Showing papers in "Nursing Research in 1984"

Physiological effects of human/companion animal bonding

Abstract: Blood pressure, heart rate, and respiratory rate were recorded in 24 subjects during 3 9-minute measurement sessions in which they petted an unknown dog, petted a dog with whom a companion bond had been established, or read quietly. Based on the findings of this study, several conclusions were drawn: (1) There is a significant difference in changes over time in both systolic and diastolic blood pressure between petting a dog with whom a companion bond has been established and petting a dog with whom no bond exists; (2) the decreases in both systolic and diastolic blood pressure that occur during petting a dog with whom a companion bond has been established parallel the relaxation effect of quiet reading; and (3) there is a " greeting response" to the entry of a dog with whom a companion bond has been established, which results in significantly higher systolic and diastolic pressures than the response either to an unknown dog or to reading.

Psychometric assessment of the Jalowiec Coping Scale.

Abstract: The Jalowiec Coping Scale consists of 40 coping behaviors culled from a comprehensive literature review, which are rated on a 1- to 5-point scale to indicate degree of use. Twenty judges classified the items to permit analysis of the coping behaviors according to a problem-oriented/affective-oriented dichotomy; 15 problem and 25 affective items resulted. Overall agreement by the judges was 85%, with greater consensus on problem items. Evaluation of stability using a two-week retest interval (N = 28) yielded significant rhos of .79 for total coping scores, .85 for problem, and .86 for affective. With a one-month interval (N = 30) coefficients were .78, .84, and .83, respectively. Alpha reliability coefficients of .86 (N = 141) and .85 (N = 150) supported instrument homogeneity. Content validity is substantiated by the systematic manner of tool development, by the large number of items used, and by the inclusion of diverse coping behaviors. Factor analysis (N = 141) was used to investigate construct validity. A two-factor solution to evaluate the validity of the dichotomous classification showed that 80% of the problem items loaded on Factor I, but only 56% of the affective items loaded on Factor II. To examine this multidimensional aspect, several other factor solutions were explored. Ultimately, the four-factor solution provided the most intelligible conceptual pattern with the least loss of information. Conceptual composition of these factors is discussed, and several tentative labels for each factor are suggested.

The Measurement of Clinical Pain

Abstract: Major problems in the measurement of clinical pain are created because of (1) its subjective nature, (2) a limited number of reliable and valid instruments that measure the experience, and (3) a multitude of clinical issues such as type of pain, cause, and patient sample characteristics. Instruments currently available measure intensity, behavioral and/or physiologic phenomena associated with pain, and multiple dimensions of the experience of clinical pain. Important factors the nurse must consider when selecting a measuring instrument are the various definitions of pain, the goals of the measurement problem, and the type of pain being measured. Additional factors are specific sample characteristics, ease of administration and scoring, and reliability and validity data. A careful and deliberative selection process should help provide useful and relevant information.

Head nurse leadership style with staff nurse burnout and job satisfaction in neonatal intensive care units.

Abstract: Leadership style has been defined as a two-factor construct composed of "consideration" and "initiating structure." Research has suggested that these factors affect the behavior and attitude of subordinates. This study's purpose was to quantify the relationships of head nurse leadership style with self-reported staff nurse burnout and job satisfaction in Neonatal Intensive Care Units (NICUs). Three instruments--the Minnesota Satisfaction Questionnaire, the Tedium Scale, and the Leadership Opinion Questionnaire--were voluntarily completed by 283 registered nurses employed by 14 level-III NICUs in the United States. The leadership dimensions of consideration and structure were distinct (r = -.10). Staff nurse satisfaction and burnout were related (r = -.41). Head nurse consideration was clearly related to staff nurse satisfaction (r = -.55) and to a lesser extent to burnout (r = -.29). Initiating structure alone was not related to satisfaction or burnout. Aggregate perceptions of head nurse leadership were ranked across NICUs in order to classify the head nurses on consideration and structure. The 14 head nurses were separated into four groups: high consideration-high structure, high consideration-low structure, low consideration-high structure, and low consideration-low structure. Satisfaction and burnout of staff nurses in each of the leadership-style groups were then compared. Analysis of variance for satisfaction (F(3,279) = 3.10, p = .03) and burnout (F(3,279) = 3.90, p = .01) were both significant. For both satisfaction and burnout, the head nurse leadership classification of low consideration-high structure was most deviant.(ABSTRACT TRUNCATED AT 250 WORDS)

Duration of pain condition and physical pathology as determinants of nurses' assessments of patients in pain.

