Nursing

Investigation into the Relationship Between Worry and Self Efficacy on Self-management in an Asian Pacific Islander Population with Type 2 Diabetes

Wong, Lorrie — Thu, 01 Jan 2009 00:00:00 GMT

Diabetes Mellitus is a complex chronic disease that is prevalent throughout the world (Wild, Roglic, Green, Sicree, & King, 2004). People living with this disease are confronted with lifestyle modifications that require daily attention to a myriad of self care behaviors and health practices. Adherence to these self care recommendations can prevent the devastating complications that are associated with diabetes (UKPDS Group, 1998; Stratton, Adler, Neil, et al., 2000). Though knowledge plays an important role in the self management of diabetes, education alone does not ensure adherence to life-long behavior changes (Norris, Lau, Smith, Schmid, & Engelgau, 2002; Krichbaum, Aarestad, Buethe, 2003). It is recognized that additional research is needed to understand barriers and facilitators to behavior change. Studies have identified that people with diabetes have worries about their disease and specific sources of worries include worries about being able to carry out family responsibilities in the future, worries about their financial future, worries about weight, and worries about risk for hypoglycemia (Peyrot, Rubin, Lauritzen, Snoek, Matthews, & Skovlund, 2005). Investigation into the effects of worry on health has focused primarily on worry's motivational properties and little is known about how worry impacts self management adherence in the diabetic population. The purpose of this study was to investigate the relationship between worry, self efficacy and adherence to self management recommendations in the API diabetic population. An analysis of data previously collected from a two arm randomized controlled intervention trial (ENHANCE project) was undertaken to answer the research questions. The findings of this study suggest that levels of and types of worry have an effect on self efficacy and on self management adherence. Social worries had a direct effect on self efficacy and positively moderated self efficacy's impact on self management adherence. Disease specific worries had a negative direct effect on self efficacy and negatively moderated self efficacy's effect on adherence. In addition, our study supported the understanding that worry perception and impact may differ among ethnic groups. The Hawaiian and Pacific Islanders in our study experienced less worries as measured by our social worry tools than the Asian participants.

The Lived Experience of Remorse Among Male, Adolescent Offenders: A Phenomenological Inquiry

Wolff, Kathleen — Sat, 01 Jan 2011 00:00:00 GMT

Remorse continues to play an important role in the legal system and in offender rehabilitation; yet, it remains an understudied concept. Research related to remorse at the phenomenological level is sparse and studies that focus on youthful offenders are nearly non-existent. The purpose of this study was to describe the essence of the lived experience of male, adolescent offenders, who have experienced the phenomenon of remorse in the context of their crimes. Colaizzi‟s descriptive, phenomenological approach to inquiry and analysis guided this qualitative study. Narratives from in-depth, semi-structured interviews with 13 male, African American and European American, ages 16-18 year-old offenders placed in privately owned Residential Treatment Programs served as data. Eight clusters of themes and 18 themes emerged from the data and provided rich descriptions of the remorse experience among this population. Findings supported the positive and negative aspects of remorse noted in the literature. Implications for future nursing research, nursing practice, and policy were provided.

Assessing the Relationship Between Transition to Motherhood, Early Mother-Infant Interaction, Stress, and Social Support Among Taiwanese First-Time Mothers

Tsai, Shiow Meei — Sat, 01 Jan 2005 00:00:00 GMT

Transition to motherhood is referred to as change in the new role and relationship during women's developmental stages. Difficult transitions may cause problems in the mother-infant relationship and influence the acceptance of this role. The purpose of this study was to investigate transition to motherhood as it relates to early mother infant interaction, stress and social support of first time Taiwanese mothers, and to determine other maternal characteristics related to transition to motherhood. Purposive sampling was used to recruit 63 first-time postpartum mothers between ages of 18 to 35 who intended to breastfeed their infants. The subjects were recruited from a maternity unit of one medical center in south of Taiwan between year 2004 to year 2005. Four major instruments were used to collect the data: Revised What Being the Parent of a Baby is like Questionnaire, The Nursing Child Assessment Scale, The Perceived Stress Scale and The Interpersonal Support Evaluation List. The first administration of all questionnaires was conducted and the feeding interaction was observed and scored on the postpartum day during hospitalization (Time 1). After observation, immediate feedback regarding their feeding interaction including positive feedback and suggestions were given to all participants by the investigator. The second administration of all questionnaires was conducted at 4 weeks postpartum (Time 2). The last administration of all questionnaires was mailed to participants at 4 months postpartum (Time3). T-test, analysis of variance, Pearson Correlation and stepwise multiple regression were utilized to analyze the data. Findings indicate that first- time mothers with lower perceived stress and longer breastfeeding had an easier transition process to motherhood. During this transition, social support mediates the effect of perceived stress. The data fit the model and explained 42 % of the variance in transition to motherhood. Up to 29 % of variance was explained by perceived stress and of 13 %was explained by the length ofbreastfeeding. The study provides a knowledge base for further research on transition to motherhood and designing advanced educational program for new parents and clinical practice is required. Key words: transition, motherhood, mother-infant interaction, stress, social support.

