Showing papers in "Research in Nursing & Health in 2006"

The content validity index: Are you sure you know what's being reported? critique and recommendations

Abstract: Scale developers often provide evidence of content validity by computing a content validity index (CVI), using ratings of item relevance by content experts. We analyzed how nurse researchers have defined and calculated the CVI, and found considerable consistency for item-level CVIs (I-CVIs). However, there are two alternative, but unacknowledged, methods of computing the scale-level index (S-CVI). One method requires universal agreement among experts, but a less conservative method averages the item-level CVIs. Using backward inference with a purposive sample of scale development studies, we found that both methods are being used by nurse researchers, although it was not always possible to infer the calculation method. The two approaches can lead to different values, making it risky to draw conclusions about content validity. Scale developers should indicate which method was used to provide readers with interpretable content validity information.

Quantifying work-family conflict among registered nurses.

Abstract: Work-family conflict is challenging for nurses and the nursing profession. Still unclear is how frequently nurses experience work-family conflict and which nurses experience it most frequently. We document the prevalence and frequency of work-family conflict and describe the demographic predictors of frequent work-family conflict. Nurses reported greater work interference with family than family interference with work. Fifty percent of nurses reported chronic work interference with family (occurring at least once a week); another 41% reported episodic work interference with family (occurring less than 1-3 days per month). In contrast, 52% of nurses reported episodic family interference with work, and 11% reported chronic family interference with work. Few demographic characteristics predicted either work interference with family or family interference with work.

Identifying predictors of breastfeeding self-efficacy in the immediate postpartum period.

Abstract: Researchers have found evidence that breastfeeding self-efficacy is an important variable that significantly influences initiation and duration rates. The purpose of this study was to develop a multi-factorial predictive model of breastfeeding self-efficacy in the first week postpartum. As part of a longitudinal study, a population-based sample of 522 breastfeeding mothers in a health region near Vancouver, British Columbia completed mailed questionnaires at 1-week postpartum. Bivariate correlations were used to select variables for the multiple regression analysis. The best-fit regression model revealed eight variables that explained 54% of the variance in Breastfeeding Self Efficacy Scale (BSES) scores at 1-week postpartum: maternal education, support from other women with children, type of delivery, satisfaction with labor pain relief, satisfaction with postpartum care, perceptions of breastfeeding progress, infant feeding method as planned, and maternal anxiety. The BSES may be used to identify risk factors, enabling health professionals to improve quality of care for new breastfeeding mothers.

Measuring participation in a prevention trial with parents of young children.

Abstract: This paper describes parent participation in a clinical trial of preventive parent training (PT) targeting low-income parents of young children. Participation encompassed enrollment, attendance, and engagement. Average enrollment rate was 34.9%, although enrollment rates were significantly higher in the control (39.1%) than in the intervention (30.6%) centers. Parents attended an average of 39% of the PT sessions. Higher attendance was associated with lower parenting self-efficacy, more parent-reported child behavior problems, and attending the first PT session. Level of engagement in the PT sessions was related to improvements in parent and child outcomes. Findings suggest that attendance is linked to parent perceived need for help and that resources should be focused on ensuring parent attendance at the first intervention session.

Somatic awareness, uncertainty, and delay in care‐seeking in acute heart failure

Abstract: Symptom monitoring is difficult for heart failure (HF) patients. Difficulties physically sensing and determining symptom meaning may lead to uncertainty and delay treatment. Somatic awareness may provide insight into symptom monitoring ability. A model combining physical and cognitive aspects of the symptom experience was developed to examine factors affecting care-seeking among HF patients. Adults hospitalized with acute HF were interviewed and completed questionnaires measuring somatic awareness and uncertainty. HF symptom duration prior to admission measured delay. HF specific somatic awareness and symptom pattern predicted delay. Uncertainty correlated with somatic awareness, but did not predict delay. Few responded to early HF symptoms delaying until acutely ill. Development of interventions to improve symptom monitoring is needed.

