Showing papers in "Western Journal of Nursing Research in 1997"

Manager leadership and retention of hospital staff nurses.

Abstract: This study used causal modeling to trace the effects of manager leadership characteristics on staff registered nurse (RN) retention in 4 urban hospitals. Unique to the study were the all-RN sample, using Leavitt's (1958) model of behavior within an organization to group variables, manager characteristics and unit structure variables as predictors, and focus on the work unit rather than the hospital. Effects of manager characteristics were traced to retention through work characteristics, job stress, job satisfaction, commitment, and intent to stay. Theoretical variables explained 22% of the retention variance. Manager consideration of staff and RN intent to remain directly affected retention; other variable effects passed through intent to stay. Different predictors were important to retention, unit separation, and turnover.

Quality of life in women with ovarian cancer

Abstract: Despite growing interest in quality of life (QOL) as an important variable in nursing and health care, little research focuses on QOL in women with ovarian cancer (OVCA). The purpose of this study was to examine QOL in OVCA survivors. The convenience sample consisted of 152 women in all disease stages. Quantitative data were collected using the QOL-Cancer Survivors tool and a demographic sheet. Qualitative data were collected by asking participants to write their definitions and experiences of QOL since their diagnosis. Reliability and validity of all data and findings were established. Findings reveal that QOL is moderately high for this group of cancer survivors, despite some specific negative facets of the illness and treatment experience. Qualitative analysis elaborates the four domains of Ferrell's QOL model: physical, psychological, social, and spiritual well-being. Qualitative data also reflect the complexity of the cancer experience.

Social support and network conflict in firefighters and paramedics.

Abstract: The relationship(s) between self-rated social support network conflict (both at work and off-work) and self-report measures of occupational stressors, job satisfaction, and health outcomes were examined in samples of currently employed professional firefighters (n = 1,730) and paramedics (n = 253). In both samples, perceived social support and network conflict at work were more strongly correlated with job satisfaction and work morale, as well as a measure of their appraised occupational stressors, than with their comparable home (off-work) satisfaction/conflict ratings. The path analysis generated suggested that, with only one exception, social support and relational conflict in the combined respondent sample could be conceptualized as direct sources of stress influencing the respondents' appraisal of their occupational stressors. The path model further suggested that firefighter/paramedics' appraisal of their occupational stressors mediated the network variables' influences on self-reported job dissatisfaction and stress symptom health outcome measures.

Decisions to have a baby by HIV-infected women.

Abstract: As the epidemiologic picture of HIV changes to include increased numbers of women of childbearing age, particularly those of African American heritage and thosefrom rural southern cultures, those who provide services to these women need to understand the processes used by HIV-infected women to make reproductive decisions. Focus-group data with subsequent content analysis were used to discover themes surrounding pregnancy decisions among 22 women in two predominantly rural southeastern states. The results both validated and amplified previous findings and added new perspectives. The analyses revealed six overarching themes: spiritual and religious beliefs, knowledge and beliefs about HIV: previous experience with childbearing attitudes offamilies and sex partners, personal health, and intrapersonal motivation to have a baby.

Perceived control and well-being in Parkinson's disease.

Abstract: Sense of control in the context of an uncontrollable chronic illness is explored by analyzing the impact of the patient's perceived control over symptoms (PCS) and perceived control over disease progression (PCDP) on patient and caregiver outcomes. PCS was significantly associated with patient well-being, caregiver well-being, and less caregiver burden. No relationship was found between PCDP and patient well-being, caregiver well-being, or caregiver burden. Findings support the importance of symptom management, viewing the patient-caregiver dyad as a unit, and the need for future research on control and transition points in chronic illness.

Trauma and Addiction Experiences of African American Women

Abstract: Substance abuse affects African American women at an increasingly alarming rate. The interaction of substance abuse and traumatic events requires exploration. For many African American women, early life trauma plays a critical role in how and when they fall victim to the ravages of substance abuse. This article about a phenomenological study of 15 African American women uses intense narratives to disclose experiences of incest, rape, abuse, and other horrors that led to drug and alcohol use to extinguish pain. The themes include family history of substance abuse, lack of a caring childhood environment, pain resulting from trauma, and coping and recovery. The womens' stories provide insights for nurses in practice and research related to the psychosocial health of women.

Recruitment and retention of families in clinical trials with longitudinal designs

Abstract: The Family Home Visitation Program: Nurse as Coach was a 3-year, National Cancer Institute-funded, multisite, randomized trial of a nursing intervention. It tested the effectiveness of an in-home coaching intervention designed to enhance long-term adjustment of breast cancer's effect on familyfunctioning. We summarize our recruitment and retention experiences, review accrual and retention issues identified from our experiences and those of other researchers, and suggest 24 specific strategies to maximize sample size in future clinical trial studies. Our target sample consisted of 200 women with early stage breast cancer and their male partners and children. We obtained 313 eligible referrals from 91 sites: 217 participants (69.3%) were accrued, 96families (30.7%) refused, 181 participants (83.4%) were retained, 11 (5.1%) were dropped because of changes in eligibility status or because of scheduling error, and another 25 (11.5%) elected to withdraw.

