Showing papers in "Nursing Research in 1994"

Functional status and the forward progress of merry-go-rounds: toward a coherent analytical framework.

Abstract: Functional status is frequently discussed as a key element of nursing practice and a critical outcome criterion, and yet this phenomenon is poorly understood. Many important questions have not been addressed, in part because terms such as functional status, functional ability, health status, and quality of life have been used interchangeably. Failure to clearly outline the terminology and refine the definitions has placed us on a functional status merry-go-round that inhibits scientific progress in this area. The purpose of this article is to introduce an analytical framework for the study of functional status. Four dimensions of functional status are proposed: functional capacity, performance, reserve, and capacity utilization. These terms are defined and clarified through a discussion emphasizing the consequences for measurement, intervention, and clinical trials. The article concludes by illustrating the utility of the framework in recognizing and appreciating functional status trajectory patterns in aging and chronic illness.

Infusing research into practice to promote quality care

Abstract: This article describes the Iowa Model of Research in Practice, a heuristic model used at the University of Iowa Hospitals and Clinics for infusing research into practice to improve the quality of care. The components of the model are presented with examples. The impact of the model on patient, staff, and fiscal outcomes is delineated.

Pain: its mediators and associated morbidity in critically ill cardiovascular surgical patients.

Abstract: This study was conducted to determine the effects of age, sex, personality adjustment, and analgesic administration on the magnitude of pain experienced by 74 cardiac and abdominal vascular surgical patients during their first few postoperative days. The relationship of pain magnitude to postoperative complications was also examined. Pain intensity was moderate and did not diminish over the first few postoperative days. Physical sensations and emotional tension associated with pain caused little distress. The primary consistent mediator of pain magnitude after surgery was the amount of analgesics administered to patients, although they received small amounts. Neither age nor personality adjustment influenced the magnitude of any pain dimension. However, women and patients having abdominal vascular surgery reported more disturbing physical sensations associated with their pain. Patients with greater pain intensity had a significantly greater incidence of atelectasis as a postoperative complication.

Use of distraction with children during an acute pain experience.

Abstract: The purpose of this study was to investigate the effectiveness of a distraction technique in reducing a child's perceived pain and behavioral distress during an acute pain experience. A convenience sample of 100 children, ages 3 years 6 months through 12 years 11 months, scheduled for routine blood draws, was recruited and randomly assigned to an experimental or control group. During venipuncture, the control subjects received standard preparation, which consisted of being comforted by physical touch and soft voices, while experimental subjects were encouraged to use a kaleidoscope as a distraction technique. Results of the MANCOVA, with age as a covariate, indicated a significant difference between the groups. Univariate post hoc tests confirmed that the experimental group perceived less pain and demonstrated less behavioral distress than the control group.

Physiological responses of premature infants to a painful stimulus.

Abstract: The purpose of this study was to describe the physiological responses of premature infants to an acute tissue-damaging stimulus and to determine how severity of illness and behavioral state influenced these responses. The physiological responses (heart rate, oxygen saturation, and intracranial pressure) of a convenience sample of 124 premature infants between 32 and 34 weeks gestational age were described during four phases of a routine heel stick procedure. Analysis of the results showed a significant multivariate main effect of phase on the group of physiological responses. Behavioral state was found to influence the physiological responses, but severity of illness did not.

Maternal-infant attachment of experienced and inexperienced mothers during infancy.

Abstract: Seventy-nine experienced fathers (with one or more previous children) and 93 inexperienced (first-time) fathers were studied for differences in paternal-infant attachment at postpartal hospitalization and at 1, 4, and 8 months following birth. No significant differences were observed between the groups for reported attachment to their infants; scores varied little. Over the 8-month period, from 27% to 47% and from 9% to 22% of the variance in attachment was explained for experienced fathers and inexperienced fathers, respectively. Fetal attachment was a major predictor for attachment for experienced fathers at the first three test periods, explaining 19% of the variance at early postpartal hospitalization, 16% at 1 month, and 9% at 4 months. It was a major predictor for inexperienced fathers the first month only, explaining 13% of the variance at early postpartal hospitalization and 15% at 1 month. Depression was the second most important predictor. For experienced fathers, it explained 8% of attachment at early postpartum and 22% at 8 months; for inexperienced fathers, it explained 7% at 1 month and 9% at 4 months. Environmental factors such as social support and stress had no effects on fathers' attachment to their infants.