Predictors of distress in caregivers of persons with a primary malignant brain tumor.

Abstract: The purpose of this cross-sectional, descriptive study was to identify predictors of distress for family caregivers of persons with a primary malignant brain tumor (PMBT). The effect of the care recipient's functional, cognitive, and neuropsychiatric status on caregiver burden and depressive symptoms was examined through telephone interviews with 95 caregivers. Care recipients' neuropsychiatric status consistently affected caregivers' depressive symptoms and burden, and assisting with activities of daily living affected burden related to caregivers' schedules and health. The care recipient's cognitive status and need for assistance with instrumental activities of daily living did not affect any outcome variable. Results may help identify caregivers at risk for negative outcomes, and suggest interventions to improve caregivers' emotional health.

Symptoms, self-efficacy, and physical activity among individuals with multiple sclerosis

Abstract: Using social-cognitive theory, we examined the associations among symptoms, self-efficacy, and physical activity in 196 individuals with multiple sclerosis (MS). Participants completed symptoms, self-efficacy, and physical activity measures and wore an accelerometer for 7 days. There was a moderate inverse correlation between symptoms and physical activity (varphi = -.42). Subsequent analyses indicated that symptoms had direct negative relationships with self-efficacy (gamma = -.32) and physical activity (gamma = -.24), and self-efficacy had a direct positive relationship with physical activity (beta = .57). This study provides initial support for symptoms as a correlate of physical activity in individuals with MS. Monitoring symptoms during a physical activity program and altering the exercise prescription during symptom exacerbation might be a method for increasing exercise adherence.

Health-related research on older inmates: an integrative review.

Abstract: The literature on older inmates' health is fragmented and insufficiently developed. In this integrative review, 21 research articles on health and older inmates were identified, critiqued, and synthesized to determine: the minimum age criterion most commonly used; health-related variables explored; health status; the health impact of incarceration; and aging-specific policies, programs, and facilities. Age 50 and older was used most often. The top three health variables were psychiatric conditions, physical illnesses, and substance abuse. Self-reports of health status varied across studies; however, inmates consistently reported health declines since incarceration. Older inmates' health needs appear often to be left unmet. Nursing investigations are needed leading to practice innovations to enhance prisoners' self-management to reduce disease burden and fiscal and societal costs.

Testing a model of symptoms, communication, uncertainty, and well-being, in older breast cancer survivors.

Abstract: Among older, long-term breast cancer survivors, symptoms from previous treatment can generate uncertainty about whether they represent co-morbid conditions, recurrence, or normal aging. This uncertainty can result in emotional distress and thoughts of recurrence. Communication with health care providers may help women reduce uncertainty and improve both emotional and cognitive well-being. To assess the influence of symptoms, uncertainty, and communication with providers on well-being, data from 203 Caucasian and African American survivors, 5-9 years post treatment, were tested using structural equation modeling. Symptoms, age, and uncertainty had the strongest influence on well-being, regardless of race. There was an unexpected positive association between patient-provider communication and thoughts of recurrence. Descriptive analysis revealed that 52% of women were unable to achieve their desired decision-making role with health care providers.

Adherence to "Doing-the-month" practices is associated with fewer physical and depressive symptoms among postpartum women in Taiwan.

Abstract: According to traditional Chinese custom, women should be confined to home and assisted with tasks for 1 month after giving birth to a child. This restrictive regimen is referred to as doing-the-month. The objectives of this study were to describe adherence to doing-the-month practices and to explore the association between adherence to doing-the-month practices and physical symptoms and depression among postpartum women in Taiwan. Participants were 202 women at 4-6 weeks after delivery. Adherence to doing-the-month practices was associated with lower severity of physical symptoms and lower odds of postnatal depression, after adjustment for potential confounders. Adherence to doing-the-month practices was associated with better health status among postpartum women in Taiwan.

