Showing papers in "Journal of Nursing Scholarship in 2003"

Push and pull factors in international nurse migration.

Abstract: Purpose: To describe the push and pull factors of migration in relation to international recruitment and migration of nurses. Organizing Construct: Review of literature on nurse migration, examination of effects of donor and receiving countries, and discussion of ethical concerns related to foreign nurse recruitment. Findings: The primary donor countries are Australia, Canada, the Philippines, South Africa, and the United Kingdom (UK); the primary receiving countries are Australia, Canada, Ireland, the UK, and the United States (US). The effects of migration on donor countries include the loss of skilled personnel and economic investment; receiving countries receive skilled nurses to fill critical shortages with less economic investment. Ethical concerns include the potential for exploitation of foreign nurses. Conclusions: Nurses migrate to seek better wages and working conditions than they have in their native countries. Given the current conditions, developed countries continue to actively recruit foreign nurses to fill critical shortages. Migration is predicted to continue until developed countries address the underlying causes of nurse shortages and until developing countries address conditions that cause nurses to leave.

Concepts in caregiver research

Abstract: Purpose To clarify and delineate conceptualizations of the effects of caregiving for nursing research and practice with family caregivers. Organizing construct The biopsychosocial (psychosocial and physiological) sequelae, both negative and positive, associated with providing care for a relative or friend with a chronic illness. Methods Literature reviewed was obtained via searches of CINAHL, MEDLINE, and PsycInfo computerized databases through mid-2002. Key words for the searches were caregiver, caregiving, family caregiving, caregiver burden, and caregiver appraisal. Reports of both earlier reviews of literature and original research were included. Findings Negative concepts included caregiver burden, hassles, strain, and stress. Positive concepts included caregiver esteem, uplifts of caregiving, caregiver satisfaction, finding or making meaning through caregiving, and gain in the caregiving experience. A neutral concept for describing the caregiving process is caregiver appraisal. Although earlier studies were focused on negative aspects of caregiving, more recent research has also included positive aspects. Conclusions More attention should be given to (a) gender and cultural differences in caregiving, (b) development of flexible interventions, and (c) the biophysical sequelae of caregiving.

The effects of an educational intervention on antipsychotic-induced weight gain.

Abstract: Purpose: To assess the effect of an educational intervention on antipsychotic-induced weight gain among patients with schizophrenia. Design and Methods: Quasi-experimental. Seventy patients with a DSM-IV diagnosis of schizophrenia or schizoaffective disorder entered this 6-month study condicted in the United States. All participants began receiving olanzapine treatment when they entered the study. The patients were then randomly assigned to an intervention group or a standard care group. Over the next 4-months, the intervention group participated in weekly psychoeducation classes focused on nutrition, exercise, and living a healthy lifestyle. Patients were followed for an additional 2 months to assess weight change. Findings: A statistically significant difference in weight change between the two groups was observed post-treatment and at endpoint. At endpoint, the mean weight change of the intervention group was -.06 pounds, while the mean weight change in the standard care group was 9.57 pounds. In both groups, men gained significantly more weight than did women. Conclusions: The results indicate that a structured educational intervention might have a positive effect on antipsychotic-induced weight gain among patients with schizophrenia.

Beyond MEDLINE for literature searches.

Abstract: Purpose: To describe strategies for a comprehensive literature search. Organizing Construct: MEDLINE searches result in limited numbers of studies that are often biased toward statistically significant findings. Diversified search strategies are needed. Methods: Empirical evidence about the recall and precision of diverse search strategies is presented. Challenges and strengths of each search strategy are identified. Findings: Search strategies vary in recall and precision. Often sensitivity and specificity are inversely related. Valuable search strategies include examination of multiple diverse computerized databases, ancestry searches, citation index searches, examination of research registries, journal hand searching, contact with the “invisible college,” examination of abstracts, Internet searches, and contact with sources of synthesized information. Conclusions: Extending searches beyond MEDLINE enables researchers to conduct more systematic comprehensive searches.

