Showing papers in "Nursing Research in 2004"
TL;DR: Four themes emerged that described the essence of women’s experiences of birth trauma: To care for me: Was that too much too ask?
Abstract: → Background: The reported prevalence of posttraumatic stress disorder after childbirth ranges from 1.5% to 6%. → Objective: To describe the meaning of women's birth trauma experiences. → Methods: Descriptive phenomenology was the qualitative research design used to investigate mothers' experiences of traumatic births. Women were recruited through the Internet, primarily through Trauma and Birth Stress (TABS), a charitable trust located in New Zealand. The purposive sample consisted of 40 mothers: 23 in New Zealand, 8 in the United States, 6 in Australia, and 3 in the United Kingdom. Each woman was asked to describe the experience of her traumatic birth and to send it over the Internet to the researcher. Colaizzi's method was used to analyze the 40 mothers'stories. → Results: Four themes emerged that described the essence of women's experiences of birth trauma: To care for me: Was that too much too ask? To communicate with me: Why was this neglected? To provide safe care: You betrayed my trust and I felt powerless, and The end justifies the means: At whose expense? At what price? → Conclusions: Birth trauma lies in the eye of the beholder. Mothers perceived that their traumatic births often were viewed as routine by clinicians.
380 citations
TL;DR: A glimpse into the lives of mothers with post-traumatic stress disorder attributable to childbirth provides an impetus to increase research efforts in this neglected area.
Abstract: Methods: The qualitative research design used for this study was descriptive phenomenology. The main recruitment approach was via the Internet through the help of Trauma and Birth Stress, a charitable trust in New Zealand. Purposive sampling was used and resulted in 38 mothers participating from the countries of New Zealand, the United States, Australia, and the United Kingdom. The participants were asked to describe their experiences with post-traumatic stress disorder after childbirth. Their stories were analyzed using Colaizzi’s method of data analysis. Results: Mothers with post-traumatic stress disorder attributable to childbirth struggle to survive each day while battling terrifying nightmares and flashbacks of the birth, anger, anxiety, depression, and painful isolation from the world of motherhood. Conclusions: This glimpse into the lives of mothers with posttraumatic stress disorder attributable to childbirth provides an impetus to increase research efforts in this neglected area.
248 citations
TL;DR: The results of the study indicate that the Family Involvement in Care intervention improves the caregiving experience of family members in nursing homes as well as nursing home staff attitudes toward family members.
Abstract: " Background: Despite the increasing number of individuals with dementia relocated from caregiving at home to a nursing home, there is only a small body of literature examining the influence of institutional family-oriented practices on family member perceptions of care and family-staff relationships. " Objective: The study tested the effects of the Family Involvement in Care partnership intervention on family members' perceptions of their caregiving role, relationships with staff, and satisfaction with the care of relatives with dementia residing in special care units as well as the effects on staff attitudes toward families and staff satisfaction with a caregiving role. " Methods: A quasi-experimental design with nonequivalent groups and repeated pretest and posttest measures was used to examine the effects of the Family Involvement in Care intervention. The study recruited 14 Midwestern nursing home special dementia care units, matched by aegis and staff turnover, and randomized from matched pairs to experimental and control conditions. The samples included 185 family members and 895 staff. The Family Involvement in Care intervention is a protocol for family and staff negotiation of a written partnership agreement. Family caregiver outcomes were measured using instruments pretested for reliability and validity. Data were analyzed using hierarchical linear modeling. " Results: With adjustment for multiple tests, statistically significant beneficial intervention effects were found in three areas of family caregiver outcomes (emotional reactions to the caregiving role, perceptions of relationships with staff, and perceptions of care for relatives) and in one of three areas of staff outcomes (staff perceptions of the family caregiving role). For family members, effects were found for the measures assessing loss, captivity, staff disregard, resident activities, and physical care. Some of the intervention effects for family members were found only for caregivers of the same generation as the resident. For staff, effects were found for measures of dominion, disruption by family, and irrelevance of family. " Conclusions: The results of the study indicate that the Family Involvement in Care intervention improves the caregiving experience of family members in nursing homes as well as nursing home staff attitudes toward family members. The intervention did not influence the perceived conflict with staff on the part of family caregivers or the perception of a partnership with family caregivers on the part of staff.
164 citations
TL;DR: This study represents initial efforts to address the needs of Spanish-dominant Latino youth and identifies salient beliefs that may predict sexual risk and protective behavior that are relevant to the design of culturally and linguistically effective interventions.