Development of the Breast-Feeding Attrition Prediction Tool

Abstract: The psychometric properties of the revised Breast-Feeding Attrition Prediction Tool, based on the Theory of Planned Behavior, were examined in this study. The sample consisted of 201 postpartum women who planned to breast-feed at least 8 weeks. Four scales identified by factor analysis measured the three TPB constructs. All scales showed moderate internal consistency (alphas .79 to .85). Two scales distinguished between women with and without prior breast-feeding experience (p < .05). Three scales were significantly related to breast-feeding attrition at 8 weeks. Women who weaned prematurely received less breast-feeding support from their social and professional network, believed breast-feeding was difficult, and saw more advantages to formula feeding than to breast-feeding. A discriminant analysis of the scales correctly identified 73% of the women who weaned prematurely.

Predictors of maternal role competence by risk status.

Abstract: One hundred seventeen men whose partners had experienced a low-risk pregnancy (LRM) and 61 men whose partners had been hospitalized during pregnancy for an obstetrical risk (HRM) were studied to determine whether they differed in paternal role competence from the time of their partners' early postpartal hospitalization to 1, 4, and 8 months after birth No differences were found between LRM and HRM in paternal role competence, and their trajectory of paternal competence did not differ During the 1-month and 8-month postpartal period, paternal competence increased from 7607 to 7714 for HRM and from 7721 to 7829 for LRM From 15% to 34% of the variance in paternal competence was explained among HRM, and from 41% to 44% was explained among LRM Anxiety was the major predictor of paternal role competence for HRM, and sense of mastery and depression were major predictors for LRM

Social support and well-being in adolescents: the mediating role of hopefulness.

Abstract: The purpose of this study was to examine the extent to which hopefulness mediates the relationship between perceived social support and general well-being in midadolescents. The sample consisted of 99 high school students, aged 15 to 17, all of whom completed the Personal Resource Questionnaire (PRQ85-Part II), a social support measure, the Hopefulness Scale for Adolescents, and the Adolescent General Well-Being Questionnaire in classroom settings. Statistically significant positive correlations were found between perceived social support and general well-being, perceived social support and hopefulness, and hopefulness and general well-being. Hopefulness was a potent mediator in the relationship between perceived social support and general well-being in midadolescents.

Coping with unplanned childhood hospitalization: effects of informational interventions on mothers and children.

Abstract: Two types of information, separately and in combination, were evaluated for their effects on the process and outcomes of maternal and child coping with unplanned childhood hospitalization. One hundred eight mothers of hospitalized children, 2 to 5 years old, were randomly assigned to one of four study groups. Child behavioral information and parental role information had positive effects on maternal state anxiety as well as on parental support and participation in their children's care during hospitalization. Ten to 14 days following hospitalization, positive main effects were shown for child behavioral and parental role information on mothers' state anxiety levels and for child behavioral information on children's negative behaviors.

The insider/outsider dilemma: field experience of a white researcher getting in' a poor black community

Abstract: "Getting in," the process of gaining, building, and maintaining trust with the group under study, is difficult for any researcher. Differences of ethnicity, age, and class between the researcher, who is considered an Outsider, and the Insiders, members of the group being studied, pose special problems. A 3-year nursing ethnography of a senior citizen center in a poor, inner-city black ghetto is used to analyze the Insider/Outsider dilemma; to highlight the five phases of getting in (impressing, behaving, swapping, belonging, and chillin' out); and to provide strategies to help researchers studying groups different from themselves.