Parental Experience and Meaning Construction during a Pediatric Health Crisis

Abstract: This study explores parental lived experience following admission of their child to a pediatric intensive care unit. The interview data used were collected from 10 randomly chosen families from the Family Impact of Catastrophic Childhood Illness Project recruited during the early phase of critical care hospitalization of their child. A 3-stage contextual analysis procedure integrating interactional and contextual perspectives into Colaizzi's phenomenological approach was used to reduce text data to thematic content. The analysis uncovered a multidimensional and holistic phenomenon consisting offourorganizing concepts: initial boundaryambiguity, parents'coping patterns, family resources, andfunctioning of thefamily boundary. These results provide evidence of a collective family level perception of stress when experiencing the health crisis of a child and supportfurther use offamily stress perception as afamily levelphenomenon that represents family meaning construction during critical illness of a child.

The Importance of the Social Environment in Dementia Care

Abstract: To manage the care of residents with dementia, many long-term care facilities have created special care units designed to meet the unique needs of this group. This article describes results of the qualitative component of a larger research project examining environment-behavior relationships in dementia care settings. The study includes 18 in-depth interviews that were conducted with 9 staff and 9 family members of special care unit (SCU) residents. Thematic analysis was conducted using grounded theory techniques. Although participants described residents 'needs in relation to both the physical and social environments, the latter was perceived to have more impact on quality of life andfunctional ability. This article focuses on five areas of need, identified by participants, in relation to the social environment: stimulation and meaningful activity, human contact, safety and supervision, individualized care, andflexibility.

Afghan refugee issues in the U.S. social environment.

Abstract: Since Afghan refugees began coming to the United States in the early 1980s, the Afghan community of the San Francisco Bay Area has become the largest in the United States. This population copes with a number of stressors that negatively affect their health and psychological well-being. Based on an ethnographic study, we focus on the social context in which Afghan refugees find themselves, describing Afghans' perceptions of their interactions with mainstream American citizens and health and social service providers. The theme running through all such interactions is information--its scarcity, character, and cultural differences in type, purposes, and means of transmission. Quotes from interviews illustrate four types of problems: economic and occupational problems, health-care access, family and children's issues, and immigration issues/ethnic bias. Policy and program recommendations are applicable to other recent refugee populations that experience similar information problems with regard to the dominant society.

Social Support and Long-Term Survivors of AIDS

Abstract: A naturalistic study design using ethnographic interviews was employed to elicit data about the phenomenon of being a long-term survivor of AIDS from 14 men and 6 women. Data were generated through multiple intensive open-ended interviews, demographic data sheets, and self-reported CD4 counts. Data were analyzed using latent and manifest content analysis techniques and the method of constant comparison. One of the dimensions that emerged from the data was "being in relation to others, " the complex set of interpersonal relationships that have been renegotiated to maintain the reconstructed life. Specific ways of being in relation to others included dealing with one's family, renegotiating the friendship group, helping others with HIV: and developing a relationship with a higher power The results of this study have implications for counseling people with HIV disease, and for nursing actions to enhance social support in this vulnerable group.

The experiences of postmenopausal women with coronary artery disease.

Abstract: The lifetime probability that a woman will develop coronary artery disease (CAD) is 46%. Hormonal changes, resulting in a shift in the ratio of the protective high density lipoproteins to low densi...

Benefits and Burdens of Genetic Carrier Identification

Abstract: This qualitative study examined experiences of adults requesting genetic-carrier testing for four autosomal-recessive and X-linked-recessive disorders. The sample consisted of 34 adults with a positive family history or membership in an ethnic group at risk for the inherited disorder. A semistructured interview guide was used to collect data during an interview 1 month after receipt of test results. Noncarriers experienced benefits of emotional relief and freedom to move ahead with reproductive planning. Carriers experienced burdens of sadness and loss of reproductive expectations. Some subjects in both groups experienced difficulty disclosing results to selected family members and expressed concerns regarding disclosure of testing to insurance providers.

The Meanings of Home in the Stories of Older Women

Abstract: The concept of home emerged as a theme in the stories of inner strength told by older women. In this study, 12 women over the age of 65 (7European American and SAfrican American) were asked to tell...

Studies of Ethical Conflicts by Nursing Practice Settings or Roles

Abstract: This article summarizes the body of research about ethical conflicts described by nurses in various fields of practice and recommends direction for the use and extension of this information. Twenty-three studies that fit criteria for inclusion were located. As a group, studies use inconsistent terminology, pay little attention to measurement characteristics of the instruments used, and do not use explanatory theory about how and why ethical conflicts develop or are experienced. Several studies of nurses practicing in community and home care settings, in intensive care units, and in administrative roles show some common areas of ethical conflict. Studies of ethical conflicts can be used as a basis for improving practice.