Abstract: Background Spanish-dominant Latino youth represent a growing yet underserved segment of the U.S. population, especially in terms of protection from sexually transmitted HIV infection. There is evidence to suggest that this subgroup engages in both risk and protective behaviors that may be different from the behaviors of English-dominant Latino youth. Objective To examine theoretical predictors (attitude, subjective norm, behavioral beliefs, normative beliefs, control beliefs) of sexual intercourse and condom use with a sample of Spanish-dominant Latino youth. Methods Participants in this study were part of a larger randomized controlled intervention designed to reduce the risk of sexually transmitted HIV among Latino youth. This article is based on preintervention data from 141 Spanish-speaking Latino adolescents (77 girls and 64 boys) who completed a Spanish version of the questionnaire. Results Multiple regression analyses showed significant effects of attitudes, perceived partner approval, self-pride, and parental pride on intentions to engage in sexual intercourse. Attitudes, intentions to engage in sex in the next 3 months, self-pride, parental pride, goals, and partner approval predicted sexual intercourse in the preceding 3 months. Attitudes, subjective norms, self-efficacy, partner and parental approval, and impulse control beliefs were significant predictors of intentions to use condoms. Conclusions This study represents initial efforts to address the needs of Spanish-dominant Latino youth. The identification of salient beliefs that may predict sexual risk and protective behavior are relevant to the design of culturally and linguistically effective interventions.
158 citations
TL;DR: The research utilization field would benefit from more substantive conceptual and empirical work, and more collaboration among emerging scholars, and to identify the structure of this scientific community, including the current network of researchers.
Abstract: Background Research utilization is the use of research to guide clinical practice. However, little is known about the characteristics of the research utilization literature in nursing, including the development and organization of this field of study. This article addresses the knowledge gap in this field of study by bibliometrically analyzing the research utilization literature in nursing. Objective To map research utilization as a field of study in nursing using bibliometric methods, and to identify the structure of this scientific community, including the current network of researchers. Method A search of electronic and hard copy databases resulted in bibliographic data for 630 articles on research utilization in nursing published between 1972 and 2001. Bibliometric techniques used included a statistical analysis of publication counts, co-word analysis, and co-citation analysis. Results The analyses showed a trend of increased productivity since the early 1990s. Most publications were authored by a single author, with no tendency toward increased collaboration over time. Most references cited in the articles were nursing references, indicating that there is very little flow into nursing from other fields. Only 4% of the references cited were actual research articles about research utilization, consistent with applied fields in which clinicians most commonly cite other clinicians. The 630 articles were published in a total of 194 different journals, with the Journal of Advanced Nursing identified as a key journal in the field. Conclusions According to the analysis, tremendous growth has occurred in the field of research utilization. However, the limited amount of collaborative research and the repeated citation of a few references indicate that the field is under-developed. The research utilization field would benefit from more substantive conceptual and empirical work, and more collaboration among emerging scholars.
140 citations
TL;DR: The Perceived Nursing Work Environment (PNWE), a measure of the work environment as perceived by nurses, represents the latest version of the Nursing Work Index—Revised based on current practice and exhibited sound psychometric properties.
Abstract: Background:Different concepts and measures have been used to evaluate the work environment of nurses in hospital settings. There is increasing need for updated measurement tools that reflect the evolving nature of the work environment.Objectives:To report the psychometric properties of the Perceived
137 citations
TL;DR: The pain was responsive to the management strategies used by the parents and children, and functional status was above the median score at the seven interviews.
Abstract: → Background: Children with cancer experience pain related to the disease process, the treatment, and the associated procedures. For children with leukemia, the pain experienced after diagnosis has received scant attention. → Objective: To examine the pain experience, management strategies, and outcomes during the first year after the diagnosis of acute leukemia. → Methods: A longitudinal descriptive approach was used to collect data at seven data points from 95 English- and Spanish-speaking children, ages 4 to 17 years, receiving care in one of three southern California hospitals, and from their English- and Spanish-speaking parents. Age-appropriate instruments were used to examine the variables of pain intensity, location, pattern over time, and quality, as well as strategies for managing pain, perceived effectiveness of management strategies, and functional status. → Results: All the children reported pain over the course of the year. Pain intensity scores incorporated the full range of possible responses. For the children 4 to 7 years old, the highest and lowest mean scores, respectively, were 2 and 1.6 (scale, 0-4). For the children 8 to 17 years old, the highest and lowest mean scores, respectively, were 50.1 and 39.5 (scale, 0-100). The most common location of pain was the legs (26.5%) in all seven interviews. Other frequently noted sites were the abdomen (16.6%), head/neck (16.6%), and back (14.2%). The words used most frequently by the older English- and Spanish-speaking children to describe pain were "uncomfortable" (incOmodo) and "annoying" (molesto). According to the interviews, the most frequently used strategy for pain management was stressor modification (e.g., medication, sleep, hot/cold, and massage). The most common coping strategies according to a Likert scale rating were "watch TV" (n = 426), "lie down" (n = 421), "wish for it to go away" (n = 417), and "tell my mother or father" (n = 416). The pain intensity scores after pain management were significantly lower for the younger children in three of the seven interviews and for the older children in all seven interviews. For both the younger and older children, functional status (i.e., the ability to engage in routine activities) was above the median score at the seven interviews. → Conclusions: Children with leukemia experience pain throughout the first year of treatment. In this study, the pain was responsive to the management strategies used by the parents and children.
110 citations
TL;DR: The reported programming allows the user to complete mediation testing with the user’s own data in a single-step fashion and is a useful tool for describing the relation between three or more variables.