Infant Passenger Restraint Education Study

Tessier, Karen — Mon, 01 Jan 2007 00:00:00 GMT

This study evaluates whether a hands-on educational intervention makes a significant difference in the proper use of an infant passenger restraint by a parent. The sample was chosen from parents who were at least seven months pregnant and who planned to transport their infants in passenger motor vehicles. Each participant was randomly placed in one of two groups. All participants received a free infant car seat and a standardized education session on the safety and use of infant passenger restraints. The experimental group received an additional component consisting of a hands-on demonstration and return demonstration of correct installation and use in their own vehicle. All hands-on teaching was done by RNs who were nationally certified Child Passenger Safety Technicians. Follow up observations of correctness of use was done by appointment several months after birth using a standardized observation tool. The total sample consisted of 111 parents. There were 56 in the intervention group and 55 in the control group. Participants ranged in age from 19 to 53 years, with the majority in their 30's. Most were women. They were well educated, with above average incomes. A high number were of Asian ethnicity. A total of24 (22%) had correct use. Of these, 18 (32%) were in the intervention group and 6 (11%) were in the control group. The intervention group was 4 times more likely to have correct use than the control group (odds ratio 4.3, P value=0.0074). The number of errors per person was 0 to 7, with most having 0 to 2. The rates of errors were 33% less in the intervention group (ratio of 0.67). There were few serious errors. Secondary variables tested in regression analysis were age, education, income, and help from others. None of these variables was found to have a significant effect on the outcome. The hands-on educational intervention made a significant difference in the proper use of a child passenger restraint by a parent. This study demonstrates the value of hands on teaching for parents to learn how to install and use a child car seat. Everyone who transports a child in a motor vehicle should have access to this type of education. Nurses, physicians, and others working with families should encourage them to seek out this kind of teaching, and should advocate for more programs which offer this service.

Expatriate Japanese Women's Growth and Transformation Through Childbirth in Hawai'i

Taniguchi, Hatsumi — Mon, 01 Jan 2007 00:00:00 GMT

Transition to motherhood is an on-going developmental process that requires adaptation or change in restructuring behavior and role identity. When living in a foreign culture, women's challenges are increased exponentially because of bi-cultural conflicts and the presence of limited support. The purpose of this study was to describe the essential structure of the lived experience of the childbirth experience in Hawaii for expatriate Japanese women who were transitioning to motherhood. The research design was descriptive, using a phenomenological approach reflected in Colaizzi's method. A sample consisted of 10 Japanese expatriate women. Major findings of this study consisted of four Theme Categories: Challenges Living Overseas, Challenges of Motherhood, Reaching the Goal of Motherhood, and Relationship with Others. In the essential structure of the lived experience ofthe childbirth in Hawaii, the expatriate Japanese women experienced difficulties in their childbirth process, but as a result they understood their parents' values and also identified themselves as worthwhile individuals through the separation from family during the childbearing process. The new contribution of this study to nursing knowledge was the importance of family for women giving birth in a foreign country. The results of this study reflected the conceptual orientation, transition: a middle-range theory. The experience provided an opportunity for them to reflect their lives and to find the direction needed for their growth and transformation to successful parents. The women rebuilt the relationships with their husbands and further deepened their marital bonds.