Improving outcomes of nursing home interactions.

Abstract: In this study, an intervention designed to improve staff-resident communication was evaluated in three nursing homes. Audio recordings of staff speech from baseline, and immediately and 2 months post-intervention, were compared on elderspeak (infantilizing speech) and rated for care, respect, and control. After the intervention, staff used less elderspeak (i.e., diminutives, collective pronoun substitutions, shortened statements, and simplistic vocabulary). Immediate post-intervention conversations were rated as less controlling, but more respectful and caring. After 2 months, communication was more controlling, less respectful, and less caring. Reduction in staff elderspeak use continued for psycholinguistic measures, but improvements in care, respect, and control decayed, suggesting the need for ongoing reinforcement of training.

Research With Families Facing Cancer: The Challenges of Accrual and Retention

Abstract: The purposes of this article are: (a) to describe and analyze the accrual and retention patterns in a longitudinal randomized clinical trial with prostate cancer patients and their partners, and (b) to discuss strategies that were used to overcome challenges in conducting this family-based study. Initially, 429 dyads were referred to the study. Of these, 166 were not enrolled due to refusal (n ¼ 120) or ineligibility (n ¼ 46), 21 of whom did not meet one or more of the inclusion criteria, and 25 of whom could not be reached within the 2-month window of eligibility. Of the 383 eligible dyads, 263 dyads were enrolled (enrollment rate of 68.7%). Accrual and retention patterns differed by research site, referral procedures, and phase of prostate cancer. The retention rate was very good with the majority of dyads (n ¼ 218) completing all three follow-up assessments at 4, 8, and 12 months (82.9%). 2006 Wiley Periodicals, Inc. Res Nurs Health 29:199-211, 2006

Acculturation, social alienation, and depressed mood in midlife women from the former Soviet Union

Abstract: Level of acculturation has been linked to depressed mood in studies across culturally diverse immigrant groups. The purpose of this study was to determine the effects of acculturation, social alienation, personal and family stress, and demographic characteristics on depressed mood in midlife immigrant women from the former Soviet Union. Structural equation modeling showed that higher acculturation scores, measured by English language and American behavior, were indirectly related to lower scores for depressed mood. Higher acculturation levels promoted mental health indirectly by reducing social alienation and, subsequently, lowering family and personal stress, both of which had direct relationships to symptoms of depression. These findings support the ecological framework that guided our research and point to the importance of focusing on contextual factors in developing interventions for new immigrants.

Fatigue and associated factors in hemodialysis patients in Taiwan.

Abstract: The number of patients suffering from end-stage renal disease is increasing rapidly around the world, including in Taiwan. Hemodialysis (HD) patients report fatigue as a major stressor. The purpose of this correlational study with systematic sampling was to explore fatigue and associated physiological, psychological, and situational factors in 119 Taiwanese HD patients. Results indicate that levels of fatigue were mild. Three variables (gender, employment, and depression) had a significant impact on fatigue. Some differences in physiological factors by depression, gender, and employment were found. Stepwise regressions showed that depression, age, and urea reduction ratio were significant predictors for overall fatigue and two of its dimensions. Some relationships from the theory of unpleasant symptoms were supported.

Relationship between nursing interventions and outcome achievement in acute care settings

Abstract: The extent to which nursing interventions provided during hospitalization are associated with patients' therapeutic self-care and functional health outcomes was explored with a voluntary sample of 574 patients. Nurses collected data on patient outcomes at admission and discharge using the minimum data set (MDS) and the therapeutic self-care scale (TSCS). Research assistants audited charts for documentation of nursing interventions. The results indicated that nursing interventions aimed at exercise promotion, positioning, and self-care assistance predicted functional status outcome. Higher functional status outcome predicted therapeutic self-care ability at hospital discharge. The results demonstrate that nurses can use MDS and TSCS data on patient outcomes to gain insight into the effectiveness of their interventions.

