Showing papers in "Research in Nursing & Health in 2007"

Is the CVI an acceptable indicator of content validity? Appraisal and recommendations

Abstract: Nurse researchers typically provide evidence of content validity for instruments by computing a content validity index (CVI), based on experts' ratings of item relevance. We compared the CVI to alternative indexes and concluded that the widely-used CVI has advantages with regard to ease of computation, understandability, focus on agreement of relevance rather than agreement per se, focus on consensus rather than consistency, and provision of both item and scale information. One weakness is its failure to adjust for chance agreement. We solved this by translating item-level CVIs (I-CVIs) into values of a modified kappa statistic. Our translation suggests that items with an I-CVI of .78 or higher for three or more experts could be considered evidence of good content validity.

A meta‐analysis of studies of nurses' job satisfaction

Abstract: Although several variables have been correlated with nursing job satisfaction, the findings are not uniform across studies. Three commonly noted variables from the nursing literature are: autonomy, job stress, and nurse-physician collaboration. This meta-analysis examined the strength of the relationships between job satisfaction and autonomy, job stress, and nurse-physician collaboration among registered nurses working in staff positions. A meta-analysis of 31 studies representing a total of 14,567 subjects was performed. Job satisfaction was most strongly correlated with job stress (ES = -.43), followed by nurse-physician collaboration (ES = .37), and autonomy (ES = .30). These findings have implications for the importance of improving the work environment to increase nurses' job satisfaction.

Using qualitative metasummary to synthesize qualitative and quantitative descriptive findings

Abstract: The new imperative in the health disciplines to be more methodologically inclusive has generated a growing interest in mixed research synthesis, or the integration of qualitative and quantitative research findings Qualitative metasummary is a quantitatively oriented aggregation of qualitative findings originally developed to accommodate the distinctive features of qualitative surveys Yet these findings are similar in form and mode of production to the descriptive findings researchers often present in addition to the results of bivariate and multivariable analyses Qualitative metasummary, which includes the extraction, grouping, and formatting of findings, and the calculation of frequency and intensity effect sizes, can be used to produce mixed research syntheses and to conduct a posteriori analyses of the relationship between reports and findings

The analysis and interpretation of cognitive interviews for instrument development

Abstract: Cognitive interviews assess respondents' understanding of questionnaire items and are increasingly used to improve instrument design. Although investigators have described the contributions of cognitive interviews for instrument development, few guidelines are available for analyzing data from cognitive interviews when they are used for that purpose. In this article we address the development and application of analytic strategies for summarizing, interpreting, and using data from cognitive interviews that were conducted during the process of creating a measure of parental management of childhood chronic conditions. We discuss the contribution of cognitive interviews to establishing content validity and address the importance of developing standardized guidelines for analyzing and interpreting cognitive interviews in order to maximize their usefulness for instrument development.

Predictors of quality of life in old age: a cross-validation study.

Abstract: A replication study was undertaken to validate a model of quality of life (QOL) generated in an earlier study on a random sample of 202 older adults. Pathways found to be significant were retested using QOL data from a convenience sample of 420 older adults. Using path analysis, we found that financial resources, health, and meaning in life directly and positively influenced QOL. Health, emotional support, and the physical environment indirectly affected QOL through purpose in life. All but one pathway were replicated, explaining 50.5% of the variance in QOL. Further explorations of the influence of spirituality, emotionally close ties, and opportunities for active engagement on QOL in older age are warranted.

Effects of preoperative therapeutic play on outcomes of school-age children undergoing day surgery

Abstract: The purpose of this study was to examine the effects of therapeutic play on outcomes of children undergoing day surgery. Two hundred and three children admitted for day surgery were invited to participate in a randomized controlled trial. The experimental group received therapeutic play; the control group received routine information preparation. Children in the experimental group reported significantly lower state anxiety scores in pre- and postoperative periods and exhibited fewer negative emotions at induction of anesthesia than children in the control group. No significant differences were found between the two groups in postoperative pain. The study provides some evidence that therapeutic play is effective in pre- as opposed to postsurgical management of children.

Correlates of mother-premature infant interactions.