Male Self-Disclosure of HIV-Positive Serostatus to Sex Partners

Sullivan, Kathleen — Sat, 01 Jan 2005 00:00:00 GMT

HIV-positive men face multiple challenges when deciding whether or not to disclose their serostatus to sex partners. This survey design using repeated measures examined disclosure of HIV-positive serostatus to sex partners in an ethnically diverse population of men (N= 93) recruited from the community in O'ahu, Hawai'i. The framework guiding the research was Social Cognitive Theory (Bandura, 1987), with a specific focus on self-efficacy for disclosure decision-making and for negotiating safe sex. The aims of the research were to: 1) describe HIV serostatus disclosure to sex partners; 2) describe self-efficacy for disclosure to sex partners and self-efficacy for negotiating safer sex; 3) determine the relationships between demographic, HIV-illness, drug use history, self-efficacy and sex partner variables (relationship status, serostatus), and self-disclosure, and; 4) determine the relationships between demographic, HIV-illness, drug use history, self-efficacy, sex partner variables, self-disclosure, and condom use by the men in the sample. A convenience sample of HIV-seropositive men was enlisted through both active outreach and passive recruitment (posters and public advertisement). Survey responses were anonymous, as the subject matter being asked was sensitive in nature. Results reveal that self-disclosure to sex partners varied based on sex partner serostatus and relationship status, and was significantly influenced by perceived self-efficacy, by income, education, years since diagnosis and contextual factors including cocaine use before sex. Subjects were least likely to disclose to a sex partner whose serostatus was not discussed. An unknown partner serostatus was also significantly associated with less disclosure. The more committed the relationship, the greater the likelihood that a subject would self disclose. The longer the time since initial HIV diagnosis the more likely a subject was to disclose to sex partners. High self-efficacy scores were associated with self-disclosure, and with condom use. Cocaine use before sex was associated with less disclosure and less condom use. Self-disclosure was significantly associated with condom use as well. Although a causal relationship is not implied, self-disclosure practices did influence safe sex behavior. Implications for nursing and for future research are discussed.

Exploring Healthy Lifestyle Behaviors, Deployment Factors, and Adjustment Among Military Spouses

Suarez, Norma — Sat, 01 Jan 2011 00:00:00 GMT

Background Military family separations have increased significantly in the past decade and military readiness has never been so critical. This can have an impact on the adjustment of military spouses. There have been many interventions to promote the well-being of military spouses, but little, if any, has been documented on the engagement of healthy lifestyle behaviors as a tool for adjustment. Objectives The overall aim of this study is twofold: the first aim is to explore the healthy lifestyle behaviors of military spouses of service members stationed at Fort Hood, Texas. The second aim is to investigate whether healthy lifestyle behaviors, deployment factors, and demographic factors are associated with and predict adjustment in these military spouses. Methods After approval by appropriate channels, study surveys were distributed to military spouses at Fort Hood, Texas. The following instruments were used for data collection: demographic questionnaires including deployment questions, the Healthy Lifestyle Profile II, the Psychological General Well-Being Index, and the Depression, Anxiety, and Stress Scale. Analysis was conducted using SPSS 18.0 for Mac. Results A convenience sample of 158 military spouses who met study criteria completed the study survey. Results of the study indicate that most health-promoting behaviors correlate significantly with adjustment while spiritual growth, health responsibility and stress management predict adjustment. Unfortunately, only a small percentage of military spouses were actively engaged in health-promoting behaviors. Several demographic and deployment variables also correlate highly with adjustment, but after a multiple regression analysis and a multiple analysis of variance, none of these variables were found to predict adjustment. Conclusion The employment of healthy lifestyle behaviors as a coping strategy was found to predict adjustment in military spouses. Therefore, new efforts are needed to promote opportunities for military spouses to engage more frequently in healthy lifestyle behaviors.

Health Related Quality of Life for Children with Cleft Lip and/or Palate

Sinclair, Sandra — Sat, 01 Jan 2011 00:00:00 GMT

A child's health-related quality of life (HRQOL) is a multidimensional, subjective construct that is perceived as a result of the impact that a condition has on the child's physical, emotional, social, and cognitive functioning (WHO, 1995). This study measured HRQOL for a culturally diverse sample of children with cleft lip and/or palate to include parent proxy reports and child self reports. A descriptive quantitative design was utilized. One hundred subjects participated in the study, including 62 parents and 38 children who completed the PedsQL instrument. Results revealed that parents of children with an oral cleft rated their children's Physical Health higher than a normative sample of parents of healthy children which was an unexpected finding. Otherwise, parents of children with an oral cleft and the children themselves rated their Emotional Functioning, Social Functioning, School Functioning, overall Psychosocial Functioning, and Total HRQOL lower than healthy children and higher than children with a chronic condition. Parent-child concordance was quite low in all domains with the highest correlation being only .20 on the Emotional Functioning scale. Demographic variables, speech impairment, and hearing severity did not affect HRQOL scores. Wearing a hearing aid had a significant affect on School Functioning according to the parent's perspective. Overall, the PedsQL was found to be an effective and quick measure of HRQOL for children with an oral cleft that could be utilized during the multidisciplinary cleft clinic to identify children who are at-risk for impaired HRQOL. Since parent-child agreement was low, children should be given every opportunity to rate their own HRQOL. Once individual concerns have been identified, health care providers can then implement care and treatment to maximize the child's satisfaction with health and well-being.