Responding to sexual assault victims' medical and emotional needs: a national study of the services provided by SANE programs.

Abstract: We measured the consistency with which a national random sample of 110 Sexual Assault Nurse Examiner (SANE) programs provided 17 services to sexual assault victims. SANE programs consistently offered forensic evidence collection, sexually transmitted infection (STI) prophylaxis, information on HIV, information on pregnancy risk, and referrals to community resources. Reasons programs did not routinely offer particular services (e.g., STI cultures, HIV testing/prophylaxis, emergency contraception (EC)) included financial constraints, difficulties balancing medical care with legal prosecution, and affiliations with Catholic hospitals.

The health care relationship (HCR) trust scale: development and psychometric evaluation.

Abstract: A sequential multi-method approach using focus groups, individual interviews, and quantitative instrument development procedures was used to develop and evaluate a scale to measure patient trust in health care providers (HCPs). The resulting 15-item Health Care Relationship (HCR) Trust Scale was tested for internal consistency, test-retest reliability, and construct validity. The Cronbach alphas were .92 (time 1) and .95 (time 2), respectively. Test-retest reliability was .59 (p < .01). The HCR Trust Scale did not correlate with the Marlowe-Crowne Social Desirability Scale (r = .20, p = .07) or the Rapid Estimate of Adult Literacy in Medicine scale (r = -.21, p = .13). Principal component factor analysis with varimax rotation revealed a three-factor solution that explained 69% of the estimated common variance in the HCR trust scale. Cronbach alphas for the 3 factors ranged from .81 to .89. Findings of this study support the use of the HCR Trust Scale for measuring trust in various HCPs by diverse patient populations. More work is needed to test the usefulness of the scale with a greater number of patients and in other chronic illness populations.

Gynecological health impact of sexual assault.

Abstract: We examined the relationship between sexual assault and gynecological health symptoms (e.g., pelvic pain, painful intercourse) in a sample of predominately African American female veterans. Those who had been sexually victimized experienced significantly more frequent gynecological health symptoms than those who had not been assaulted. Multiple forced penetrations, assault by an intimate partner, having weapons used, physical injury, belief that the victim's life was in danger during the assault, and serving in the military at the time of assault increased the likelihood of reporting particular gynecological health symptoms. Screening women in health care settings for a history of violence can link women to resources and treatment for assault-related health symptoms.

Enacting a theory of caring to recruit and retain vulnerable participants for sensitive research

Abstract: The recruitment and retention of research participants always presents challenges to researchers. This process is made more complicated when the research being undertaken is socially sensitive and the populations of interest are considered vulnerable. The purpose of this article is to illustrate how Swanson's middle-range theory of caring can be used as a framework for recruitment and retention for studies on sensitive topics that involve vulnerable participants. We provide an overview of the theory as well as illustrations from three separate studies that involved in-depth interviews with vulnerable participants. These studies included parents who had either experienced the death of their infant or were involved in life support decisions because of potentially giving birth to an extremely premature infant (22-25 weeks gestation).

Ethnic and generational influences on emotional distress and risk behaviors among Chinese and Filipino American adolescents.

Abstract: The purpose of this study was to explore ethnic and generational influences among Chinese, Filipino, and Euro American adolescents on emotional distress and risk behaviors. Hierarchical multiple regression analyses were conducted with 216 Chinese, 387 Filipino, and 400 Euro American adolescents from the National Longitudinal Study on Adolescent Health to investigate the influence of ethnicity on depression, somatic symptoms, delinquency, and substance use; and to examine the influence of generation on the outcome variables among Chinese and Filipino American adolescents. Ethnicity predicted depression and delinquency scores, while generation within ethnic groups predicted somatic symptoms and substance use. The findings diverge from theories using acculturation as an explanatory mechanism for distress and risk behaviors and underscore the importance of examining sub-groups and generations of Asian American youth.