Abstract: Background: Mediation modeling can explain the nature of the relation among three or more variables. In addition, it can be used to show how a variable mediates the relation between levels of intervention and outcome. The Sobel test, developed in 1990, provides a statistical method for determining the influence of a mediator on an intervention or outcome. Although interactive Web-based and stand-alone methods exist for computing the Sobel test, SPSS and SAS programs that automatically run the required regression analyses and computations increase the accessibility of mediation modeling to nursing researchers.
Objectives: To illustrate the utility of the Sobel test and to make this programming available to the Nursing Research audience in both SAS and SPSS.
Methods: The history, logic, and technical aspects of mediation testing are introduced. The syntax files sobel.sps and sobel.sas, created to automate the computation of the regression analysis and test statistic, are available from the corresponding author.
Results: The reported programming allows the user to complete mediation testing with the user’s own data in a single-step fashion. A technical manual included with the programming provides instruction on program use and interpretation of the output.
Conclusion: Mediation modeling is a useful tool for describing the relation between three or more variables. Programming and manuals for using this model are made available.
93 citations
TL;DR: This initial investigation suggests that actigraphy has concurrent validity with a self-report measure of activity intensity and frequency, as evidenced in this sample of wheelchair users in free-living conditions.
Abstract: " Background: Research has indicated that actigraphy is valid and reliable for measuring low levels of physical activity among ambulatory individuals, and that it may be a valid indicator of energy expenditure for wheelchair users in laboratory conditions, but there are no reports of its evaluation in free-living conditions. " Objective: To assess the suitability and validity of actigraphy as a measure of free-living physical activity for wheelchair users with spinal cord injury. " Methods: In a methodologic descriptive correlational study, measures of physical activity by an actigraph and a self-report physical activity record were obtained for six individuals in laboratory conditions and 22 individuals in free-living conditions during a 4-day period. At the completion of the home monitoring trial, all the participants completed a questionnaire about their experience wearing the monitor and maintaining the record. " Results: Mean activity counts by actigraphy during active tasks were significantly different from the counts during inactive tasks (p =.003). During home monitoring, the participants wore the monitor, on the average, 95% of the prescribed wearing time, rated it as very comfortable, and were willing to wear it again. Pearson correlation coefficients of activity counts with self-reported activity intensity varied from.30 to.77 (p < .01) for individual participants. The mean correlation across the sample was.60 (p < .01). Activity counts varied with reported activity, indicating concurrence between the two activity measurement methods. " Conclusions: Actigraphy is suitable as a measurement of activity for people with spinal cord injury. This initial investigation suggests that it has concurrent validity with a self-report measure of activity intensity and frequency, as evidenced in this sample of wheelchair users in free-living conditions.
93 citations
TL;DR: Future efforts to improve smoking cessation in this patient group might focus on the delivery of more direct methods for encouraging spouse cessation and support to the patient in quitting, and the use of bupropion (Zyban) as an adjunct to cessation for this heavy smoking patient group.
Abstract: ' Background: Smoking cessation of patients with cancer can improve treatment efficacy and survival. ' Objective: To determine whether a motivational interviewing intervention increased successful smoking cessation attempts of patients with cancer attending a South Australian public hospital, as compared with usual care. ' Methods: A randomized controlled trial was used to study 137 patients with mixed cancer sites, including 74 intervention patients and 63 control patients. The motivational interviewing intervention was delivered over a 3-month period. The intervention included a visit with a smoking cessation counselor, provision of smoking cessation booklets, nicotine replacement therapy, family advice to quit, and an in-person or telephone follow-up conversation. ' Results: At the 6-month follow-up visit, an intention-to-treat analysis found no difference in biochemically confirmed 3-month prevalence quit rates between the intervention (5%) and control (6%) groups A sensitivity analysis using more lenient criteria indicated quit rates of 29% for the intervention group and 18% for the control group (p =.32). The predictors of smoking cessation at 6 months for all the patients included a smoking-related cancer site, more cessation attempts in the year before enrollment in the study, and no radiation therapy. ' Conclusions: Future efforts to improve smoking cessation in this patient group might tocus on the delivery of more direct methods for encouraging spouse cessation and support to the patient in quitting, and the use of bupropion (Zyban) as an adjunct to cessation for this heavy smoking patient group.
87 citations
TL;DR: Factor analysis found that the identified three-factor solution has psychometric properties at least as strong as those found with the original five-factor LPI solution.
Abstract: BackgroundOriginally developed for educational use, the Leadership Practice Inventory (LPI) is used to measure leadership practices in nursing research. There is limited reporting of LPI psychometric properties when used to measure leadership practices of nurses.ObjectiveThis study aimed to investig
TL;DR: A sample lifeline from a study of young women's developmental transitions is used to demonstrate the application of this technique to nursing research.