Reconceptualizing the Nurse‐Patient Relationship

Abstract: Purpose: To review assumptions inherent in the nurse-patient relationship as historically described and practiced, and to propose an alternate framework for nurse-patient interaction that is congruent with current health care environments. Organizing Constructs: The theory of human relatedness and the nurse-patient relationship. Methods: Analysis of assumptions inherent in the current theoretical and empirical literature on nurse-patient relationships and evidence from observation of nurses engaged in practice. Proposal and discussion of the theory of human relatedness as an alternative model for conceptualizing nurse-patient relationships. Conclusions: The theory of human relatedness framework provides new insights and opportunities for assessment, intervention, and research within the context of nurse-patient relationships.

Parental consent and adolescent risk behavior research.

Abstract: Purpose: To identify methodological issues related to the use of active or passive parental consent in school-based research on adolescent risk behavior research and to propose recommendations consistent with current legal and ethical standards in the United States. Methods: Review and synthesis of the professional literature related to adolescents and parental consent, federal regulations and guidelines in the United States, and the author's experience presenting these arguments and issues to institutional review boards and funding agencies for over 10 years. Findings: The procedures used for parental consent affect a study's participation rates, costs, and selection bias. When active parental consent is required, parental permission is typically obtained for only 30%–60% of students, compared to 93%–100% when passive consent is used. Extensive follow-up may result in 55%–100% of parents giving permission, but at significant cost (typically $20–$25 per student). Active consent results in the exclusion of minorities, students having problems in school, and students already engaged in or at risk for problem behaviors. Strong methodological reasons were identified for using passive parental consent procedures when possible. Current federal regulations include four areas for possible waiver or alterations in parental consent procedures, including the use of passive parental consent. Conclusions: Health researchers must understand the methodological, legal, and ethical issues related to parental consent to produce high-quality, valid research about adolescents and to provide evidence for laws, policies, and regulations.

Professional values held by baccalaureate and associate degree nursing students.

Abstract: Purpose: To determine the congruency in value orientation of graduating students in baccalaureate and associate degree programs. Design and Methods: A survey design with a convenience sample of 1,450 graduating nursing students from all baccalaureate and associate degree nursing programs in Texas. Data were collected using the Nurses Professional Values Scale (NPVS). Descriptive and parametric statistics were used for analysis. Findings: ADN and BSN students did not differ significantly on the NPVS total score, however, ADN students scored higher on 5 of the 11 subscales than did their BSN counterparts. Men from both programs scored significantly lower than did women on the total scale and all subscales. Ethnic groups differed on the responses to three of the subscales representing nurses' values: respect for human dignity, safeguarding the client and public, and collaborating to meet public health needs. Conclusions: Professional values in graduating nursing students were significantly related to sex and ethnicity, regardless of educational program. Nursing faculty members are challenged to address these differences during the educational process and mentoring of students.

Psychosocial factors related to nausea, vomiting, and fatigue in early pregnancy.

Abstract: Purpose: To test whether nausea and vomiting or fatigue correlated with psychosocial variables. Design: Descriptive, using secondary data from a prenatal database of 113 women in prenatal care in Texas. Mean gestational duration was 59 days at the time of data collection. Methods: Psychosocial factors, frequency of nausea and vomiting and of fatigue were determined by use of questionnaires. Psychosocial measures had reliability and validity and included the Personal Resources Questionnaire and Center for Epidemiologic Studies Depression Scale. A checklist was used for measuring nausea and vomiting and fatigue. Findings: Of 113 participants, 30 (26.5%) reported no, 43 (38.1%) occasional, and 40 (35.4%) frequent nausea and vomiting. Depressive symptoms had the highest correlation with nausea and vomiting. Social support was negatively related to nausea and vomiting. Four (3.5%) women reported no fatigue, 49 (43.4%) reported occasional fatigue, and 60 (53.1%) reported frequent fatigue in the past month. Depressive symptoms had the highest correlation with fatigue. The chi-square statistic showed that fatigue was significantly related to employment. Fatigue was not significantly associated with work hours or stressfulness of jobs. Conclusions: Only a limited number of psychosocial factors were associated with nausea and vomiting and fatigue in early pregnancy. Depression was related to physical symptoms, but unclear was whether depression preceded or resulted from the symptoms. Many women experienced symptoms, and better understanding of causality is needed to ameliorate the effects on women's well-being.