Dietary Consumption of Fat, Sugar, Fruits, and Vegetables, Dietary Acculturation and Anthropometric Indicators Among Filipino-Americans in North Carolina

Serafica, Reimund — Sat, 01 Jan 2011 00:00:00 GMT

The role of dietary acculturation and consumption of fat, sugar, fruits, and vegetables among Filipino- Americans (FAs) in the United States (US) remains unclear. Despite the growing numbers of FAs in the US, little is known about their dietary acculturation and fat, sugar, fruits, and vegetable consumption. The purposes of this study were to describe the relationship among demographic variables, level of acculturation, dietary consumption of fat, sugar, fruits and vegetables and dietary acculturation among FAs and to describe the relationships among these variables to their anthropometric measurements. The study sample consisted of 128 FAs (N = 128) residing in North Carolina (NC). The participants were recruited through churches, businesses, events and by word of mouth in Winston-Salem, NC. Participants completed the demographics, the Block’s Short Food Frequency Questionnaire (SFFQ), a Short Acculturation Scale for Filipino Americans (ASASFA), and the Dietary Acculturation Questionnaire for Filipino Americans (DAQFA). Anthropometric measurements such as weight, height, waist and hip circumference were also taken from the participants. Body Mass Index (BMI) and Waist Hip Ratio (WHR) of each participant were also calculated. Changes in weight and waist were also determined by asking the participants if their measurements had changed since their arrival to US. Partial Least Squares (PLS) path modeling was used to explore the predictive relationships between the latent (composite) variables constructed using principal components factor analysis and the indicator (manifest or predictor) variables measured by the researcher. The most important positive predictors of the anthropometric indicators were the Western Scale (path coefficient = .503, p < .05) and the intake of fats and sugars (path coefficient = .282, p < .05). Fruit and Vegetables (path coefficient = -.034), Acculturation (path coefficient = .035), the Filipino Scale (path coefficient = -.086) and Demographic factors (path coefficient = .133) were not significant predictors of the anthropometric measures at the .05 level. The implications were that a high number of food items chosen from the Western Scale, in combination with an increased intake of fat and sugar, predicted a significant increase in BMI, WHR, waist and weight circumference. First generation FAs should be encouraged to decrease their fat and sugar consumption. Less acculturated FAs may also be encouraged to maintain their healthful dietary pattern. Nurses and family nurse practitioners who cater to the FAs may suggest alternative meal options to new FAs who are not familiar with US food selections and choices. Nurses and other healthcare practitioners should consider the positive and negative influences of dietary acculturation in their dietary education for FAs.

A Study to Determine the Effects of Cinnamon on Blood Glucose and Lipid Levels in Person's with Type - 2 Diabetes

Rosado, Julieta — Fri, 01 Jan 2010 00:00:00 GMT

Diabetes is the most common metabolic disease worldwide; one in twenty Americans are affected. This chronic disease can lead to a host of complications including blindness, amputations, stroke, nerve damage, heart disease and kidney failure. Many of these complications can be avoided by maintaining normal blood glucose and lipid levels. Researchers have speculated that certain spices such as cinnamon may help to normalize. The objective of this double blind, placebo-controlled study was to determine whether cinnamon improves blood glucose, triglyceride, total cholesterol, and low density lipoprotein (LDL) cholesterol levels in persons with type-2 diabetes. The population included 40 men and women diagnosed with type-2 diabetes, who had a fasting blood glucose level between 126-300 mg/dl, or a glycosylated hemoblogbin (HgbAlc) level greater than 7% despite metformin treatment for glucose control. The subjects were randomly assigned to a treatment or control group. The treatment group received lgm of the water-soluble extract of cinnamon in capsule form daily. Their fasting blood glucose, total cholesterol, triglyceride, high density lipoprotein (HDL) cholesterol, LDL cholesterol and postprandial glucose levels were measured on days 0, 20, 40, & 60 of the study. Expected outcomes included normalization of all measured blood levels, except HDL cholesterol levels, for which no significant changes were expected. After 40 days of supplementation, fasting glucose levels were similarly decreased in both groups, an 8% decrease was found in the treatment group and a 5% decrease in the control group. Postprandial glucose levels decreased by 3% in both the treatment and control groups. Total cholesterol levels decreased by 4% in the treatment group and by 3% in the control group. LDL cholesterol levels decreased by 12% in the treatment group and by 15% in the control group. Triglyceride levels decreased by 18% in the treatment group and increased by 7% in the control group. HDL cholesterol levels did not change over time in the treatment nor in the control group. No significant differences were found between treatment and control in any of the end points of this study.