Using Critical Incident Technique to Inform Aged and Extended Care Nursing

Abstract: Flanagan's critical incident technique was used to explore the beliefs of a cross-section of careers (both nursing and others) and consumers about the value of nursing and the nature of nursing's contribution in aged and extended care. The exploratory study found that nurses' being there, with and for residents, their families, and other health professionals, was influenced by two major themes that emerged from the data: personal and structural considerations. In this article, the potential of critical incident technique as a research method in nursing and for generating information about critical aspects of nursing work in aged and extended care is demonstrated.

Health-Promoting Behaviors of Black and White College Women

Abstract: There is growing recognition that race and socioeconomic variables in health research demand greater attention. The investigators compared racial differences in health definition, health value, and health-promoting behavior of 62 pairs (N = 124) of Black and White college women matched on age, body mass index, and socioeconomic status. Both groups of women had similar definitions of health, valued health to the same extent, and reported similar levels of self-actualization, health responsibility, exercise, and stress management. Black women, relative to White women, practiced fewer nutrition behaviors and had less interpersonal support. Interventions to reduce health risk associated with nutrition practices of Black women are warranted and further research is needed to explore the influence of the social structure of educational institutions on interpersonal relationships and other health behaviors. When socio-economic status is taken into consideration, Black and White college women demonstrated more com...

Home-Care Nurses as Strangers in the Family

Abstract: As nurses move from the hospital into the home setting, they are challenged to examine boundaries of practice and family-nurse relationships. This phenomenological study was undertaken to explore the experiences of nurses working with families of technology-dependent children in the home. The main theme emerging from the data was the nurse's presence as "a stranger in the family." Additional themes focused on the nurse's advocacy for the child and family, boundary setting, collaboration, and occupational demands.

HIV risk behaviors become survival techniques for aboriginal women.

Abstract: In northern Alberta, the Aboriginal (native) female population appears to be overrepresented in the HIV statistics. A qualitative research study was designed to explore the cultural factors that relate to the high HIV infection rate in these women. Eight HIV-positive women were interviewed for the study, representing about one third of the population. A model was developed to explain the relationships that exist between the women's formative years, their self-esteem, and the survival techniques they used prior to becoming HIV-positive. These survival techniques may have placed them in situations that increased their risk of infection with the HIV virus.

A Concept Analysis of Respect Applying the Hybrid Model in Cross-Cultural Settings:

Abstract: Respect was analyzed as a concept in the domain of nursing action using the hybrid model of concept development. Field research methods provided empirical descriptions of respect in two different cross-cultural settings. Participant observations were conducted in an outpatient clinic ofa large U.S. hospitalproviding services toa multicultural clientpopulation, and key informant interviews were undertaken in a Canadian First Nations community. Data analysis proceeded according to a variation of Schatzman and Strauss 's notation system. Findings from analyses of field data revealed patterns of interaction indicative of respect and lack of respect. By synthe-sizing theoretical and empirical findings, key indicators, potential operational indicators, and a conceptual definition of respect were developed. Thefindings provide preliminary descriptions of respect that lay the foundation for future analyses and applications in nursing.

First-Year Swedish nursing students' experiences with elderly patients

Abstract: Nursing students' attitudes toward elderly people have frequently been found to be negative. This study's aim was to describe the experiences of first-year nursing students with elderly people. Thi ...

Public Health Nurses' Decision Making in Canada, Finland, Norway, and the United States

Abstract: The purpose of this study was to describe the decision-making processes of 369 public health nurses in Canada, Finland, Norway, and the United States, and to discuss any differences observed among these countries. The results indicate that public health nurses used different decision-making models on the job and that these models varied considerably. Five different decision-making models were identified, each exhibiting features of different decision-making theories. The differences between decision making of public health nurses in different countries were statistically significant. The differences in decision making appear to be due to differences in health care systems in the 4 countries and the nature of the nursing task and context.

Spiritual interventions provided by mental health nurses

Abstract: This descriptive qualitative study explored the spiritual nursing interventions provided by mental health nurses. Fifty mental health nurses responded to open-ended interrogative statements to report on nursing interventions in three situations that supported the spiritual needs of patients and families. Their responses were grouped into four categories, nurses being with the client, doing for the client, encouraging the client to look inward, and encouraging the client to look outward. Being with was demonstrated through the presence of the nurse. Doing for included interventions performed on the clients behalf and included the nurse using time, people, and space to provide care. Clients were encouraged to look inward for strength and look outward for people and objects that could be resources for them. A serendipitous finding was that mental health nurses were able to describe the ideal spiritual interventions but reportedfewer instances of actually having intervened.