Parental Uncertainty and Posttraumatic Stress in Serious Childhood Illness

Abstract: Purpose: To explicate the link between parental uncertainty and posttraumatic stress as a way to stimulate advancement in the design and evaluation of nursing interventions for parents of children with serious illness. Methods: The literature on Mishel's uncertainty in illness theory and its reconceptualization-parental uncertainty in serious childhood illness-and posttraumatic stress are reviewed and synthesized. Pertinent methodological and sociocultural issues are discussed. Conclusions: The literature indicates support for the theoretical link between parental uncertainty and posttraumatic stress. This linkage provides direction for the design and evaluation of nursing interventions to support parents of children with serious childhood illness.

Patient problems, advanced practice nurse (APN) interventions, time and contacts among five patient groups.

Abstract: Efforts to provide high quality health care services while controlling health care costs have resulted in dramatic changes in health care systems, the delivery of health care services, and methods of reimbursement in the United States (American Medical Association, 2000; Baradell & Hanrahan, 2000; Goldfield, 2000; Lesser & Ginsburg, 2001; Oz et al., 2001). In these changed systems of care, providing high quality services while controlling costs remains an essential objective. Wellness programs and ambulatory care services including day surgery have shown cost savings while providing quality services (Drinkard et al., 2001). Care for people with major illnesses has raised more complex challenges for cost containment because of the need for costly procedures and drugs, adequate lengths of hospital stay, home care services, and continuity of care between health care settings and patients' homes. Maintaining continuity of care through the use of home care services has been linked to improved patient and family outcomes (Kearney, York, & Deatrick, 2000). However, recent reductions in reimbursement for home care services have the potential for loss of health gains and increased use of hospital and acute care services (Goldfield, 2000). Achieving high quality health care services and reasonable health care costs requires testing and evaluating types and levels of services capable of maintaining health at reasonable cost. Such testing requires knowledge of the problems of specific patients' groups needing health care services, provider interventions, provider time and number of patient contacts associated with optimal patient outcomes, and whether provider interventions could be more efficient and cost effective (Daly, Maas, & Johnson, 1997; Delaney, Reed, & Clarke, 2000; O'Conner, Kershaw, & Hameister, 2001; Stange et al., 1998). These issues are critical when the contracted care involves high-risk, high-cost, high-volume groups. To achieve this end, data are needed to accurately and adequately document health care problems of specific patient groups, to examine the processes of care, and to establish links among process, desired health outcomes, and consumer satisfaction. This analysis was conducted to determine those linkages.

Comparing various short-form Geriatric Depression Scales leads to the GDS-5/15.

Abstract: Purpose: To compare three published short GDS scales and to identify a valid and reliable short-form alternative to the 15-item Geriatric Depression Scale. Design: Comparative validation study via retrospective chart review of 816 acute care patients in an 830-bed academic medical center in the USA in 2001. Methods: Data of the 15-item Geriatric Depression Scale, the Mini-Mental State Examination, and demographic data were extracted from medical records after patient discharge. Three scales: the D'Ath GDS-4, van Marwijk GDS-4, and Hoyl GDS-5, were compared to the 15-item Geriatric Depression Scale. Results: The Hoyl 5-item version showed the highest sensitivity (97.9%). Concern for GDS-5 false positives when compared to the 15-item GDS (specificity 72.7%) led to re-ordering the 15 GDS items into a new two-tiered instrument, the GDS-5/15. In this study of 816 older adult inpatients, 60% were screened as “not depressed” using the first 5 items on the GDS-5/15, leaving 40% for continued screening and completion of all 15 GDS items. Conclusions: A shorter screening tool might encourage more providers to add depression screening to routine health care visits. The GDS-5/15 is an alternative screening tool.