Assessing Fruit and Vegetable Intake in an Ethnically Diverse Population

Roark, Randall — Fri, 01 Jan 2010 00:00:00 GMT

Background Studies indicate that the vast majority of adult Americans do not regularly consume recommended daily servings of fruits and vegetables. One major issue with research in this area is how to measure fruit and vegetable intake, especially in ethnically diverse populations. Objectives The specific aims of the study were to a) compare the percentage of participants categorized as regularly consuming five or more („5 or more‟) daily servings of fruits and vegetables using two commonly used instruments, b) assess if percentages varied by race/ethnicity, and c) assess if the different instruments interacted with race/ethnicity. Methods The source for the current study was the Healthy Hawai„i Initiative (HHI) which collected baseline data from adult residents of Hawai„i in 2002. The data used in this study are baseline data from the HHI longitudinal study. „Five or more‟ was calculated using two instruments: a single question instrument and a multi-item food frequency questionnaire (FFQ) 19-item instrument. The latter allowed for variations in how „5 or more‟ was calculated (e.g. not including fried potatoes). Percentages were compared overall and by race/ethnicity. Results The percentage meeting „5 or more‟ criteria varied greatly depending on how „5 or more‟ was calculated ranging from 20.9% with the single question instrument to 60.8% when all items on the multi-item FFQ instrument were used. Caucasians were iii significantly more likely to consume „5 or more‟ than were Japanese and Filipinos. With the single question instrument the results for Filipinos were exceedingly low and inconsistent with results using the multi-item FFQ and with State of Hawai„i survey data for 2002. Female gender and older age were also associated with „5 or more‟ while education was not. No specific food items explained differences by race/ethnicity. Conclusions The percentage of participants meeting „5 or more‟ criteria varied significantly depending on how „5 or more‟ was calculated. Race/ethnicity was significantly associated with „5 or more‟. The single question method for determining „5 or more‟ categorization appeared to interact with race/ethnicity, greatly underestimating intake for some groups relative to Caucasians and therefore it should not be used in studies in Hawai„i.

Mothers' Perspective of How They Relate to Their Young Pregnant Adolescents: An Ethnography

Richardson, Karol — Sat, 01 Jan 2005 00:00:00 GMT

Adolescent pregnancy and birth rates in the United States continue to decline, however, approximately four in ten adolescent girls become pregnant before they reach 20 years old (Kirby, 2001). There is a paucity of research on the perceptions of mothers and how they relate to their young pregnant adolescents (15 years old and younger) during pregnancy. This study describes the attitudes, values, beliefs, and cultural meaning from the mothers' perspective of the relationship with their pregnant daughters. A descriptive design and naturalistic approach (Lincoln & Guba, 1985) was taken to allow the researcher to learn from people rather than to simply study them (Spradley, 1979). Audio taped interviews were conducted using a semi-structured interview guide. A non-random, purposive, convenience sample of five mothers of pregnant adolescents (ages 13 to 15) were recruited and interviewed when their daughters were 30 to 35 weeks gestation. Three cultural themes emerged from the analysis: (1) mothers' relationship with their young pregnant adolescent daughter although somewhat conflicted prior to pregnancy, draws them closer together as the pregnancy progresses focusing on caring for and meeting the needs ofthe pregnancy; (2) reactions of mothers to finding out about the pregnancy have qualities similar to the process of grief/loss; and (3) mothers' advice to parents of preteens/young teens is to keep communication open and teach about sex and birth control, however, ifthe teen becomes pregnant, be there for her. This study confirms previous literature and research about the relationship of mothers and daughters and adds groundbreaking new information about how mothers relate to their young pregnant adolescents during pregnancy. This study adds to nursing science insight into changes in the mother-daughter relationship caused by pregnancy and related issues of parenting a pregnant adolescent. The notion that the mother needs to continue parenting her daughter while she is pregnant is important. Further research needs to be done to explore the needs of mothers of young pregnant adolescent daughters. The risk status of mothers needs to be addressed, practice approaches need to be generated and developmental programs for mothers at risk may need to be created and tested.

Pilot Testing a Paperless Nursing Assessment of Medical, Psychiatric, and Addiction Treatment and Re-entry Needs Among Women at Jail Intake