The effect of low intensity aerobic exercise on muscle strength, flexibility, and balance among sedentary elderly persons.

Abstract: An experimental group of 20 elderly subjects participated in 8 weeks of low-intensity aerobic exercise while 27 subjects in a comparison group maintained their usual level of activity The program consisted of stretching and strengthening chair exercises A significant difference between the groups was found for flexibility of the ankles and the right knee No significant difference was found between the groups for muscle strength or balance, although the experimental group improved their balance by 22%

Determinants of exercise and aerobic fitness in outpatients with arthritis.

Abstract: Factors that influenced exercise behaviors and aerobic fitness were identified in 100 outpatients with rheumatoid arthritis or osteoarthritis. Data included perceived health status, benefits of and barriers to exercise, and impact of arthritis on health; demographic and biologic characteristics; and past exercise behavior. Exercise measures included range-of-motion and strengthening exercises, 7-day activity recall, and the exercise subscale of the Health-Promoting Lifestyle Profile. An aerobic fitness level was obtained on each subject by bicycle ergometer testing. The theoretical model predicted 20% of the variance in composite exercise scores but none of the variance in aerobic fitness levels. Perceived benefits of exercise was a significant predictor of exercise participation. Subjects with less formal education, longer duration of arthritis, and higher impact of arthritis scores perceived fewer benefits of exercise, while subjects who reported exercising in their youth perceived more benefits of exercise.

Test of the Health Promotion Model as a causal model of workers' use of hearing protection.

Abstract: The Health Promotion Model (HPM) was tested as a causal model to predict workers' use of hearing protection (N = 645). Measures indicated an excellent fit of the theoretical model. The exploratory analyses found the same cognitive-perceptual factors most important in predicting use. However, in contrast to the theoretical model, two modifying factors (job category and situational factors) had direct effects on use. The hypothesized model accounted for 49.3% of variance and the exploratory models accounted for 50.7% to 52.7% of variance in hearing protection use. Results of testing the HPM are consistent with the recently proposed revision of the model by Pender, Walker, Frank-Stromborg, and Sechrist (1990a, 1990b). The strongest effects on behavior came from the behavior-specific influences and demographic characteristics. Situational factors had a direct effect on the health behavior.

Health-promoting behaviors of African American women.

Abstract: Limited information exists concerning health behaviors of African American women. The purposes of this study were to describe health-promoting lifestyle behaviors among a sample of 187 African American women and to compare findings to other published reports on the Health-Promoting Lifestyle Profile (HPLP) instrument. Subscales with the highest means in this study were interpersonal support and self-actualization. However, when compared to reports of HPLP scores for other groups, total HPLP and subscale scores of women in this study were generally lower. Readability and applicability of the HPLP instrument may affect its validity and reliability in a diverse sample.

Predicting metabolic control in diabetes: A pilot study using meta-analysis to estimate a linear model

Abstract: The purpose of this pilot study was to determine the feasibility of using data from replicated descriptive studies to test a four-variable model designed to explain metabolic control in diabetes. Predictors of metabolic control selected for this analysis were knowledge; health beliefs (and the subscales of barriers, commitment, cues, expectancies, impact on lifestyle, support, and susceptibility); and compliance/adherence. A total of 17 studies, published between 1982 and 1991, were located that met inclusion criteria. Findings indicated that health beliefs have direct and indirect effects on diabetes metabolic control, depending on the individual health belief subscale analyzed. For example, commitment to the benefits of therapy was found to have a statistically significant direct effect on metabolic control; barriers had a statistically significant indirect effect through compliance. The effects of knowledge were consistent throughout the five path models explored. An inverse direct effect was noted on metabolic control and a positive indirect effect was noted on metabolic control through compliance.

Examination of the factor structure of the Ways of Coping Questionnaire with clinical populations.