Abstract: BackgroundLife histories are data collection strategies that detail an individual's life Lifelines are a visual depiction of a life history, displaying events in chronological order and noting the importance, or meaning, of events.ApproachA sample lifeline from a study of young women's developmental
TL;DR: A profile of sociostructural and intrapersonal factors with potential for predicting behavior in relation to future coronary events was developed and can be categorized into a small number of patterns termed decision trajectories.
Abstract: Background Women's delay in seeking treatment for acute myocardial infarction symptoms results in higher rates of mortality and morbidity for women. Objectives To describe decision trajectories used by women when experiencing symptoms of acute myocardial infarction, and to identify predictors of the decision trajectory used by women with acute myocardial infarction. Methods A cross-sectional, descriptive design was used. The nonprobability sample included 52 women hospitalized for acute myocardial infarction. To elicit descriptions of decision making, focused, semistructured interviews were used in this mixed-methods study. Predictors of decision trajectories were measured with standardized instruments among the same women. Narrative analysis was used to examine the stories from the qualitative data and to identify decision trajectory types. Discriminant analysis was used to predict trajectory type membership. Results The median delay time was 4.25 hours. Most of the women used one of two trajectory types: knowing (defined as those women who knew almost immediately that they would seek help, n = 25) and managing (those women who managed an alternative hypothesis or minimized their symptoms, n = 23). Discriminant analysis correctly classified 71% (chi [4] = 11.2; n = 48; p =.02) of the cases into trajectory types on the basis of four predictor variables: social support, personal control, heart disease threat, and neuroticism. Discussion Women's behaviors during the period between onset of acute myocardial infarction symptoms and treatment seeking can be categorized into a small number of patterns termed decision trajectories. A profile of sociostructural and intrapersonal factors with potential for predicting behavior in relation to future coronary events was developed.
TL;DR: The results indicate that memory and behavior changes of stroke survivors and family conflict surrounding stroke recovery are important considerations for assessment during the poststroke recovery period.
Abstract: (74%), college-educated (73%) spouses (80%) of survivors. Most of the caregivers (66%) reported family conflict. The caregivers from families with lower family functioning scores reported worse mental health. The caregivers reported lower mental health when they were caring for stroke survivors with a combination of high memory/behavior changes and low motor function ( R² .30). Family conflict appears to exacerbate the impact of memory and behavior changes on caregiver mental health. Higher caregiver education and no major health problems were associated with better caregiver physical health ( R² .36). Caregiver physical health was not associated with family functioning or stroke survivor memory and behavior changes. Conclusions: These results indicate that memory and behavior changes of stroke survivors and family conflict surrounding stroke recovery are important considerations for assessment during the poststroke recovery period. troke recovery is a dynamic process for stroke survivors, primary caregivers, and their families. In the current healthcare environment, stroke survivors experience decreased lengths of stay in acute and rehabilitation settings (Dobkin, 1995), which shifts a greater responsibility for care to the family early in the recovery process. The emotional and tangible support that a family provides a member with a serious illness is substantial, and the impact on the family can be considerable (Ell, 1996). The influence of the stroke survivors’ specific problems and the family context on caregiver outcomes is unclear.
TL;DR: Single-item measures in general, and faces scales in particular, can be valid and reliable measures for global concepts, and nurse researchers should seriously consider single- item measures as part of their methodological research "toolkit."
Abstract: Background: Single-item measures of constructs are parsimonious alternatives to multiple-item measures in many types of research. Before selecting a particular instrument, researchers must first determine whether to use amulti-item or single-item instrument to measure the concept to be evaluated. Currently, single-item measures are widely used for both pain and job satisfaction research. Objective: To review theoretical and empirical studies of single-item measures, with an emphasis on graphic representational (faces) scales. Methods: In this review, theoretical considerations, reliability, validity issues, and comparisons between single- and multiple-item measures are discussed. Faces scales are emphasized as an economical method for assessing such affective responses as pain and job satisfaction. Results: Single-item measures in general, and faces scales in particular, can be valid and reliable measures for global concepts. Conclusions: Because of their ease of administration, lessened respondent burden, and global concept representation, single-item measures have great potential for various types of research. Nurse researchers should seriously consider single-item measures as part of their methodological research "toolkit."
TL;DR: The results suggest that sleep contributes to both physical functional and emotional well-being 4 and 8 weeks after cardiac surgery.
Abstract: BackgroundEmotional well-being and physical function are important quality-of-life outcomes after cardiac surgery. Alterations in sleep patterns, including sleep deprivation and altered circadian patterning, also are common. The relations among sleep pattern alterations, physical function, and emoti
TL;DR: Comparing nursing homes that score in the upper and lower quartiles on the Minimum Data Set bedfast prevalence quality indicator for proportion of bedfast residents, activity and mobility nursing care, and amount of time all residents spend in bed helps evaluate whether residents who spend more time in bed are different from those who spend less time inBedfast according to functional measures.