Palazzo, Michael — Fri, 01 Jan 2010 00:00:00 GMT

This research was a pilot study at improving the medical, psychiatric and addiction care provided to women detainees at the jail. Few studies have been completed with women atjail intake, yet the population is suspected of having a multitude of medical, psychiatric and addiction in jail treatment and community reentry needs. Utilizing a descriptive, cross-sectional survey design, the following aims were completed for this pilot study: documented the creation of a nursing research infrastructure within a large jail; compared the results of the traditional 16- item paper and pencil Intake Service Center Screen with the 8-item paperless Brief Jail Mental Health Screen obtained via Audio Computer Assisted Self Interviewing (ACASI) technology; compared Addiction Severity Index scores and addiction treatment motivation and readiness scores obtained via ACASI technology with normative data; assessed the frequency of HIV risk behaviors and the medical, psychiatric and addiction treatment needs obtained via ACASI technology; while assessing the frequency and the average length of time for screening by providers at the jail via medical chart review. The results showed that the ACASI technology proved to be more effective than paper and pencil methods. This technology not only assessed detainee treatment needs, but simultaneously created reentry/discharge plans. The study demonstrated that HIV risk behaviors and the prevalence of past suicide attempts were high among the participants. The Addiction Severity Index scores and the Circumstance Motivation and Readiness scores demonstrated that methamphetamine addiction, and mental health severity is high among this population however motivation and readiness for treatment arc low. Therefore, recommendations for the most suitable jail psychiatric Advanced Practice Registered Nurse candidates could be given as a result of the study. This study was the first phase at improving the medical, psychiatric and addiction care provided to detainees at the jail. In future phases of this study more valid and reliable assessment tools and treatment planning aimed at reduced recidivism rates will be established. Future phases will build on the lessons learned here about working with security staff, collaborating with experienced researchers in the community, and seeking advice from the Department of Justice recognized experts.

The Development and Testing of the Life Sustaining Treatment Attitude Questionnaire (LSTAQ)

Misola, Jane — Fri, 01 Jan 2010 00:00:00 GMT

Purpose: To develop and test the validity and reliability of the Life Sustaining Treatment Attitude Questionnaire (LSTAQ), a survey instrument to elicit family member decision-maker attitudes toward life sustaining treatments for the critically ill at end of life. Background: Attitudes toward life sustaining treatments (LST) have been shown to influence decision-making at end of life (EOL). A reliable and valid tool to elicit attitudes specifically from family member decision-makers may help healthcare professionals facilitate decision-making during serious illness at end of life. Methods: A 33-item LSTAQ instrument was tested in 170 adults. Construct validity was evaluated by exploratory factor analysis. Correlations established convergent and discriminant validity. Reliability testing for internal consistency was assessed by Cronbach's alpha and corrected split half reliability coefficients. All procedures were done with Statistical Package for Social Sciences (SPSS version 18) software (SPSS Inc., Chicago, 111). Results: A 30-item final LSTAQ tool was derived from this study. Principal components factor analysis extracted six factors explaining 62.7% of variance. Correlations with a similar tool supported convergence (r = .72, ? <.01). Discriminant validity was confirmed by the absence of significant correlation with the dissimilar tool. LSTAQ internal consistency was good (Cronbach's alpha = .92). A preliminary exploration of differences in LSTAQ scores by ethnicity revealed a sampling size and distribution that was not optimally responsive to detection of ethnic differences. Conclusion: The LSTAQ is a reliable and valid tool to elicit LST attitudes specifically from family member decision-makers. The knowledge gained may help healthcare professionals promote interventions that facilitate family decision-making on life support for the ill relative at end of life. This might help reduce decision difficulties that cause preventable discomfort, unnecessary treatment and prolonged suffering for the terminally ill patient, as well as avoidable distress among family members involved in decisions for the sick relative.

Exploring the Lived Experience of Individuals With Acute Infections Transitioning in the Home With Support by an Advanced Practice Nurse Using Telehealth

Marineau, Michelle — Sat, 01 Jan 2005 00:00:00 GMT

The use oftelehealth in individual's homes is increasing in the United States in an effort to cut cost by limiting admissions to hospitals and/or reduce length of stay. This increase has not been driven by conclusive research findings in support of this technology; furthermore, the majority of research conducted has been in the area of chronic disease management. It is important to expand the knowledge base related to transitioning from an acute illness in the home with telehealth from the individual's perspective. Due to the lack of empirical data available, phenomenology was used to explore the individual's perceptions in the use of this new health care delivery model. In exploring this new phenomenon, eidetic phenomenology was used to capture the essential structure of the lived experience as told by individuals who had been enrolled in a pilot quantitative telehealth study over the past two years. The purpose of this study was to describe the "lived experience" of individuals with acute infections transitioning in the home with support by an advance practice nurse (APN) using telehealth in an effort to avoid a hospitalization or to promote an earlier discharge. Purposeful sampling was used to enroll the sample often participants. Major findings of this study consisted of three Theme Categories: Initial Response, Engaging in Care, and Experiencing the Downside. The essential structure as it relates to the health/illness transition that occurs when an individual with an acute infection is discharged from the hospital to the home supported by telehealth technology revealed an overall positive experience from the ten participants. There was one negative experience in a participant who had two separate telehealth enrollments. This knowledge adds valuable information to future health care providers from the individual's perspective as it relates to understanding the transitional process that occurs with an acute illness from the hospital to the home with support by an APN using telehealth.