Abstract: This article is based on an experiment that examined features distinguishing chronic from acute pain syndromes, and their influence on nurses' estimates of patient suffering, pain relief actions, and attitudes toward patients. Two hundred sixty-eight nurses received one-paragraph descriptions of patients complaining of severe pain. Descriptions varied on the dimensions of duration (acute vs. chronic), signs of physical pathology (positive vs. negative), signs of depression (positive vs. negative), and diagnostic category (low back vs. headache vs. joint pain). Subjects estimated the intensity of the hypothetical patient's suffering, indicated priorities for specific pain relief actions, and rated the patient on a series of trait dimensions. Subjects attributed less intense pain when the patient had no signs of pathology and when duration was long-termed and chronic. They also assigned lower priorities to medication-related nursing actions when signs of pathology were negative. Finally, more negative personality and behavioral traits were attributed to the patient when signs of pathology were negative. The results reflect a dichotomous, organic versus psychogenic model of pain on the part of health care staff. Since the data indicate the chronic pain sufferer is negatively stereotyped by staff, a need exists to develop and disseminate more integrative models of the pain experience.

The relationship between social support and self-care practices.

Abstract: A two-study approach was used to investigate the relationship between individuals' perceived level of social support and their performance of specific, positive health practices. One sample consisted of 97 adults, age 55 and older, attending activities at a senior citizen's center. The second sample was comprised of adults attending a health fair. Subjects were surveyed using the Lifestyle Questionnaire and the Personal Resources Questionnaire. The primary study hypothesis--that a strong, positive association would be found between the social support and health practices variables--was upheld for both samples. A secondary hypothesis--that married participants would score significantly higher on both the social support and health practices instruments than would their nonmarried counterparts--was supported only among the senior center participants. An additional hypothesis generated for the senior center participants--that participants with a confidant would have significantly higher scores on both the social support and health practices instruments--was upheld.

Nursing's search for scientific knowledge.

Abstract: This analysis describes the characteristics of nursing research today, and identifies trends and changes in research over the past three decades. A sample was drawn from four nursing research journals of 137 substantive studies, 14 published in 1952-53, 20 in 1960, 40 in 1970, and 63 in 1980. The analysis revealed that over this period nursing research (1) increased substantially in amount; (2) became more clinically focused; (3) demonstrated a greater theoretical orientation; and (4) became more sophisticated and sound in methods employed. Among the limitations noted were insufficient conceptualization and the failure to build a cumulative science. Suggestions are offered for future research.

Morale and perceived control in institutionalized elderly.

Abstract: This study explored patterns of causal relationships among perception of situational control, health, socioeconomic status, functional dependency, length of stay, and morale in institutionalized elderly. Causal patterns in residents at two levels of care were contrasted. A total of 113 residents on intermediate and skilled care units chosen randomly from 4 urban proprietary nursing homes were studied. Variables were measured by means of an interview. Instruments included the Philadelphia Geriatric Center Morale Scale, Chang's Situational Control of Daily Activities Scale, and the Resident's Questionnaire. Path analysis was used with a causal model to estimate direct and indirect effects of the independent variables on morale. Important differences in the way the independent variables affected morale for residents on the two levels of care were reported. Perception of situational control proved to be a key variable, significantly related to the morale of residents on both levels of care, although the strength of the association was stronger for residents on skilled care. Functional dependency, health, and socioeconomic status had significant direct effects on the morale of residents on intermediate care but not those on skilled care.

Children's Locus of Control Beliefs as Predictors of Preoperative Coping Behavior

Abstract: This study examined the relationship between children's locus of control beliefs (as measured by the Nowicki-Strickland Locus of Control Scale) and their preoperative coping behavior. Subjects were 51 children between the ages of 8 and 12 who were scheduled for minor elective surgery. They were inte

Preadmission self-instruction booklets, postadmission exercise performance, and teaching time.