An international perspective on the time to treatment for acute myocardial infarction.

Abstract: Purpose: To compare delay and circumstances of decisions to seek care in patients with acute myocardial infarction (AMI) in the United States (US), England, Australia, South Korea, and Japan. Design: Comparative prospective design. Methods: Patients diagnosed with AMI (N=913) were interviewed within 72 hours of hospital admission for confirmed AMI using the Response to Symptoms Questionnaire. Delay times were calculated from review of emergency room records and patients’ interviews. Analysis of variance was used to test differences in delay time among countries. Findings: Median delay ranged from 2.5 hours in England to 6.4 hours in Australia, with the three Pacific Rim countries reporting median delay times > 4 hours. The majority of patients experienced initial symptoms at home (range: 56% in Japan to 73% in the US) with the most common witness being a family member (32% in South Korea to 48% in England). Ambulance use was widely divergent with the highest use in England (85%) and the lowest use in the US (42%). Conclusions: In all countries, median delay was too long to obtain maximum benefit from AMI therapies, particularly thrombolysis. Education and counseling of patients and families to reduce prehospital delay in AMI episodes might be more effective if the various factors influencing patients’ first responses to symptoms are considered, as well as differences in health care systems.

Profession and Society

Abstract: Purpose: To determine the frequency and sources of verbal abuse against nurses working in clinical settings in different hospitals in the last 12 months, to identify nurses' perceptions about verbal abuse, and to determine types of emotions experienced by nurses who had encountered verbal abuse. Design and sample: This descriptive study was conducted in May 2001 in Turkey. Data were collected from 467 nurses working in various clinical settings in three hospitals. Methods: The instrument was a 23-item questionnaire on verbal abuse. Data were evaluated using frequency and descriptive statistics. Findings: The findings revealed that the majority of nurses had experienced verbal abuse in the last 12 months (86.7%, n= 405). Most nurses (92%) reported that verbal abuse negatively affected their morale. The most common sources of verbal abuse were patients' relatives and patients themselves. Conclusions: Workplace verbal abuse events cannot always be anticipated. Contingency plans to handle potential situations should be developed.

Experiences of Pioneer Nurse Practitioners in Establishing Advanced Practice Roles

Abstract: Purpose: To describe pioneers' experience of establishing the nurse practitioner (NP) role, and their experiences in maintaining and building the NP role in the contemporary practice environment. Design: The study sample included 50 middle-aged women currently practicing in Washington State as licensed advanced practice nurses, who began the NP role during 1965–1979. Methods: This descriptive study included interviews and focus groups to gather data about the nurses' early experiences. Interpretative methods of grounded theory were used in data collection and analysis. Findings: The central organizing theme, Advancing Autonomy to Make a Difference, was manifested through six broad themes: Breaking Free, Molding the Clay, Encountering Obstacles, Surviving the Proving Ground, Staying Committed, and Building the Eldership. Conclusions: Autonomy was requisite to practice to one's full potential and maintain commitment over time. The data findings show the evolution of advanced nursing practice in the United States and provide guidance for nurses who are working to establish advanced practice nursing in other countries.

Effects of a relationship-enhancing program of care on outcomes.

Abstract: Purpose: To examine the effects of a relationship-enhancing program of care (REPC) on resident and care provider outcomes. Design and Methods: A quasi-experimental, repeated measures design, with intervention and comparison groups. Questionnaires were distributed to 50 residents, and observations were conducted of 40 residents and 34 nursing staff at baseline and 3 months after the intervention, on two Canadian nursing home units. An investigator-designed educational program based on Winnicott's theory of relationships and the empirical literature, was provided to care providers and their supervisors on the intervention unit. Repeated measures analysis of variance (RM-ANOVA) was used to compare the intervention and comparison groups in regard to changes in the outcomes over time. Findings: The REPC had statistically significant effects on (a) residents' perceptions of care providers' relational care, (b) care providers' relational behaviors, and (c) continuity of care. Conclusions: Evidence showed that these care providers were taught how to enhance their relational skills with residents living in long-term care facilities without added staff. Recommendations for practice and research are discussed.