Abstract: Background: Excessive time in bed has negative effects on both physical conditioning and functioning. There are no data or practice guidelines relevant to how nurses should manage the in-bed times of nursing home residents, although all nursing homes receive a bedfast prevalence quality indicator report generated from the Minimum Data Set. Objectives: To compare nursing homes that score in the upper and lower quartiles on the Minimum Data Set bedfast prevalence quality indicator for proportion of bedfast residents, activity and mobility nursing care, and amount of time all residents spend in bed, and to evaluate whether residents who spend more time in bed are different from those who spend less time in bed according to functional measures. Methods: A cohort design used medical records, resident interviews, and direct observation data to compare 15 nursing homes (n = 451 residents) on the proportion of bedfast residents, the amount of time residents spent in bed, the frequency of activity, and the scores on six activity and mobility care process indicators. Results: Significant differences were found between upper (i.e., higher prevalence of bedfast residents) and lower quartile nursing homes in the proportion of time residents were observed in bed (43% vs. 34%, respectively; p = .007), and in the proportion of residents who spent more than 22 hours in bed per day (18% vs. 8%, respectively; p = .002). All nursing homes underestimated the number of bedfast residents. The residents of upper quartile homes showed more activity episodes and reported receiving more walking assistance than the residents of lower quartile homes. Discussion: Minimum Data Set bedfast quality indicator identified nursing homes in which residents spent more time in bed, but did not reflect differences in activity and mobility care. In fact, upper quartile homes provided more activity and mobility care than lower quartile homes. Across all the nursing homes, most of the residents spent at least 17 hours a day in bed. Further study of activity and mobility care and bedfast outcomes in nursing homes is needed, and nurses need to note the amount of time nursing home residents spend in bed.
TL;DR: These findings suggest that data transformation is not always needed or advisable when the Cronbach alpha or Pearson product-moment correlation is calculated for instruments with skewed item responses.
Abstract: → Background: Although data transformation is generally recommended, its benefits of have not been widely studied. This report reviews evidence regarding the costs and benefits of transforming skewed data with respect to two statistics commonly used in psychometric analyses: the Cronbach alpha and the Pearson product-moment correlation. → Methods: Data describing 758 immigrants from the former Soviet Union who completed a Russian language version of the Symptom Checklist-90-Revised (SCL-90-R) were used to demonstrate the effects of transformation. More than half (55%) of the SCL-90-R items had a problematic skew. The Cronbach alpha and the Pearson product-moment correlation were calculated for original item responses as well as for square root and log transformations of these responses. Sample size (full, 30%, 20%), trans? formation type (square root or log transformation), and transformation method (sum items first and then transform, transform items first and then sum) were manipulated to evaluate the relevance of these factors to transformation. Results: Regardless of sample size, neither the Cronbach alpha nor the Pearson product-moment correlation showed a difference between original and transformed data, with one exception. When items were transformed first before being summed in the calculation of the Pearson product-moment correlation, inconsistently higher (+.05) or slightly lower values (-.01) were observed relative to those created with the non-transformed data across the different sample sizes. Conclusions: These findings suggest that data transformation is not always needed or advisable when the Cronbach alpha or Pearson product-moment correlation is calculated for instruments with skewed item responses.
TL;DR: The eight categories of self-care strategies identified in this study showed that people with HIV/AIDS not only seek the help of medications, but also follow a wide array of other self-developed or self-taught nonpharmaceutical strategies to allay their symptoms.
Abstract: Background Self-care is one of the challenges that people with HIV/AIDS face in the long-term symptom management of the disease. Objective To identify the category schemes of self-care strategies and sources of information for symptom management reported by HIV-positive individuals. Methods A secondary analysis was conducted in a large dataset of an HIV/AIDS symptom management study. Narrative data of symptom self-care management strategies and sources of information for symptom management were analyzed by a content analysis technique to identify category schemes. The 359 participants in the study reported 776 symptom self-care strategies and 526 sources of information for these strategies. Results The symptom self-care management strategies were summarized into eight categories: medications (23.45%), self-comforting (15.21%), complementary treatments (14.69%), daily thoughts and activities (12.89%), diet changing (10.95%), help seeking (9.28%), spiritual care (6.83%), and exercise (6.70%). There were four categories of information sources: self (34.41%), healthcare provider (27.95%), personal network (19.20%), and community (18.44%). The category schemes had moderate to high interrater reliability (Cohen's kappa:.49-1.00 for self-care strategy and .70-.87 for source of information). Most of the self-care strategies were perceived as helpful. Except for complementary treatments, self-care strategies were used differently among people with the six most frequently occurring symptoms (chi2 [5, n = 286] = 28.53-79.89). Discussion The eight categories of self-care strategies identified in this study showed that people with HIV/AIDS not only seek the help of medications, but also follow a wide array of other self-developed or self-taught nonpharmaceutical strategies to allay their symptoms.
TL;DR: The findings may lead to wider development and use of childbirth-parenting programs designed to meet the unique strengths and needs of the childbearing military wife.