Abstract: The relative effects of preadmission self-instructional information on levels of performance and time needed to achieve level of mastery of exercise behaviors were examined using a sample of 130 presurgical cholecystectomy and herniorrhaphy patients. Experimental interventions were (1) no preadmission information, (2) specific preadmission instructions, and (3) nonspecific preadmission instructions. Preadmission instructions consisting of either a specific or nonspecific booklet mailed to patients focused on techniques for coughing, deep breathing exercises, leg movements, and ambulatory behaviors. During hospitalization, patients' exercise behaviors and the length of teaching time required for patients to perform the exercise steps were measured. Findings showed that subjects in the specific exercise instruction group performed significantly more of the exercise behaviors common to both booklets than subjects in the nonspecific exercise instruction group. Subjects in the specific instruction group also performed significantly more of the behaviors available to them than the nonspecific instruction group. Required postadmission teaching time did not differ significantly between the specific and nonspecific information groups, but both the groups required significantly less teaching time in the hospital than the no-preadmission instruction group.

Development of the Chronicity Impact and Coping Instrument: Parent Questionnaire (CICI:PQ).

Abstract: The CICI: PQ--Chronicity Impact and Coping Instrument: Parent Questionnaire--was developed to determine the impact of a child's chronic illness on parents and how parents cope with the impact. This article describes the development of the CICI:PQ and the results of three pilot studies to increase the instrument's reliability. Hoyt's coefficient of reliability for the total instrument is .95. The CICI:PQ is useful to health professionals working with chronically ill children and their families and to researchers interested in the same population.

Parental attitude and adjustment to childhood epilepsy.

Abstract: Parenteral attitudes and adjustment to epilepsy were assessed for 50 parents of children aged 6 to 14 with epilepsy. Fishbein's Expectancy-Value Model of Attitude was used to assess parental attitudes. Parental adjustment was measured both by a self-report instrument and by an independent psychosocial assessment conducted by a psychiatric social worker. The major finding was a strong positive relationship (R = .67, p less than .001) between parental attitude and adjustment for the mothers. The attitude-adjustment relationship was not significant for the fathers. In addition, parental attitudes and perception of seizure control accounted for 60% of the variance in the mothers' adjustment scores. Seizure control was significantly positively related (p less than .05) to parental adjustment.

[Therapeutic and physical touch: physiological response to stressful stimuli].

Abstract: Sixty female college students were exposed to a stressful stimulus and treated by therapeutic or physical touch. Groups were compared on levels of physiological response through electromyographic, skin conductance, and peripheral skin temperature measures. The hypotheses predicted that the therapeutic touch group would remain more relaxed than the physical touch group. None of the hypotheses were confirmed using a one-way analysis of covariance.

Progressive relaxation training in cardiac rehabilitation: effect on psychologic variables.

Abstract: The purpose of this study was to investigate the effect of progressive relaxation training as a stress management technique for cardiac patients who were participants in a cardiac exercise program. After pretesting, 18 patients received 3 weeks of relaxation training in addition to their exercise therapy; a control group of 19 patients was not taught the technique. Pretesting used two instruments to measure stress levels-the Spielberger State-Anxiety Scale and selected dimensions of the Symptom Checklist-90-Revised. At the completion of the relaxation training program, both groups of patients were retested on stress-level measures. An analysis of covariance was used to test for the effects of the relaxation training program. The findings were: posttreatment mean anxiety scores for the treatment group were significantly lower (p less than .05) than that of the control group; and the posttest scores for the treatment group were significantly lower for the dimensions of (p less than .01) somatization and interpersonal sensitivity and (p less than .05) anxiety and depression than that of the control group. No systematic changes were induced in either the obsessive-compulsive or hostility dimension scores by the relaxation program.

Stress-buffering effects of social support on maternal discipline.

Abstract: The purpose of this study was to investigate whether social support and stress influence maternal discipline of the six-month to three-year-old child with a developmental delay. Ninety-one mothers completed self-administered measures of support, stress, and discipline. Results of multiple regression analyses revealed that the stress and support interaction variable showed a strong trend (p less than .09) in predicting restrictive discipline. The failure of the independent variables, social support and stress, to have significant main effects appeared to be due, in part, to the multicollinearity (r = -.51, p less than .001) of these variables. For subsequent analyses, stress was used as a categorization variable. The total number of subjects was categorized first into two subgroups using a median split--high or low maternal stress--and into two other subgroups based on number of developmental delays. Pearson correlations indicated that social support was inversely related to restrictive discipline for high-stress mothers, but not for low-stress mothers. The positive influence of social support was also found for mothers of children with three to five delays but not for mothers of children with one to two delays. A negative response style of maternal discipline was reduced when the mother felt supported.

Coping in hospitalized children: an analysis of published case studies.