Abstract: This study's purpose was to examine whether child characteristics, child illness severity, maternal characteristics, maternal psychological well-being, and paternal support influenced interactions between 108 premature infants and their mothers. Mothers with singletons or more infant illness stress showed more positive involvement. Mothers with less infant illness stress, less education, or less participation in caregiving by fathers showed more negative control. First-time mothers and mothers of singletons provided more developmental stimulation. Children of younger and White mothers showed more social behaviors. Less maternal education and shorter period of mechanical ventilation were associated with greater developmental maturity. Greater maternal worry was related to more child irritability. These findings are consistent with the developmental science view that the mother-premature relationship is a complex, reciprocal process.

The effect of a multi-component smoking cessation intervention in African American women residing in public housing†

Abstract: The purpose of this study was to test the effectiveness of a multi-component smoking cessation intervention in African American women residing in public housing. The intervention consisted of: (a) nurse led behavioral/empowerment counseling; (b) nicotine replacement therapy; and, (c) community health workers to enhance smoking self-efficacy, social support, and spiritual well-being. The results showed a 6-month continuous smoking abstinence of 27.5% and 5.7% in the intervention and comparison groups. Changes in social support and smoking self-efficacy over time predicted smoking abstinence, and self-efficacy mediated 6-month smoking abstinence outcomes. Spiritual well-being did not predict or mediate smoking abstinence outcomes. These findings support the use of a nurse/community health worker model to deliver culturally tailored behavioral interventions with marginalized communities.

Measuring nurses' practice environments with the revised nursing work index: evidence from registered nurses in the Veterans Health Administration.

Abstract: The Revised Nursing Work Index (NWI-R) is a widely used instrument for evaluating registered nurses' (RNs) practice environments. The existence of multiple subscale sets from the NWI-R raises questions about its generalizability. We tested the validity of the one-, three-, and five-subscale sets from the NWI-R and derived a short-form subscale set using a sample of RNs from the Veterans Health Administration (VHA). The prior sets do not have an excellent fit to these data. Results of exploratory factor analyses suggested a four-factor model with Opportunity for Advancement, Collegial Nurse-Physician Relations, Staffing Adequacy, and Nurse Manager Leadership as the most salient and parsimonious solution. Additional research is needed to corroborate these findings in other nurse samples and settings.

The Enduring and Contextual Effects of Physical Health and Depression on Care-Dyad Mutuality

Abstract: Mutuality is a protective factor in family care situations, but little is known about changes in care-dyad mutuality. In this study, we examined mutuality in 103 care dyads over 20 months, and the enduring and contextual impact of older adult and family caregiver health on changes in mutuality. Care dyads consisted of frail older adults and their family caregiver. Older adults reported higher levels of mutuality than family caregivers, but their mutuality declined significantly faster over time. Although changes in physical health were more important than mean health for both older adults and family caregivers, mean depression was more important than changes in depression for older adults. This study shows the importance of examining time-varying covariates in the care dyad.

Contexts and evolution of women's responses to miscarriage during the first year after loss.

Abstract: Descriptions of 85 women's feelings about miscarriage at 1, 6, 16, and 52 weeks were inductively coded, rank-ordered, and clustered into 3 responses: healing, actively grieving, and overwhelmed. Women who were actively grieving or overwhelmed at 1 week experienced significantly less distress from 6 weeks on. Responses at 1 week differed with regards to those who had a history of perinatal loss or went on to experience negative life events or sexual distance after loss. One year responses differed based on who was pregnant or gave birth, miscarried again, lived through a higher number of post-loss negative life events, or experienced interpersonal or sexual distance from their mate. Responses were not influenced by gestational age at loss or having other children.

Staff - Family relationships in the care of older people : A report on a systematic review

Abstract: This article reports on a systematic review of the strategies, practices, and organizational characteristics that promote constructive staff-family relationships in the care of older adults in the health care setting. Research evidence points to the need to address power and control issues, communication, and collaborative approaches to care. Interventions designed to promote family-staff relationships are more likely to achieve maximum benefit when implemented with accompanying information sharing, education, and managerial support.

The influence of end-of-life cancer care on caregivers.