Abstract: " Background: Current research suggests that women married to military service members may experience difficulty during the transition to motherhood attributable to the additional stressors of military life and inabilityto access traditional support systems. " Objective: To test the effects of a nursing intervention on prenatal and postpartum maternal role adaptation among military wives. " Methods: Primigravid military wives were assigned randomly to either a traditional childbirth education program (n = 47) or Baby Boot Camp (n = 44). The Baby Boot Camp is a 4-week childbirth-parenting preparation program based on a resilience paradigm. The strategies of Baby Boot Camp include identification of nontraditional external resources and development of internal resources to facilitate maternal role adaptation. The Prenatal Self-Evaluation Questionnaire, Personal Resource Questionnaire, and Resilience Scale were administered at baseline (32 to 37 weeks gestation), immediately after the intervention, and at 6 weeks postpartum. " Results: The outcomes suggest that Baby Boot Camp strategies to enhance external and internal resources may have been successful in facilitating maternal role adaptation. An independent t-test showed that, as compared with the military wives who attended traditional childbirth education courses, the Baby Boot Camp participants experienced significantly greater prenatal and postpartum adaptation. As demonstrated by repeated measure analysis of variance, the Baby Boot Camp participants experienced an increase in external and internal resources immediately after the intervention. However. these differences in resources were not sustained at 6 weeks postpartum. " Conclusions: The findings may lead to wider development and use of childbirth-parenting programs designed to meet the unique strengths and needs of the childbearing military wife.
TL;DR: Caregiver pessimism early in the caregiver role was found to be a warning sign for poor current and future caregiver health, and nurses and clinicians have a unique opportunity to detect and intervene with caregivers who show high levels of pessimismEarly in the caregiving trajectory.
Abstract: Background: Although pessimism and optimism are associated with health-related outcomes, the long-term effects of pessimism and optimism in the caregiving process are understudied, and little is known about their role in health changes over time. Objective: To determine whether pessimism and optimism can be used as early warning signs for negative changes in caregiver depressive symptoms and physical health over a 10-year period. Methods: Multilevel modeling was used to examine longitudinal data from 311 spouse caregivers of individuals with Parkinson’s disease, with data points at baseline, Year 2, and Year 10. Measures included the Life Orientation Test, the Center for Epidemiological Studies—Depression Scale, and the SF-36 Health Survey physical functioning scale. Results: Caregiver pessimism early in the caregiver role was found to be a warning sign for poor current and future caregiver health. High baseline pessimism signaled high levels of baseline depressive symptoms and poor physical health, as well as a faster decline in health over the 10-year study. Optimism played a role in predicting baseline depressive symptoms, although the magnitude of its beneficial contribution was not as great as the deleterious effects of pessimism. Conclusions: Nurses and clinicians have a unique opportunity to detect and intervene with caregivers who show high levels of pessimism early in the caregiving trajectory.
TL;DR: Pain, depression, and fatigue are important factors to consider in the provision of care to abdominal surgery patients with a relatively uncomplicated postoperative course and specific interventions to reduce pain, depression and fatigue need to be evaluated.
Abstract: " Background: Little research has examined the recovery patterns of older adults who have had major abdominal surgery. " Objective: To determine whether pain, depression, and fatigue are significant factors in the return of older adults who had major abdominal surgery to functional status and self-perception of recovery in the first 3 months after discharge from the hospital. " Methods: A correlational predictive study involved adults 60 years of age or older who had undergone major abdominal surgery. Data were collected during hospitalization (n = 192), then 3 to 5 days (n = 141), 1 month (n = 132), and 3 months after discharge to home (n = 126) using the Brief Pain Inventory, the Geriatric Depression Scale-Short Form, the Modified Fatigue Symptom Checklist, the Enforced Social Dependency Scale, and the Self-Perception of Recovery Scale. " Results: Multiple regression analysis indicated that pain, depression, and fatigue are significantly related to patients' self-perception of recovery and functional status. Pain, depression, and fatigue explain 13.4% of the variation in functional status at 3 to 5 days, 30.8% at 1 month, and 29.1% at 3 months after discharge. These three factors also explain 5.6% of the variation in self-perception of recovery during hospitalization, 12.3% at 3 to 5 days, 33.2% at 1 month, and 16.1% at 3 months after discharge. " Conclusions: Pain, depression, and fatigue are important factors to consider in the provision of care to abdominal surgery patients with a relatively uncomplicated postoperative course. Specific interventions to reduce pain, depression, and fatigue need to be evaluated for their impact on the postoperative recovery of older adults.
TL;DR: The results of this study support the use of the Differentiation of Self Inventory with adolescents, indicating that greater differentiation of self predicted fewer symptoms over and above chronic anxiety, and lending support to the construct validity of the DSI in adolescent populations.
Abstract: BackgroundEvidence of psychometric support is needed for use of the Differentiation of Self Inventory with adolescents as a clinical assessment instrument to evaluate psychotherapeutic progress and outcomes, and for its use as a research instrument to evaluate the effectiveness of interventions on t
TL;DR: The application of the Beck Depression Inventory-II among African American people would generate needed information about how depressive symptoms may be expressed among them, and resulted in a two-factor solution.