Abstract: This study examined the range of coping behaviors identified by the authors of 39 published case studies of hospitalized children age 20 months to 10 years and the pattern of coping revealed when the behaviors described in the published studies were analyzed according to the category system based on the Lazarus stress and coping paradigm. The behaviors reported in the case studies were subjected to a content analysis of the various labels attributed by the authors to the behaviors and then to a detailed content analysis according to the Type of Coping Behavior Category System. The range of labels of coping behavior used in the case studies showed that there had been no systematic and consistent approach to analysis of the children's coping strategies. The results of the analysis using the category system indicated that the coping strategies could be categorized in a systematic way. The pattern of coping revealed indicates that the system is sensitive to the influence of level of development.

Effect of nursing interventions on nutritional and performance status in cancer patients.

Abstract: Cancer patients, assessed as nutritionally at risk, were randomly assigned to a control group or to one of four intervention groups receiving (a) nutritional supplementation, (b) relaxation training, (c) both nutritional supplementation and relaxation training, or (d) neither nutritional supplementation nor relaxation training. Fifty-five subjects completed a four-month intervention period during which they were visited biweekly by a nurse (except control subjects). In repeated measures analyses of variance, significant group-by-time interactions were obtained for weight and arm muscle circumference (a measure of protein stores), indicating that for these measures the groups changed differentially during the intervention period. The group-by-time interaction approached significance on the Karnofsky Performance Status Scale. For all three variables, gain was greatest for the relaxation group; the most severe loss occurred in the control group. These findings suggest that the cachexia of cancer may be slowed or reversed through noninvasive nursing interventions.

Therapeutic touch: is there a scientific basis for the practice?

Abstract: The research-related literature on the topic of therapeutic touch is critically reviewed. The purpose of the review is to explore the current scientific basis for the teaching and practice of therapeutic touch as a treatment modality. An examination of published research literature indicates that empirical support for the practice of therapeutic touch is, at best, weak. The results of well-designed, double-blind studies have been transient, of no significance, or are in need of independent replication. Current practice of therapeutic touch is empirically little more than practice of placebo. Considerations for further nursing research are also presented.

Clinical evaluation of three techniques for administering low-dose heparin.

Abstract: The purpose of this study was to investigate the effect of three techniques for administering subcutaneous low-dose heparin on the formation of bruises at the injection site in adult postoperative cardiothoracic surgery patients. Forty-three subjects comprised the sample. All received subcutaneous injections of heparin, 5,000 units every 12 hours postsurgery. Three subcutaneous injection techniques, identified to study the variables of needle manipulation and tracking of the medication, were administered randomly to each subject. Forty-eight hours after the third injection, the sites were observed and bruises, if present, were measured. Data were analyzed by means of the Friedman test, and a 0.569 level of significance was obtained. It was concluded that, for this sample, none of the three techniques appeared clearly superior in yielding smaller or fewer bruises.

Collaborative nursing research: anatomy of a successful consortium.

Abstract: The purpose of this paper is to describe the collaborative efforts of one successful research group. The Tube Feed Consortium Group was composed of seven investigators who lived in four different geographic locations. One of the members served as principal investigator and chairman of the group; the others as coinvestigators. A coinvestigator served as principal investigator in each location, managing subcontracted budgets and scientific concerns. This structure promoted efficiency in budget management, conflict management, and division of labor. Major advantages to this approach to the conduct of research included (a) a large number of subjects studied in a relatively short time period; (b) a data collection structure, which permitted wider generalization than data collected in one institution by one investigator; (c) a mechanism for direct replication and replication with expansion; (d) maximum usage and distribution of resources between investigators. Mechanisms established early in the history of the group helped to achieve maximum communication, resolve potential conflicts, ensure reliability of data, ensure publication and presentation rights of collaborators, and manage the overall budget and subcontracts. The group remained intact for eight years, completed all the proposed studies plus other related studies, presented numerous papers, and continues to publish findings of these endeavors.

Cerebrovascular status of severe closed head injured patients following passive position changes.