Abstract: The purpose of this secondary analysis was to glean from prospective data whether those caring for elderly family members recently diagnosed with cancer who ultimately died reported different caregiver depressive symptomatology and burden than caregivers of those who survived. Findings from interviews with 618 caregivers revealed that caregiver depressive symptomatology differed based on family members' survival status, and spousal caregivers experienced greater burden when a family member was near death than did non-spousal caregivers. Family member symptoms and limitations in daily living, as well as caregiver health status, age, and employment, were associated with caregiver depressive symptomatology and burden; however, these associations had no interaction with family member survival status.

Reliability and validity of the Eyberg Child Behavior Inventory with African-American and Latino parents of young children.

Abstract: This study evaluated the reliability, equivalence, and convergent validity of the Eyberg Child Behavior Inventory (ECBI) in 682, 2- to 4-year-old children. For analysis, parent informants' data were blocked by race/ethnicity (African–American, Latino, non-Latino White), family income (low versus middle/upper), child's gender, and ECBI language version (English and Spanish). ECBI scales had high internal consistency reliabilities and good convergence with the Child Behavior Checklist/1–5. Some racial/ethnic and income effects were found. There were no mean differences by ECBI language version or by child gender. Using confirmatory factor analysis, a single-factor invariant model of the ECBI Intensity Scale provided a good fit with the data across racial/ethnic and income groups. Implications for using the ECBI to measure behavior problems in young children of color are discussed. © 2007 Wiley Periodicals, Inc. Res Nurs Health 30: 213–223, 2007

Stress, optimism, and social support: impact on immune responses in breast cancer.

Abstract: The purpose of this study was to examine the direct and stress-buffering effect of optimism and satisfaction with social support on immune responses in women with breast cancer. Participants were 54 post-operative (M = 19 days) breast cancer patients who completed questionnaires on stress, optimism, and satisfaction with social support and provided blood to measure natural killer cell activity (NKCA) and interferon-gamma (IFN-gamma) from whole blood. Higher levels of stress were associated with decrements in NKCA and IFN-gamma. Optimism moderated the relationship of stress on NKCA but was not related to IFN-gamma. Satisfaction with social support was unrelated to immune responses. Results suggest that interventions aimed at reducing stress and enhancing optimism in women with breast cancer might promote optimal immune response.

Taking the long view: the prenatal environment and early adolescent overweight.

Abstract: The purpose of this study was to assess the independent effects of the prenatal environment and cumulated social risks on the likelihood of being overweight at age 12/13 years. Maternal prepregnancy weight and smoking during pregnancy were the measures of prenatal exposures. Average lifetime per capita income and mother's lifetime marital status were the measures of cumulative social risks. Analysis of data from the National Longitudinal Survey of Youth's Child–Mother file indicated that exposures to tobacco smoke in utero, maternal prepregnancy overweight/obesity, and maternal unmarried status were significant risks for adolescent overweight. The risk for overweight was reduced by breastfeeding if the mother was overweight/obese prepregnancy. Prenatal and early life factors were related to adolescent overweight, providing an important window for intervention. © 2007 Wiley Periodicals, Inc. Res Nurs Health 30: 297–307, 2007

Psychometric evaluation of the Acute Coronary Syndrome (ACS) response index

Abstract: Knowledge, attitudes, and beliefs of persons with ischemic heart disease are important predictors of delay in seeking treatment. We tested the psychometric profile of the Acute Coronary Syndrome (ACS) Response Index, a measure assessing patient knowledge, attitudes and beliefs about ACS symptoms and response, in 3,522 patients. On factor analysis, 21 dichotomous knowledge items loaded onto four factors (alpha .82). In a separate factor analysis, another five items loaded on two attitude factors, and seven items loaded on two belief factors (alpha .76). The scales discriminated between patients previously exposed to medical experts. Scale scores were significantly correlated but without evidence of multicolinearity. Initial tests of reliability and validity support further testing of this new instrument.

The protective role of tangible support on post‐traumatic stress disorder symptoms in urban women survivors of violence

Abstract: We examined social support as a protective factor in the relationship between lifetime exposure to traumatic events and Post-Traumatic Stress Disorder (PTSD) symptomatology among urban women. Seventy-six women who sought care in a trauma center for injuries from physical or sexual violence completed an interview. When tangible support, rather than total social support, and the interaction of tangible support and lifetime trauma were tested, tangible support moderated the relationship between lifetime trauma and PTSD. Given the complex etiology of lifetime trauma, risk for future trauma and the health needs of women who have experienced trauma, a broader range of intervention strategies that include attention to tangible support need to be developed and evaluated.