Development and psychometric testing of The Care in Obstetrics: Measure for Testing Satisfaction (COMFORTS) scale.

Abstract: This paper describes the development and psychometric assessment of a scale to measure satisfaction with intrapartum and postpartum care in hospital: The Care in Obstetrics: A Measure For Testing Satisfaction (COMFORTS) scale. A sample of 415 participants completed the 40-item scale. Cronbach's alpha for the scale was .95. Evaluation of construct validity through principal components factor analysis with varimax rotation yielded six subscales: confidence in newborn care, postpartum nursing care, provision of choice, the physical environment, respect for privacy, and labor/delivery nursing care. The COMFORTS scale was able to discriminate between multiparous versus primiparous women, and between women cared for in single room maternity care versus in separate labor/delivery and postpartum rooms. Pending further validation, the COMFORTS scale has potential to measure women's satisfaction with childbirth care and contribute to an assessment of the quality of care provided.

Family patterns of decision-making in pediatric clinical trials.

Abstract: The decision-making process related to a child's participation in clinical trials often involves multiple family members. The aim of this study was to compare family patterns of decision-making within and across family units in pediatric clinical trials. Participants for this secondary analysis included 14 families from a larger study of informed consent. Four distinct patterns of decision-making were identified: Exclusionary, informative, collaborative, and delegated. These patterns varied with regard to three dimensions of parents' decision-making goals, child level of involvement, and the parental role. These patterns of decision-making affect how parents and children communicate with health professionals and influence the effectiveness of health care providers interactions with the family related to the decision-making process.

Comparison of the original and revised structures of the Health Promotion Model in predicting construction workers' use of hearing protection.

Abstract: Pender's health promotion model (HPM) has been revised, including substantial changes in its structure. The purpose of this study was to compare the fit and predictive usefulness of the original and revised structures of the HPM as applied to the use of hearing protection devices by 703 construction workers. Structural equation modeling was used to evaluate the two alternative forms of the model. Both forms of the model fit well, with the revised structure having a better fit and explaining more of the variance in use of hearing protection (28% vs. 18%). Results support the revised structure of the health promotion model (HPM) over the original form, and indicate it may be useful in understanding and predicting use of hearing protection.

Recruitment of African American women to a walking program: eligibility, ineligibility, and attrition during screening.

Abstract: The purposes of this study were to identify strategies successful in the recruitment of African American (AA) women to a home-based walking program and to examine factors that contribute to attrition, eligibility, and ineligibility during the recruitment screening protocol. Of the 696 women who contacted the researchers, 281 (40.4%) women enrolled in the study, 227 (32.6%) were lost to attrition, and 188 (27%) were ineligible. Those not enrolled due to attrition during screening or ineligibility reported more family risk for cardiovascular disease (CVD) and lived in neighborhoods with higher poverty. Although our recruitment strategies may have been successful in attracting low-income AA women, we were not as successful in preventing their attrition during the screening protocol, particularly for those living in poorer neighborhoods.

Perceived risk and interest in screening for lung cancer among current and former smokers.

Abstract: Factors associated with perceived risk, interest in screening information, and interest in being screened for lung cancer were examined among current and recent former smokers. Cross-sectional data were analyzed from 585 current and former smokers who participated in 12-month follow-up telephone interviews as part of a population-based cessation intervention trial. Current smokers who were thinking about or preparing to quit were more likely to perceive risk of lung cancer and be interested in lung cancer screening information than those who were not motivated to quit or who were in the process of actively quitting or maintaining abstinence. Smokers who participate in lung cancer screening may be motivated to participate in a broad range of tobacco dependence treatment options.