Nurses' experience with implementing developmental care in NICUs.

Abstract: The aim of this study was to gain insight into nurses' (N = 8) experience of working in a neonatal intensive-care unit (NICU) that incorporated the developmental-care approach. Although Als's model is family centered, the basic social process identified by nurses was putting the baby first. The process of putting the baby first was uncovered using grounded-theory methodology. The process included three phases: learning, reacting, and advocating/nonadvocating. In each of the phases, four main concepts--encountering, appraising, supporting, and gaining sensitivity--emerged from the data. Nurses appraised the advantages and disadvantages of this therapeutic approach not only to the infant but also to themselves.

Development of the Concept of Family Vigilance

Abstract: Although there is an increase in the visibility offamilies in hospitals, there was little known about the meanings, patterns, and day-to-day experience offamilies staying with hospitalized relative...

Patterns of Violence in Homeless Women

Abstract: This exploratory qualitative study describes reported patterns of violence of homeless battered women and their experiences in search for shelter in the US Using an open-ended qualitative exploratory study design seven women residing in two shelters (aged 24-51 years) were interviewed All were homeless due to abuse by their male partners and each reported significant alcohol or drug use in her most recent relationship The themes that emerged from the interviews represented four phases in the relationship Phase 1 was the early "honeymoon" period that occurred in most relationships wherein the women spoke of a time of extreme happiness love and fulfillment However this phase was marked by early betrayal as well Phase 2 was noted by the emergence of isolation/shame and harassment/humiliation directed to the woman The third phase consisted of the themes of power placate and terror Finally the fourth phase represented freedom-seeking behaviors in women: murderous thoughts awakening and escape Overall the findings from this study constitute implications for outreach case finding and identification of intervention timing for abused women

A triangulation approach to testing a family instrument

Abstract: Sequential triangulation was used to test the validity of the Assessment of Strategies in Families (ASF), a screening tool for family effectiveness, and its application to families experiencing chronic pain. First, 30 subjects with chronic pain completed the questionnaire. Next, for the purpose of item validation, the subjects explained their thought process for each choice on the questionnaire. Results showed that they interpreted the items as intended. Subjects then responded to a semistructured interview about their perception about family stability and growth patterns. Thematic analysis suggested a tendency toward isolation from the community, intense involvement in each other's lives, and rigid control of family operations. ASF results reflected the trends by a low family-growth subscore, and a high or low stability score, depending on the success in achieving cooperation of family members. The findings suggest the instrument is valid and appropriate to screen families with chronic pain.

The Interpersonal Competence Instrument for Nurses

Abstract: A new tool, the Interpersonal Competence Instrument for Nurses, was evaluated for content validity and readability. Evaluators consisted of a panel of 10 nursing experts. The instrument measures four categories of the patient-nurse interaction: translating, getting to know you, establishing trust, and going the extra mile. The content validity indexes (CVI) for 14 of 15 behaviors within the four categories rangedfrom .8 to 1.0 and are considered to have content validity. The CVIfor the 15th behavior, clicking, was calculated as. 7, and, thus, was modified. The CVIfor the entire instrument of 111 items was determined to be .84. Readability analyzed with the SMOGformula established a grade level of 8.09. Additional psychometric testing of the tool is in progress. Internal consistency reliability is being evaluated through the use of coefficient alpha and item analysis. Construct validity is being estimated through the experimental approach. The internal structure of the instrument is being assessed throughf...

Violation in caring for the physically disabled

Abstract: Based on in-depth interviews, this article reports how people with disabilities perceive and experience the care given by public health care personnel. A major and disturbing finding is that the informants describe feelings of being violated, transgressed, and infringed upon by the personnel in change of their care. Because of the way nurses and other health care personnel interact, patients' bodies are often perceived as objects. The article describes some of these feelings, including how the informants construct different body boundaries in order to handle the violation of their body and body zone, and it discusses some features of the health care professions that may cause the informants' feelings of being violated.

Three Phases of Research in Validating Nursing Diagnoses

Abstract: The purposes of this three-phase project consisting of concept analyses, nurse expert validation. and client validation were: identification of nursing definitions of anxiety and fear, validation of defining characteristics of the diagnoses by nurse experts, differentiation of the diagnoses by nurse experts, and validation of the nursing diagnosis anxiety by clients. The nurse expert sample consisted of 233 professional nurses, and the client sample consisted of 69 adult clients. Results include agreement on two critical defining characteristics ofanxiety by nurse experts and clients, the differentiation of anxiety andfearby nurse experts, the suggestion ofafear-anxiety syndrome in the literature and by nurse experts and clients, and the suggestion by nurse experts that anxiety be defined using levels ofanxiety. Recommendationsfor changes in the nursing diagnosis anxiety are discussed.