Mana From Heaven: The Essential Structure of the Lived Experiences of Nurse-Midwives with the Concept of Spirituality in Childbirth A Phenomenological

Linhares, Carmen — Mon, 01 Jan 2007 00:00:00 GMT

Spirituality is a subject of growing interest and relevance in health care. Yet, very little research has been done relating to health and spirituality in general, and even less research specifically relating to midwifery, childbirth, and spirituality. The purpose of this study was to describe the essential structure of the lived experiences of midwives who said they have experienced the phenomenon of spirituality when they have attended childbirths. The research design was descriptive, using a transcendental phenomenological approach reflected in Clark Moustakas' model. Purposive and snowball sampling were used to recruit the sample of 10 female certified nurse- midwives. The major findings of this study consisted of five Theme Categories: Belief in the Existence of a Higher Power, The Essence of Spirituality, Birth is Spiritual, The Essence of Midwifery, and Relationships. The results added new knowledge from the themes described in all five of the theme categories. The midwives interviewed for this study validate the assumption that spirituality is an integral and essential component of childbirth. The midwives described in detail, what the meaning of spirituality was for them, how they had experienced it, how it affected their personal lives, their practices, and their calling to midwifery. The midwives had experienced spirituality when attending childbirth, and used elements of spirituality as instruments that helped them to assist their patients. Spirituality also helped to foster the relationships between the midwives and the birthing families. The midwives revealed their dependence on spirituality and a belief in a Higher Being who guided their lives and their work as midwives.

Predictors of Non-Adherence to Oral Chemotherapy in Children with Acute Lymphoblastic Leukemia

Landier, Wendy — Fri, 01 Jan 2010 00:00:00 GMT

Overall survival for pediatric patients with acute lymphoblastic leukemia (A.L.L.) treated with contemporary therapy now exceeds 85%; however, approximately 20% will experience relapse. Since A.L.L. is the most common malignancy in children, relapsed patients comprise a large proportion of the total number of children with cancer. The prognosis for long-term survival following relapse is generally poor; thus, relapsed A.L.L. is a significant contributor to cancer-related mortality in children. Poor adherence to oral medication is a substantial problem in contemporary health care and may contribute to unexplained relapses in children with A.L.L. Therapy for pediatric A.L.L. includes a prolonged “maintenance” phase that requires daily 6- mercaptopurine (6MP), a self- or parent/caregiver-administered oral chemotherapy agent given for approximately two years. 6MP has been shown to be a critical component of the curative regimen for A.L.L.; thus, children with A.L.L. who fail to adhere to oral 6MP chemotherapy as prescribed may be at increased risk of leukemia relapse. This study used extant questionnaire data from a cohort of children with A.L.L enrolled on a Children’s Oncology Group study (AALL03N1) to determine the prevalence of self/parent-reported non-adherence to oral 6MP during the maintenance phase of A.L.L. therapy, and to identify sociodemographic and behavioral predictors of non-adherence to oral 6MP. Twenty-two percent of children in the cohort were non-adherent to oral chemotherapy, defined as missing more than one dose of 6MP for non-medical reasons over the 112-day observation period. The risk of non-adherence was significantly increased for those who failed to perceive the severity of the child’s illness (Odds ratio [OR] 1.89, 95% Confidence Interval [CI] 1.00-3.55, P=0.049) or the benefits of treatment with oral 6MP (OR 1.78, 95%CI 1.07-2.94, P=0.025). Vulnerable subgroups included Hispanic ethnicity (OR 2.25, 95%CI 1.30-3.90, P=0.004) and older age (OR 1.07 per year, 95%CI 1.02-1.12, P=0.005). Study findings suggest that even occasional reports of missed 6MP doses may herald a significant adherence problem; that patients and their parents may need ongoing reminders regarding the subclinical and asymptomatic nature of leukemia in remission; and that frequent review with families regarding the purpose, function, and proper administration of oral 6MP is imperative.