Predictors of Condom Use Among Adolescent Thai Vocational Students

Abstract: Purpose: To describe the prevalence of premarital sexual behavior and condom use and to identify predictors of condom use using the expanded health belief model (EHBM) among vocational students in Bangkok Thailand. Methods: A cross-sectional correlational design was used with a cluster-based sample of 425 students aged 18 to 22 years from eight randomly selected private vocational schools in Bangkok. Anonymous self-report questionnaires were used to collect the data. Stepwise multiple regression was conducted to identify predictors of condom use. Results: Overall 49.9% of participants were sexually active 64.8% of men and 32% of women. Of the sexually active participants only 6.3% reported using condoms every time when having sex in the beginning of the relationship and 10.2% during the last few times. Twenty-four percent of sexually active participants had unplanned pregnancies and 7% had sexually transmitted diseases (STDs). The predictive model of condom use consisted of perceived benefits from using condoms; interactions between intention to use condoms and gender: knowledge of STDs HIV AIDS pregnancy and peer norms; and alcohol use and age. Adjusting for modifying factors the predictor set explained 27% of the variance in condom use. Conclusions: Most of this sample of sexually active Thai vocational students practiced unsafe sex and many had unplanned pregnancies and STDs. The EHBM provided a modest predictive model of condom use. (authors)

Barriers to utilization of prenatal care services in Turkey.

Abstract: Purpose: To identify barriers to utilization of prenatal care services in Turkey, including pregnant women's attitudes toward pregnancy and prenatal care. Design: Descriptive. The population was Turkish women who lived in Erzurum and had delivered their infants but were still hospitalised. Methods: The sample of 446 women had or had not received prenatal care, had no complications during pregnancy, carried their pregnancies to term, and were considered to have normal deliveries. Attitudes toward pregnancy and prenatal care and barriers to prenatal care services were measured by use of a questionnaire. Findings: Low education of pregnant women and unwanted pregnancy were barriers to use of prenatal care services. Additional barriers were negative attitudes toward pregnancy and attitudes toward prenatal care. These barriers decreased frequency of use and delayed early initiation of prenatal care. The most important barrier reported by the women was being too busy at home to seek care. Conclusions: Although this sample was limited, the findings indicate barriers for attention by health care providers to ensure appropriate prenatal care and maternal and infant health.

Media portrayal of nurses' perspectives and concerns in the SARS crisis in Toronto.

Abstract: Purpose: To describe nursing work life issues as portrayed in the media during the SARS crisis in Toronto. Methods: Content analysis of local and national news media documents in Canada. Media articles were sorted and classified by topic, and themes were identified. Findings: Themes were: (a) changing schemas of nursing practice: the new normal; (b) barriers to relational nursing work; (c) work life concerns: retention and recruitment; (d) nursing virtue: nurses as heroes and professionals; (e) paradoxical responses to nurses from the community; and (f) leadership in nursing during the SARS crisis. Conclusions: This analysis enhanced understanding of how nurses are portrayed in the media, but it indicated the significance of quality of work life and issues about work-home life. Some descriptions of the care and caring of nurses have made nursing seem like an important and influential profession to potential applicants who might previously have dismissed nursing as a career.

Social Capital, Health, and Health Disparities

Abstract: Purpose: To synthesize the empirical evidence that links social capital to population health with the aim of identifying implications for health disparities research. Methods: A literature search of PubMed and CINAHL databases from January 1990 to June 2002 was done using the search term ‘social capital.’ In addition, tables of contents of applicable journals from January 1997 to June 2002 were searched. Reference lists were examined for additional empirical and theoretical articles related to social capital and health. Eighty-four articles were retrieved for review and 19 articles met inclusion criteria. Findings: Although most researchers concluded that their findings supported an association between social capital and health, all research was descriptive, without conceptual development. This gap resulted in (a) lack of distinction of the concept as an attribute of a geographic space or as an individual attribute, (b) problematic use of operational variables, and (c) limited theoretical exploration of causal linkage. These deficits limit the usefulness of the concept for health disparities research. Conclusions: The lack of conceptual development diminishes the usefulness of social capital as a variable for public health research. However, the empirical evidence is sufficient to warrant further work to advance the concept in relation to population health and health disparities.