Abstract: The purpose of this study was to examine the construct validity of the Ways of Coping Questionnaire in a clinical population. The questionnaire, designed to measure coping behaviors in a community-residing well population, contained eight empirically constructed factors. Confirmatory factor analysis with LISREL was used to validate this original eight-factor model with 655 community-residing adults with multiple sclerosis or a spinal cord injury. The hypothesized model was not a good fit to the data. Subsequent analyses, using both exploratory and confirmatory factor analysis procedures, identified three different coping factors: Cognitive Reframing, Emotional Respite, and Direct Assistance. These factors appeared to have greater applicability to people with chronic conditions. The kinds of coping behaviors used to manage stressful situations by individuals who are well may be quite different from those used by community-residing populations with long-term chronic conditions.

Visual characteristics of aspirates from feeding tubes as a method for predicting tube location.

Abstract: A sample of 880 feeding tube aspirates were classified as being primarily clear or cloudy and as having one of six colors. Gastric aspirates were most frequently cloudy and green, tan or off-white, or bloody or brown. Intestinal fluids were primarily clear and yellow to bile-colored. In the absence of blood, pleural fluid was usually pale yellow and serous, and tracheobronchial secretions were usually tan or off-white mucus. However, respiratory aspirates often contained blood and therefore failed to have the expected characteristics of respiratory fluid. Staff nurses were shown photographs of a sample of 106 aspirates and asked to predict tube position. Their ability to identify 50 gastric aspirates improved significantly after reading a list of suggested characteristics of feeding tube aspirates (81.33% to 90.47%, p < .0001). Similarly, their ability to identify 50 intestinal aspirates improved from 64.07% to 71.53% after reading the list of criteria. However, nurses were often unable to identify respiratory aspirates; the accuracy of their predictions decreased after reading the list of suggested characteristics (from 56.67% to 46.11%). The appearance of aspirates is often helpful in distinguishing between gastric and intestinal placement, but is of little value in ruling out respiratory placement.

Factors associated with risk of stress urinary incontinence in women.

Abstract: The purpose of this study was to investigate risk factors for stress urinary incontinence. Using a case-control method, 140 women with and without stress urinary incontinence were recruited from three private physician practices and interviewed by telephone. The final sample included 94 cases and 46 controls, with a mean age of 51.5 and 54.3 years, respectively. Having any vaginal birth versus having only cesarean sections was associated with a substantial increase in risk for stress urinary incontinence. Episiotomy or tear during delivery was associated with a 3.78-fold increase in risk, but high parity (four or greater) was not a strong predictor. Having a mother with stress urinary incontinence was associated with a substantial increase in risk. Statistically significant associations were also found for multiple urinary tract infections.

Caregiving transitions: changes in depression among family caregivers of relatives with dementia.

Abstract: Depression among family caregivers of relatives with dementia was examined at three time intervals over a 4-year period. Comparisons were made between 46 residential caregivers, 49 caregivers of institutionalized elders, and 47 bereaved caregivers. No overall difference was found between the depression paths of the three groups. Female bereaved caregivers experienced a pattern of decreasing depression following their relative's death, while male bereaved caregivers experienced an increase in depression. Findings suggest the need for further investigation of the influences of gender on bereavement following the experience of providing family care for a relative with dementia.

Contextual factors associated with disturbing behaviors in institutionalized elders.

Abstract: Data from a longitudinal clinical trial funded by the National Institute of Aging, testing the effects of staff education and consultation on restraint reduction in nursing homes, were used to examine disturbing behaviors in institutionalized elders and to identify related environmental and personal characteristics. Subjects were 586 residents from three well-matched nursing homes. Kayser-Jone's (1989) model on environment and quality of life in long-term care institutions served as the organizing framework. Data on disturbing behaviors from the Psychogeriatric Dependency Rating Scale were factor analyzed. Three factors, Agitated Psychomotor Behaviors, Aggressive Interpersonal Communication, and Expressive Difficulty, emerged from the principal factor analysis and accounted for 35% of the variance. The Kayser-Jones model partially explained Agitated Psychomotor Behavior (R2 = .22). A model comparison approach indicated that the addition of an organizational variable, staff mix, significantly increased the amount of variance explained over and above that contributed by the personal variables.