Abstract: Background: This is the first reported study involving a factor analysis of the Beck Depression Inventory-II, which was administered to a sample of southern rural African American women. Objective: To determine the factor structure of the Beck Depression Inventory-II using data collected from southern rural African American women. Methods: Using a correlational, descriptive design, 206 southern rural African American women were invited to participate in a face-to-face interview that occurred in a variety of community-based settings. Results: The factor analysis of the Beck Depression Inventory-II resulted in a two-factor solution. Symptoms such as pessimism and worthlessness loaded high on the first factor (cognitive). The second factor explained somatic-affective symptoms of depression, with factor loadings high on tiredness and fatigue and loss of energy. Conclusions: The application of the Beck Depression Inventory-II among African American people would generate needed information about how depressive symptoms may be expressed among them. Knowledge gained from this study promises to be useful for developing appropriate research studies and population-specific treatment approaches for this group of women.
TL;DR: The results suggest that at least some noetic therapies may have beneficial effects on mood in the course of medical and surgical interventions, given their relatively low cost and limited potential for adverse effects.
Abstract: " Background: Many common medical, surgical, and diagnostic procedures performed for conscious patients can be accompanied by significant anxiety. Mind-body-spirit interventions could serve as useful adjunctive treatments for the reduction of stress. " Objective: To evaluate the effects of stress management, imagery, touch therapy, remote intercessory prayer, and standard therapy on mood in patients awaiting percutaneous interventions for unstable coronary syndromes as part of the Monitoring and Actualization of Noetic Training (MANTRA) trial, which explored the feasibility and efficacy of noetic interventions on clinical outcomes in a randomized clinical trial. " Methods: A total of 150 patients were randomized to one of the five treatment conditions. Stress management, imagery, and touch therapy were administered in 30-minute treatment sessions immediately before the cardiac intervention. Intercessory prayer was not necessarily contemporaneous with these treatments. Mood was assessed by a set of visual analog scales before and after treatment for a similar length of time for the standard therapy and prayer groups. " Results: Analysis of complete data from 108 patients showed that stress management, imagery, and touch therapy all produced reductions in reported worry, as compared with standard therapy, whereas remote intercessory prayer had no effect on mood. The ratings of other similar moods were not affected, perhaps because of the relatively positive emotional state observed in the participants before treatment. " Conclusions: The results suggest that at least some noetic therapies may have beneficial effects on mood in the course of medical and surgical interventions. Administration of these interventions was feasible even in the hectic environment of the coronary intensive care unit. Given their relatively low cost and limited potential for adverse effects, these interventions merit further study as therapeutic adjuncts.
TL;DR: The ability of the preterm infant to maintain engagement during bottle-feeding cannot be explained by characteristics of the infants or by the prefeeding condition of the infant alone, and engagement is coregulated by the caregiver and the infant throughout the feeding.
Abstract: Background: Preterm infants have difficulty maintaining engagement throughout early oral feedings, which can lead to less efficient feeding and prolonged feeding skill development. Objective: To examine contributions of the infant, mother, and feeding context to infant engagement during bottle-feeding. Methods: Bottle-feedings of very-low-birthweight infants (n = 22) by their mothers were observed. Infant and maternal behaviors were coded and synchronized with physiologic measures. At completion of the feeding, the mothers were interviewed, and their working model of feeding coregulation was scored. Feedings were subdivided into feeding episodes (n = 114). Using multilevel linear regression analyses, four dyadic characteristics (working model of the caregiver's role as coregulator, birthweight, postconceptional age, baseline oxygen saturation) and five episode characteristics (readiness at episode onset, episode baseline oxygen saturation, mean oxygen saturation during the episode, maternal feeding behavior, and phase of feeding) were examined as potential predictors of feeding episode engagement. Results: Conditions observed during the feeding observation explained most of the variation in engagement. Engagement was more likely to occur during the early phase of feeding (p <.05), during feeding episodes that began with infant readiness (p <.05), and during feeding episodes with higher mean oxygen saturation during the episode (p <,05). Feeding episodes with less jiggling of the nipple had a significantly greater amount of engagement (p <.05). Conclusions: The ability of the preterm infant to maintain engagement during bottle-feeding cannot be explained by characteristics of the infant or by the prefeeding condition of the infant alone. Rather, engagement is coregulated by the caregiver and the infant throughout the feeding. Strategies to assist infants in maintaining physiologic stability during bottle-feeding and further study of effective and contingent caregiver feeding behaviors are needed.
TL;DR: Exclusive supine infant placement appears to be underused by both nursery staff and mothers of newborn infants, with most staff citing fear of aspiration as the motivation for supine position avoidance.