Negotiating Dyadic Identity Between Caregivers and Care Receivers

Abstract: Purpose: To describe the ways in which caregivers (CGs) and their care receivers (CRs) negotiate the dyadic rules that influence how the care experience “fits into” their lives and to suggest theory based on the data. Design: This qualitative study was part of a larger, NIH-funded study of 60 care dyads and their use of respite care in the Midwestern United States. The sample for this analysis included 60 informal CGs and CRs in their home settings. Data collection for the larger study began in 1994 and continued through 1998. Methods: CGs and CRs were interviewed in their homes with one researcher interviewing the CG regarding the care experience while another researcher interviewed the CR. Qualitative content analysis was used to analyze the data. Findings: The theory of CG and CR dyadic identity development, formulated in this study, indicates that a mutually agreed-upon care dyadic identity is developed when both parties negotiate a set of rules about their conduct together in the caregiving and care receiving relationship. Failure to agree on these dyadic rules may result in strain in the care process. Three archetypes of dyadic relationships were identified, based on the degree of immersion into a dyadic identity: (a) complete and mutually accepted immersion of an identity into the care process by both parties, (b) retention of personal identities while also accepting the caregiving or care-receiving roles, and (c) rejection of the roles by one or both parties. Conclusions: Negotiation was important in these dyadic care relationships, and thus attention to assisting CGs and CRs to develop negotiation skills is needed. More research is needed to substantiate and expand this theory of CG and CR dyadic identity development, and to examine linkages between negotiated processes and outcomes.

Nurses' attitudes and practice related to hospice care.

Abstract: Purpose: To describe characteristics, attitudes, and communications of nurses regarding hospice and caring for terminally ill patients. Design: A cross-sectional study of randomly selected nurses (n=180) from six randomly selected Connecticut community hospitals was conducted in 1998 and 1999. Methods: Hospice-related training, knowledge and attitudes, demographic and practice characteristics, and personal experience with hospice were assessed with a self-administered questionnaire (response rate=82%). Logistic regression was used to model the effects of hospice-related training, knowledge, and attitudes on these outcomes, adjusting for personal experience and other characteristics of nurses. Findings: Characteristics associated with discussion of hospice with both patients and families included greater religiousness, having a close family member or friend who had used hospice, and reporting satisfaction with hospice caregivers. Greater self-rated knowledge was significantly associated with discussion of hospice with patients. Attitudinal scores indicating greater comfort with initiating discussion and greater perceived added benefit of hospice were significantly associated with discussion with patients' families. Conclusions: Nurses' discussion of hospice with terminally ill patients and their families are related to the potentially modifiable factors of self-rated knowledge and attitudes revealing comfort with discussion and perceived benefit of hospice care.

Testing an intervention for preventing osteoporosis in postmenopausal breast cancer survivors.

Abstract: Purpose: To test a 12-month multicomponent intervention for preventing or treating osteoporosis in 21 postmenopausal women who had completed treatment (except Tamoxifen) for breast cancer, and for whom hormone replacement therapy (HRT) was contraindicated. Design: Pilot intervention study. Methods: The intervention consisted of home-based strength and weight training exercises, 5 or 10 mg alendronate per day, 1500 mg calcium per day, 400 IU vitamin D per day, education on osteoporosis, and facilitative strategies to promote adherence to the intervention. Outcome measures were: adherence to the intervention, dynamic balance, muscle strength, and bone mineral density (BMD) of the hip, spine, and forearm. Findings and Conclusions: Adherence to calcium, vitamin D, and alendronate therapy was above 95%, and adherence to strength training exercises was above 85%. Over the 12 months, the 21 participants had significant improvements in dynamic balance, muscle strength for hip flexion, hip extension, and knee flexion, and BMD of the spine and hip. Participants had a significant decrease in BMD of the forearm. Three of the 21 women who had measurable bone loss at baseline had normal BMD after 12 months of the intervention.