Psychometric characteristics of the spiritual perspective scale in pregnant African-American women.

Abstract: In health disparities research, studying the vulnerabilities of African Americans should be balanced by research on resources and strengths that influence health. One resource is spirituality, yet few tools have been developed and tested in diverse populations. This study evaluated the psychometric characteristics of the Spiritual Perspective Scale (SPS) in 102 pregnant African American women. Internal consistency reliability was high and evidence of construct validity was provided. The SPS correlated as hypothesized with church attendance, religiosity, and self-reported spirituality. In addition, the SPS correlated negatively with depression, anxiety, and stress. Factor analysis revealed a two-factor solution. The SPS performed well suggesting that it is an appropriate tool to use as a measure of spirituality in pregnant African American women.

A comparison of research utilization among nurses working in Canadian civilian and United States Army healthcare settings

Abstract: Researchers and theorists working in the field of knowledge translation point to the importance of organizational context in influencing research utilization. The study purpose was to compare research utilization in two different healthcare contexts--Canadian civilian and United States (US) Army settings. Contrary to the investigators' expectations, research utilization scores were lower in US Army settings, after controlling for potential predictors. In-service attendance, library access, belief suspension, gender, and years of experience interacted significantly with the setting (military or civilian) for research utilization. Predictors of research utilization common to both settings were attitude and belief suspension. Predictors in the US Army setting were trust and years of experience, and in the Canadian civilian setting were in-service attendance, time (organizational), research champion, and library access. While context is of central importance, individual and organizational predictors interact with context in important although not well-understood ways, and should not be ignored.

The moderating influence of mother-adolescent discussion on early and middle African-American adolescent sexual behavior.

Abstract: We examined how African-American mothers' discussions with their adolescents about sex moderated the relationship between adolescents' sex-based discussions with their friends and adolescents' involvement in sexual behaviors. The 425 African-American adolescents were 12 through 15 years of age and had participated in an HIV prevention research project with their mothers. Linear and logistic regression analyses showed that, for girls, age, discussions with friends, and the interaction between mother and friend's sex-based discussions were statistically significant predictors of sexual behaviors. These findings suggest that the level of discussion with mothers had a moderating effect on the relationship between friends' discussions about sex and a girl's involvement in sexual behaviors. Although these results were not apparent for boys, there was a strong relationship between discussions with friends about sex and sexual behaviors among boys.

Assessment of caregivers' willingness to participate in an intervention research study.

Abstract: The purpose of the study was to identify factors that influenced family caregivers' decisions to participate in an intervention research study. In interviews conducted before and after the intervention, caregivers (n=21) described reasons for participation. A focused content analysis was used to examine responses. Themes that emerged included: (a) caregivers recognized a need for help; (b) expectations and motivations toward change; (c) recognition of self worth as caregivers; (d) timeliness of recruitment strategies; (e) support of research staff affected recruitment; and (f) caregivers recognized the benefits of participation. These findings support the importance of many different strategies for effective recruitment of caregivers in future studies.

Productivity and employees' organizational justice perceptions in long-term care for the elderly.

Abstract: We examined the associations between productivity, employer characteristics, and context variables, and the organizational justice perceptions of 330 female employees in long-term institutional elderly people care. The productivity measure used was the proportion of the inpatient days to total costs. Employees working in high productivity units experienced higher procedural justice than those working in low productivity units. Hostile employees experienced both the procedures and management as less fair than non-hostile employees. Unit size and resident turnover were negatively and registered nurses percentage positively associated with procedural justice perceptions.

Nurse adherence to a minimal-contact smoking cessation intervention on cardiac wards.

Abstract: Health promotion interventions are often underused by care practitioners and, therefore, are not effective. In this study, we assessed nurses' use of a smoking cessation intervention in Dutch cardiac wards and factors associated with their adherence. Ninety-four of 206 nurses did not fully apply the intervention in daily practice; they did not always provide patients with self-help guides, discuss smoking cessation aids, or provide follow-up care. The significant factors in our integrated change model accounted for 52% of the variance in adherence. Adherence was most likely if nurses consistently used an intervention card, perceived advantages of the intervention, had other nurses around them who used it, and had been involved in decision-making.