Abstract: " Background: Although advice from healthcare professionals may influence parental infant placement choice to reduce sudden infant death syndrome risk, literature on nursery staff infant placement behaviors and the degree to which they influence maternal infant sleep positioning is limited. " Objective: To assess newborn placement practices of the mother and nursery staff and their interrelationship in the hospital setting. " Methods: A cross-sectional survey-based study was conducted among hospital newborn nursery staff (n = 96) and mothers of newborns (n = 579) at eight perinatal hospitals in Orange County, California. " Results: Although a majority of sampled nursery staff (72%) identified the supine position as the placement that most lowers sudden infant death syndrome risk, only 30% reported most often placing infants to sleep in that position, with most staff (91%) citing fear of aspiration as the motivation for supine position avoidance. Only 34% of staff reported advising exclusive supine infant positioning to mothers. Approximately 36% of mothers reported using supine infant placement exclusively. Maternal infant placement choice varied by both the advice (p <.01) and the placement modeling (p <.01) provided by staff, with the highest proportion of usual supine infant placement found among mothers who reported receiving both. A mother's race/ethnicity also affected the reception of exclusive supine placement recommendations (p <.01). " Conclusions: Exclusive supine infant placement appears to be underused by both nursery staff and mothers of newborn infants. Culturally grounded educational intervention with nursery staff regarding infant positioning and placement in the hospital setting is indicated.
TL;DR: Nurses expressed the need for smoking cessation interventions similar to that of the general population, and for additional support that recognizes two concerns: confidentiality about their smoking in terms of thegeneral public, and support along with counseling with regard to their feelings of shame and guilt in relation to their public image as nurses.
Abstract: ' Background: It is estimated that 18% of registered nurses smoke. Although nurses can make an important contribution to national cessation efforts, continuing smoking among nurses has been cited as one of the barriers against higher nursing involvement. ' Objectives: To develop a national program to assist nurses in smoking cessation through an in-depth understanding of issues related to nurses' attitudes toward smoking and quitting, and to explore nurses' preferences for smoking cessation interventions. ' Methods: Eight focus groups were conducted in four states with nurses who were currert or former smokers. Content analysis was used to identify major themes. ' Results: Four themes were identified: initiation of smoking and addiction, myths and misconceptions about quitting, overcoming addictions, and strategies for enhancing successful cessation. Nurses described addiction and cessation efforts similar to those of the general population. However, nurses experienced guilt related to their smoking, and perceived a lack of understanding by nonsmoking colleagues and managers about their need of support for smoking cessation. Nurses who had successfully quit smoking were motivated by health concerns, pregnancy, and their children. Nurses suggested many interventions that would be supportive of their quit attempts, such as worksite services and Internet-based support groups. ' Conclusions: Nurses expresseo the need for smoking cessation interventions similar to that of the general population, and for additional support that recognizes two concerns: confidentiality about their smoking in terms of the general public, and support along with counseling with regard to their feelings of shame and guilt in relation to their public image as nurses.
TL;DR: Nursing care to reduce smoking and promote adequate weight gain in all women along with support for women’s efforts to seek safety from abuse may help to improve birth outcomes and promote maternal well-being.
Abstract: BACKGROUND: Intimate partner abuse of pregnant women has been linked to the delivery of low-birth-weight infants. Also, abused pregnant women have reported a greater prevalence of substance abuse, poor nutrition, and demographic risk factors for poor birth outcomes. These factors may play a role in the reported relation between intimate partner violence and birth weight. OBJECTIVES: To explore the role of substance abuse (smoking, alcohol, and drug use) and weight gain of less than 15 pounds during pregnancy as potential mediators of the relation between recent partner abuse and infant birth weight, and to investigate the role of demographic risk factors as potential moderators for the impact of abuse on birth weight. METHODS: Data were extracted on abuse screening results, demographics, birth outcomes, and a range of medical and obstetric risks and complications from the medical records of 1969 women who had been screened by clinicians for domestic abuse during pregnancy. Hypotheses were tested using multiple regression analysis. RESULTS: Recent physical or psychological abuse had a small but significant effect on birth weight in this sample. Smoking and low weight gain were weak but significant mediators of the relation between recent abuse and infant birth weight. Single marital status was the strongest demographic predictor of decreased birth weight. No moderator effects were found. CONCLUSIONS: Although prospective studies are warranted, nursing care to reduce smoking and promote adequate weight gain in all women along with support for women's efforts to seek safety from abuse may help to improve birth outcomes and promote maternal well-being. Language: en
TL;DR: In this article, the authors present a review of various products and devices used for incontinence, identify directions for research and development on technology, and outline the ways nurses can influence and participate in those investigations.
Abstract: Background: Millions of Americans with incontinence use some type of device or product to manage or collect urine or feces. However, research on their clinical uses, problems requiring nursing care, and patient satisfaction is lacking. Objectives: To review the various products and devices used for incontinence, identify directions for research and development on technology, and outline the ways nurses can influence and participate in those investigations. Methods: Existing literature on incontinence technology, devices, and products was analyzed to generate a plan for future research. Results: Gaps in knowledge exist about the uses, best practices, quality of life factors, and problems associated with catheters, absorbent products, other internal and external devices, and skin care products. Conclusions: Collaboration among public and private sectors would result in greater likelihood of high quality clinical research that has sufficient power and integrity, more efficient use of resources special to each setting, and expedited application of technologies for patient use.