Expanding Asthma Awareness in Adolescents: A Pilot Investigation

Knight, Diane — Sat, 01 Jan 2005 00:00:00 GMT

Asthma is the most common chronic childhood disease (National Center for Health Statistics, 2004). In Hawaii, 28,600 children (9.7%) currently have asthma (State of Hawaii Department of Health, 2004). This study was designed to expand asthma awareness among freshmen students at a private high school in Hawaii through informative training sessions integrated into the mandatory Physical Education (PE) class and supportive coaching for students with asthma. Of 430 freshmen at the high school study site, 83 had asthma. A pre/posttest quasi-experimental design was utilized to assess enhanced knowledge after the intervention. Nearly 400 part-Hawaiian male and female students, aged 13-15, participated in the asthma training intervention. The study enrolled 270 students. Fifty-six students with asthma participated in the asthma coaching session. Participants with asthma were classified by national guidelines as mild intermittent to moderately severe. All participants completed the Asthma General Knowledge Questionnaire before and after a training session presented in PowerPoint format. Scores were analyzed by paired t-tests. Only students with asthma participated in small group coaching sessions utilizing a PowerPoint presentation specifically tailored for adolescents. These participants completed the Pediatric Asthma Quality of Life Questionnaire before the session, then again three months after the session. Scores were analyzed using paired t test and descriptive statistics. Asthma training significantly increased general asthma knowledge scores (p :S 0.001). Although asthma coaching improved the frequency of controller medication for 50% of the students (n=lO), the increase was not statistically significant. Self management improvements and quality of life scores differences were also not statistically significant. These results may be due to the small sample size and short study duration. For an adolescent population where the rate of asthma is nearly 20%, providing asthma training to the entire group was demonstrated to be an effective means of increasing asthma awareness. Asthma education offered in a peer group setting demonstrates an innovative intervention modality that is culturally and developmentally sensitive to the adolescent population. Further study is needed over a longer time period to explore avenues to improved self-management skills and enhanced quality of life for adolescents with asthma.

Factors Influencing Osteoporosis Preventive Behavior Among Hakka

Hsieh, Ching-Hsing — Sun, 01 Jan 2006 00:00:00 GMT

There are about 4000 new hip fracture patients in Taiwan each year, and osteoporosis is the number one cause for these fractures. But, there has been no research article related to osteoporosis preventive behavior among Hakim living in countryside in Taiwan. Therefore, the purposes of this study were to assess osteoporosis preventive behavior; to measure the relationship among factors influencing OPB; to measure a model of factors influencing OPB; and to predict the direct and indirect effects of personal and social factors on OPB among Hakka living in Taichung County in Taiwan. The development of a theoretical model of factors influencing osteoporosis preventive behavior was based on the Social Cognitive Theory (Bandura, 1986, 1997, 2004) and the conceptual framework for addressing the social context of health behavior (Sorensen et al., 2003). According to the reviewed literature, the factors influencing osteoporosis preventive behavior include personal factors (age, educational level, self efficacy for calcium intake, self-efficacy for exercise, and knowledge of osteoporosis); and social factors (social support and social capital). The outcome variables are calcium intake and exercise. This was a non-experimental, cross-sectional design. Convenience and snowball sampling were used in this study. In all, 243 participants were recruited. Path analysis was used to assess and modify the theoretical model and to test all the paths between exogenous variables and endogenous variables. The goodness-of-fit indicators ofthe final model showed that X2 was 26.99 with 21 degrees of freedom; the P-value for this model was .17; goodness-of-fit index (GFI) was .98; adjusted goodness-of-fit index (AGFI) was .95; normed fit index (NFI) was .96; non-normed fit index (NNFI) was .98; and comparative fit index (CFI) was .99. The results suggested that the final model fit the data well. The final model demonstrated that the personal factors and environmental factors directly and indirectly influenced osteoporosis preventive behavior. It may provide guidance for the design of future nursing interventions, research and education related to osteoporosis prevention.

Clinical Nurses' Perceptions of Nursing Informatics Competencies

Hobbs, Steven Douglas — Mon, 01 Jan 2007 00:00:00 GMT

This is a descriptive study undertaken to identify competencies and supporting knowledge and skills in informatics perceived to be necessary by nurses for nurses engaged in clinical practice. This study applied a non-experimental, descriptive research design to a quantitative survey performed through web-based technology. Based upon the foundational work of Staggers, Gassert, and Curran (2001, 2002), the goal was to substantiate with clinical nurses and their direct nurse supervisors the clinical competencies that Staggers' identified for Beginning and Experienced clinical nurses through a Delphi methodology of nursing experts. All study facility Registered Nurses received an e-mail inviting their participation. Respondents logged on to a website and completed sections applicable to their situation; that is Beginning Nurse, Experienced Nurse, or Nurse Supervisor. Reminder emails were sent at two and four weeks after the initial invitation. Respondents who accessed and completed the survey received a $5.00 food coupon redeemable at the hospital facilities. All of the knowledge, attitudes and skills identified were supported as valuable, that is, a mean score greater than neutral. Value ranged from just above neutral to strongly agree. Factor analysis generally supported categorization; however, many items did not load into the anticipated categories. Categorization is one area which deserves further study.