Home care nurses' descriptions of important agency attributes.

Abstract: Purpose: To identify attributes of home care agencies described by nurses as important to their professional practice and job satisfaction. Design: Seven focus groups with home health care staff nurses were conducted at 6 home care agencies located in three states in the Mid-Atlantic region of the United States. A total of 58 home care nurses participated in the study. Methods: Transcriptions of tape-recorded focus groups were subjected to open and axial coding techniques. Results: Six major categories and eight subcategories of organizational attributes described by home care nurses as important to the support of their practice and job satisfaction were identified. Conclusions: Attributes described by home health nurses were not only similar to those described by hospital-based nurses as reported in the ‘magnet hospital’ literature, but they also were consistent with key concepts described in theories of professional workforce organization. Findings provide insight into developing workplace environments to support home care nurses.

Birth outcomes and maternal morbidity in abused pregnant women with public versus private health insurance

Abstract: Purpose: To compare the effects of recent intimate partner abuse on maternal and infant health in publicly versus privately insured pregnant women. Design: Exploratory descriptive analysis in 13 Massachusetts prenatal care sites from records of 2,052 women who had been screened during pregnancy for domestic violence. Methods: Clinicians screened pregnant women for domestic violence using the Abuse Assessment Screen. After delivery, prenatal and birth outcome data and abuse screening results were extracted from medical records by project staff. Odds ratios were used to compare maternal and infant health indicators in abused and nonabused women. Data from women with public and private health insurance then were examined separately, using logistic regression to control for low education and single marital status while examining the odds of adverse maternal and infant outcomes in abused and nonabused women. Findings: In the sample as a whole, recently abused women were more likely to be publicly insured and unmarried, to have less than 12 years of formal education, and to have medical and obstetrical complications. Parity, ethnic background, and infant birth outcomes did not differ in relation to abuse. In separate analyses for women with public and private health insurance, after controlling for marital status and education, abuse increased the odds of low infant Apgar scores, poor nutrition, hyperemesis, hypertension, and substance abuse in publicly insured women, and abuse increased the odds of poor nutrition and bleeding during pregnancy for privately insured women. Conclusions: The different correlates of abuse in publicly and privately insured women might be important for clinicians caring for these different populations. Screening for abuse and providing abuse-related services are indicated for pregnant women.

The Nurse-Community Health Advocate Team for Urban Immigrant Primary Health Care

Abstract: Purpose: To describe: (a) development and implementation of an urban outreach health program for Latino immigrants; (b) nurse-community-health advocate (CHA) partnership roles in primary health care delivery, and (c) lessons learned from these activities over 7 years in urban community settings. Methods: Descriptive study of a community-based health project in a large Midwestern American city. Information was gathered from participants and staff, from observing staff, and from a variety of sources to describe the program and its individual, family, and community effects. Findings: Major findings pertain to the project team's ability to address the health promotion needs of Latino immigrant families and to successfully incorporate CHAs in planning and implementing the program. CHAs were a “bridge” between health programs and the community, promoting cultural sensitivity. CHAs and nurses provided a range of services including health education and promotion, outreach through home visits, assessment of family needs for referrals to appropriate resources, and follow-up support. Conclusions: The nurse-CHA team was an effective strategy for promoting Latino immigrant families' access to needed health care. This framework allowed for flexibility in assisting clients of different cultural backgrounds to obtain appropriate health care.