Abstract: Nursing care of the severe closed head injured patient has two primary goals: (1) the prevention of secondary brain injury associated with intracranial hypertension, and (2) the prevention of complications associated with immobility. This study examined the effects of six body position changes, performed as part of routine nursing care interventions, on the cerebrovascular status of 18 severely head injured patients. These changes included turning and positioning in bed, head rotation, range of motion exercises, and raising and lowering of the head of the bed. All subjects had baseline mean intracranial pressures of less than or equal to 15 mm/Hg, and cerebral perfusion pressures of greater than or equal to 50 mm/Hg. Over 200 observations of the effects of position changes on heart rate (HR), mean arterial blood pressure (MABP), mean intracranial pressure (MICP), and cerebral perfusion pressure (CPP) were recorded and analyzed. With the exception of the intervention raising the head of the bed, all position changes produced increases in HR, MABP, MICP, and CPP. Typically, the physiologic changes were transient and showed recovery toward baseline values in one-minute postintervention measurements. The results of this study suggest that passive position changes may be performed safely upon severe closed head injured patients with baseline MICPs less than or equal to 15 mm/Hg, provided CPPs are maintained above 50 mm/Hg throughout each position change and provided multiple fractures do not preclude these position changes.

A comparison of perceptions of problematic behavior by six minority groups and mental health professionals.

Abstract: This study compared the perceptions of problematic behavior and the suggested management of those behaviors by six minority groups and mental health professionals. Minority respondents (N = 159) included Chinese-Americans, Mexican-Americans, Filipino-Americans, Native-Americans, Black-Americans, and Appalachians. Mental health professional respondents (N = 68) were from Pennsylvania, Louisiana, and California. All respondents were interviewed using a structured interview schedule. Groups were compared on responses to 10 vignettes. There were significant differences between minority and mental health professional groups, both in the labels placed on problematic behaviors and in the suggested management of the behaviors. The relationship of sample variables to response revealed that minority group status was the strongest descriptor of group response.

Value orientations as an assessment tool in cultural diversity.

Abstract: Value Orientations is the term used for a theoretical construct and its cultural assessment tool that was developed by Florence Kluckhohn in the 1950s. The tool, tested in rural and urban areas, has been useful in identifying the dominant and variant values and beliefs that characterize groups. This paper describes the tool, its theoretical underpinning, and data analysis techniques with the Annang of Nigeria as an example of how the tool is used on context of a single culture. In addition, use of the tool with individual clients to establish possible areas of culture conflict in values is examined.

Transitional newborn infants in a hospital nursery: from first oral cue to first sustained cry.

Abstract: Before crying, newborns exhibit oral cues. This study determined time and behavior between first oral cue and first sustained cry (2 minutes of crying) in 15 clinically normal infants postbirth (mean age 64 minutes). Mean minutes cue to cry was 31. Mean tonguing frequency was 108; hand-to-mouth (70); hand-passing-mouth (57); whimpering (49); rooting (19); empty sucking (14); startle (6); yawn (3); and sneeze (2). Mean minutes of intrinsic mouthing was 2.9; digit sucking (1.6); tongue sucking (1.2); sucking hand (1.1); fussing (1.0); and no cues (3.4). Mean minutes of crying was 1.1; hard crying (0.9). Mean longest single cry was 25 seconds. Mean inter-cry interval was 2 minutes. Crying occurred 13% of the time. During the physiologically critical period postbirth, responses to cues, rather than demands (cries), might prevent crying, decrease physiologic compromise, and foster appropriate care giver-infant interaction. This may enhance physiologic-psychosocial development.

Depression as an explanation for decreased subjective time in the elderly.

Abstract: This study focuses on the occurrence of depression in the elderly as an explanation for conflicting findings regarding subjective time in this age group. Subjects were volunteers from a congregate meal program in central Pennsylvania. The sample (N = 68) was restricted to women over 65 years of age. Depression was measured by the Beck Depression Inventory. Subjective time was determined by having the subject give a production estimate of an interval of 40 seconds. Analysis of data, which showed a correlation coefficient of 0.35 (p less than .002) between depression and subjective time, supports the hypothesis that depression is related to decreased subjective time. The finding provides a tentative explanation for deviations from the demonstrated trend toward increased subjective time with aging.

The Metro-Manila Developmental Screening Test: a normative study.

Abstract: This study aimed to establish Metro-Manila (Philippines) norms for the Denver Developmental Screening Test and to determine the characteristics of children whose scores are normal and those whose scores are abnormal or questionable on the test. The subjects were 6,006 children from 4,846 households of Metro-Manila. Probit analysis established the ages at which 25%, 50%, 75%, and 90% of the sample passed each of the 105 test items. Discriminant analysis showed four clusters of factors that were significantly associated with children's performance. These were a substitute-care-giver variable cluster, a mother variable cluster, a child-situational variable cluster, and an age variable cluster.