“It's not just about MOMMAS”: African-American non-resident fathers' views of paternal involvement†

Abstract: Many social and economic policies have been developed to increase fathers' involvement with their children. Yet, we know little about the meaning of involvement for African-American non-resident fathers. The purpose of this study was to obtain African-American non-resident fathers' perspectives on involvement and perceptions of their involvement. Seven focus groups were conducted with 69 fathers. Fathers' views of involvement were grouped into four major areas of importance, including sharing and caring, providing guidance, providing support, and serving in culturally specific roles. Fathers described many impediments to, and expressed dissatisfaction with, their level of involvement. The findings support the need for father-focused interventions.

Patient involvement in health-related decisions during prolonged critical illness.

Abstract: We describe patterns of communication of patients involved in health-related decision making during prolonged mechanical ventilation (PMV). Data were collected using observation, interview, and record review. Twelve of 30 patients participated in decisions about initiating, withdrawing, and withholding life-sustaining treatment, surgery, artificial feeding, financial/legal issues, discharge care, and daily care procedures. Patient involvement was largely validation or confirmation of what clinicians and families had already decided. Patients' participation was enlisted by clinicians and family members even when the patients did not exhibit full decisional capacity. Patient involvement in health-related decisions during prolonged critical illness is a shared and negotiated process that requires continued empirical study and ethical analysis.

African Americans and diabetes: Spiritual role of the health care provider in self‐management

Abstract: How African Americans with type 2 diabetes perceive the spiritual role of health care providers (HCPs) and the effects of that role on self-management was explored using a qualitative descriptive analysis. The sample consisted of 29 African American men and women ages 40-75 with type 2 diabetes and 5 ministers of African American churches. A spiritual relationship with their health provider was important in helping participants manage their diabetes. Three typologies from a parent study were expanded with a focus in this extended study on the meaning ascribed to spiritual relationships with providers and the impact of these relationships on self-management. Care perceived as spiritual may be an important component of providing culturally sensitive health care to African Americans and may facilitate their self-management.

Federal definitions of rurality and the impact on nursing research

Abstract: In rural health research, the measurement of rural residence is commonly dichotomized as urban or rural, even though researchers encourage the use of more descriptive categories to capture rural diversity. Federal categorization schemes for operationalizing rural locations include United States Census Bureau definitions, Office of Management and Budget (OMB) classifications, and categorizations developed by the United States Department of Agriculture (USDA)—Rural-Urban Continuum Codes (RUCC), Urban Influence Codes (UIC), and Rural-Urban Commuting Areas. When categorizing states by rurality, the choice of the measure used influences which states are identified as most rural. We demonstrate this premise in a study of rural home healthcare. © 2007 Wiley Periodicals, Inc. Res Nurs Health 30: 175–184, 2007

A randomized controlled trial to reduce delay in older adults seeking help for symptoms of acute myocardial infarction.

Abstract: Older adults with symptoms of acute myocardial infarction (AMI) have longer pre-treatment delay times than their younger counterparts. A 2-group, randomized controlled sample consisted of 115 adults, 65 years of age or older with a self-reported history of coronary artery disease. A pre-test was given to all participants followed by a structured education and counseling intervention to those in the experimental group. Data were re-collected at 3 months. There was a statistically significant increase in knowledge, beliefs, and perceived control without an increase in anxiety in the intervention group. There was no significant difference in attitudes. Older adults at risk for AMI should be targeted for individualized education and counseling in clinics, physician offices, and community centers.

The influence of maternal and child characteristics and paternal support on interactions of mothers and their medically fragile infants.

Abstract: The influences of maternal characteristics, infant characteristics, and paternal support on maternal positive involvement and developmental stimulation were examined over time in 59 mothers and their medically fragile infants using an ecological framework. Higher maternal education was associated with greater maternal positive involvement. More maternal depressive symptoms, more infant technological dependence, and lower birthweights were associated with less maternal positive involvement at 6 months but greater involvement at 12 months. Higher paternal helpfulness facilitated positive involvement in mothers with low depressive symptoms but not in those with elevated symptoms. Higher maternal education and more depressive symptoms were associated with more developmental stimulation. Thus, maternal interactive behaviors are affected by maternal, infant, and environment factors, and these effects change over time.