Family caregivers of people with AIDS: negotiating partnerships with professional health care providers.

Abstract: The purpose of this grounded theory study was twofold: (a) to examine AIDS family caregivers' interactions with professional health care providers, and (b) to evaluate the applicability of Swanson's middle-range theory of caring to characterize these interactions. The sample consisted of 12 family caregivers including gay partners, friends, and parents. Negotiating Partnership, defined as working out care with one another for the common good of the person with AIDS, was the basic social process explaining interactions between family caregivers and health care providers. Dimensions of negotiating partnership included conveying information, knowing, being accessible, and maintaining belief.

Physiologic status, coping, and hardiness as predictors of outcomes in chronic obstructive pulmonary disease.

Abstract: The purpose of this study was to examine the relationship of physiologic status, coping, and hardiness to exercise ability and functional status in 96 adult patients with chronic obstructive pulmonary disease (COPD). Exercise ability was measured by the distance walked in 12 minutes (12MD) and functional status by the Pulmonary Functional Status Scale (PFSS). The mean FEV1 and FVC were 1.61 +/- .81 and 3.08 +/- .95 L, respectively. The commitment (r = -.18) and challenge (r = -.21) components of hardiness were significantly correlated with the 12MD. The commitment component of hardiness was significantly correlated with functional status (r = -.17). Control was not a significant variable. Physiological status, problem-solving coping, and challenge were the best predictors of exercise ability (R2 = .26). Physiological status and commitment were the best predictors of functional status (R2 = .149).

Effects of clarification of support expectations in prenatal couples.

Abstract: The purpose of this study was to test a theoretical model of confirmation of expectations for mutual support after childbirth and to evaluate an intervention given in prenatal classes during which prospective parents clarified their expectations. Results provided support for the proposed model in that parents with greater confirmation of expectations were found to have more positive relationship satisfaction, emotional affect, and parenting attitudes. Differences in men and women emerged that demonstrated that confirmation of support expectations was more important to women, while the level of support actually received was more important to men. The prenatal class intervention did not significantly affect parent outcomes.

Artifact management in pupillometry

Abstract: A detailed analysis of pupillometry data collection and handling procedures in the initial study uncovered a number of problems that threatened the integrity of the data, including improper procedures, lack of adherence to data collection rules, and inaccurate mathematical calculation of results. Substantial modifications in procedures were made to improve data collection and reduce artifact. With the increased sampling rate from 5 to 60 Hz and use of a videotape playback system, a more accurate and thorough method for removing artifact from pupillometry data was demonstrated in a subsequent study. The automated cleaning algorithm system proved to be efficient at detecting and removing artifact, as well as alerting users to artifact that might not be replaceable automatically. Additionally, this system provided another method of data storage, videotape, which was beneficial in reviewing the pupil behavior that was digitally recorded. Now that procedures for collecting pupil data and managing artifact have been objectively tested, steps can be taken towards establishing pupillometry as a reliable and valid screening tool for detecting excessive sleepiness.

A critical analysis of hardiness.

Abstract: Hardiness is a construct with widespread appeal to nurse researchers. Of 97 papers reviewed, 35 were written by nurses. Because of its popularity, there is a pressing need to analyze hardiness carefully. This critical analysis of hardiness describes Kobasa's work as the foundation of hardiness research, provides a review of hardiness in the nursing literature, and recommends future hardiness research.

Drug combinations and potential for risk of adverse drug reaction among community-dwelling elderly.

Abstract: Data were gathered through personal interviews from a sample of 667 people 65 years of age and older, living in community settings and managing their own health. Almost two thirds of these older respondents reported at least one drug-drug or drug-alcohol combination associated with a possible adverse reaction. The largest percentage of respondents were taking combinations of medications that could place them at risk for hypotension and cognitive impairment. These results suggest the need for more detailed screening of specific medications used by older people who report taking certain categories of drugs.