Effect of guided imagery with relaxation on health‐related quality of life in older women with osteoarthritis

Abstract: Osteoarthritis (OA) is the most common cause of disability in older adults, which, in turn, leads to poor quality of life (QOL). Disability is caused primarily by the joint degeneration and pain associated with OA. A randomized pilot study was conducted to test the effectiveness of guided imagery with relaxation (GIR) to improve health-related QOL (HRQOL) in women with OA. A two-group (intervention versus control) longitudinal design was used to determine whether GIR leads to better HRQOL in these individuals and whether improvement in HRQOL could be attributed to intervention-associated improvements in pain and mobility. Twenty-eight women were randomized to either the GIR intervention or the control intervention group. Using GIR for 12 weeks significantly increased women's HRQOL in comparison to the women who used the control intervention, even after statistically adjusting for changes in pain and mobility. These findings suggest that the effects of GIR on HRQOL are not limited to improvements in pain and mobility. GIR may be an easy-to-use self-management intervention to improve the QOL of older adults with OA.

Medication adherence patterns in adult renal transplant recipients

Abstract: Patient adherence to immunosuppressive medications adherence is crucial to survival of the patient and a transplanted kidney, yet adherence is variable Using a prospective, descriptive design, immunosuppressive medication adherence of 44 renal transplant recipients was followed for 6 months at a Midwestern transplant center using electronic monitoring Four medication adherence patterns emerged from a hierarchical cluster analysis: those who took medications on time, those who took medications on time with late/missed doses, those who rarely took medications on time and who were late with morning and/or evening doses, and those who missed doses This study is a step toward developing and implementing interventions targeted to specific patterns of poor adherence

A comparison of pressure ulcer prevalence rates in nursing homes in the Netherlands and Germany, adjusted for population characteristics.

Abstract: Annual pressure ulcer surveys in the Netherlands and Germany have shown remarkable differences in prevalence rates. We explored the differences between the two populations, and the degree to which these differences were associated with differences in prevalence. To this end, data from 48 Dutch and 45 German facilities (n = 9772) from 2003 were analyzed. The prevalence of pressure ulcers (excluding grade 1) was 12.5% in the Netherlands and 4.3% in Germany. After adjusting for age, sex, and other risk factors, the probability of developing a pressure ulcer of stage 2 or higher in Dutch nursing homes was three times greater than in German homes. © 2006 Wiley Periodicals, Inc. Res Nurs Health 29: 588–596, 2006

Early predictors of post-hospital adjustment problems in critically ill young children.

Abstract: Toddlers and preschool children have been identified as being at risk for post-hospital behavioral sequelae, especially when confronted with an unanticipated intensive care unit (ICU) hospitalization. The purpose of this predictive secondary analysis was to determine demographic and clinical variables that could be assessed early during hospitalization to predict internalizing and externalizing behaviors and negative behavioral change of 2- to 7-year-old children at 3 and 6 months following an unanticipated critical care hospitalization (n = 163 mother-child dyads). The children's behavioral predilections prior to hospitalization (i.e., internalizing or externalizing behaviors) and sex, as well as elevated maternal state anxiety, marital status, and level of emotional care giving by mothers, significantly predicted child internalizing and externalizing behavior and post-hospitalization behavior changes. Results suggest several risk factors that predispose children to poor outcomes following an unanticipated hospitalization that could be targeted for intervention to improve children's emotional and behavioral health.

Factors influencing Hong Kong Chinese patients' decision-making in seeking early treatment for acute myocardial infarction.

Abstract: The purpose of this study was to identify, through in-depth interview, factors that influenced 27 Hong Kong Chinese patients' decision-making in seeking early treatment for acute myocardial infarction (AMI). The median delay time from the onset of symptoms to arrival at the hospital was 15.6 hours for men and 53.7 hours for women. Three major categories emerged from the data: (a) becoming aware of the threat, (b) maintaining a sense of normality, and (c) struggling to mobilize resources. A variety of decisions were made by patients from the onset of chest pain to seeking help. These decisions were heavily influenced by healthcare factors (access to emergency medical service (EMS) and treatment), personal factors (cognitive interpretations of symptoms), sociocultural factors (family situation, cultural beliefs, and practices), and coping strategies.