda,
Uh, good point. I didn't really notice that.
Hmm. My only problem with that sentence is that I seem to lose the point that I am asking the alcoholics why they relapsed, addiction aside. If I said: "...relatively few studies have examined the perceptions of alcoholics related to their own relapse experience" it almost seems to me like I am just asking them to reflect on it, rather than directly asking them why they felt they relapsed.
As far as the data, for the love of Pete I could hardly find the data I did. I went to nih.gov as well as alot of other sources that Hoolahan pointed me too, and it seems the most recent studies are from 1998, that look at earlier year's data. I could conclude that costs are even higher than that estimate, seeing as health care costs are higher. Would it appropriate to put that in there?