Psychological Factors in Nepali Former Commercial Sex Workers with HIV

Abstract: Purpose: To examine perceived stress, coping style, and symptoms of anxiety and depression in HIV-positive Nepali women who were formerly commercial sex workers (CSWs). Design: Descriptive, correlational study with a convenience sample of 98 Nepali women with HIV recruited from a nongovernmental organization (NGO) in Nepal. Methods: Investigator-administered questionnaires included a sociodemographic questionnaire, the Perceived Stress Scale (PSS), the Ways of Coping Questionnaire (WOC), the Center for Epidemiologic Studies Depression Scale (CES-D), and the Symptoms Checklist-90 (SCL-90) Anxiety Subscale. Analytical methods included descriptive statistics and hierarchical regression analysis. Findings: The level of perceived stress was similar to that observed in a healthy female population of similar age. The primary coping style was problem-focused, with the strategy of seeking social support used most. Depression measured with the entire CES-D was 3% but is was 18% on the somatic subscale. Twenty-two percent of the variance in depression was predicted by the combination of perceived stress and the coping strategy of escape avoidance. Twenty-four percent of the variance in anxiety was predicted by the combination of perceived stress and three coping strategies: problem solving, accepting responsibility, and distancing. Conclusions: This sample had a low prevalence of psychological symptoms. Somatic symptoms, which may be more relevant than affective symptoms in non-Western populations, were the best indicator of depression. Future studies are needed to examine culturally relevant appraisals, coping style, and psychological symptoms. Knowledge of psychological factors can be used to develop interventions for this population that has no access to treatment for HIV disease.

Views of community-dwelling, old-old people on barriers and aids to nutritional health.

Abstract: Purpose: To examine barriers and aids to maintaining the nutritional health of community-dwelling old-old residents from their perspectives. Design: Cross-sectional exploratory study completed in March 2002 of old-old people living independently in one county in the Midwestern United States (US). Methods: Sixty-eight in-home interviews were conducted with community-dwelling people aged 80 or older. Content analysis was done to examine answers to two open-ended questions about barriers and helps to nutritional health. Findings: These old-old people believed they were doing well nutritionally despite reduced independence and physical limitations. They were positive about their lives and creative in problem solving to remain independent. Social connectedness was the major factor for maintaining independence into old age. The leading barrier to maintaining nutritional health was health problems. Those with more barriers were more likely to be depressed. Conclusions: Knowledge of aids and barriers to nutritional health, from a personal perspective, gives an understanding of the issues and concerns of old-old people.

Decision-making process for living kidney donors.

Abstract: Purpose: To explore what people experienced when deciding to donate a kidney and to explore associated issues and concerns when they made their decisions. Design: Grounded theory. Methods: The data were collected in Korea through semi-structured individual interviews in 1998–1999. A purposeful sample of 14 living kidney donors participated. All interviews were audiotaped and were transcribed verbatim. Constant comparative analysis was done using the NUD*IST4.0 software program. Findings: “Wishing to give (a kidney)” was the core category integrating the six subcategories: motives, intervening conditions, inhibiting factors, facilitating factors, donor characteristics, and consequences. Two phases in the decision-making were the deliberation phase and the execution phase. Three decision-making types related to the intensity of “wishing to give” are: high intensity as voluntary type, medium as compromising type, and low as passive type. Conclusions: The decision to donate a kidney was described as a highly complicated process involving not only the medical but also psychological, interpersonal, familial, and financial concerns.

Issues and Dilemmas in Conducting Research with Vulnerable Home Hospice Participants

Abstract: Purpose: To describe issues and dilemmas related to nonparticipation, attrition, and needs for assistance in research with vulnerable home hospice participants. Design and Methods: Retrospective analysis, with descriptive statistics of the frequency of issues and dilemmas that occurred in a research study with a vulnerable population. Findings: From a group of 113 potential participants, 16 (14.1%) people who gave initial consent were unable to participate or were lost to the study (subset I) for the following reasons: unable to give informed consent, cognitive disturbance, and physical distress. Of the 97 participants who completed testing, 28 (28.8%) required assistance (subset II) because of poor vision, physical weakness, and other physical impairments. Conclusions: Loss of potential participants limited this study and hampered effect size. Research with home hospice patients required careful assessment for symptoms that precluded informed consent. Issues with cognition indicated need for a tool to assess mental acuity. Although several participants required assistance, those who completed testing expressed gratitude at being able to contribute information that they believed would benefit others.