Clinical Nursing Research current issue

Lessons Learned, Rewards Received

Cacchione, P. Z. — 2008-07-10

Denial and Compliance in Adults With Asthma

McGann, E. F., Sexton, D., Chyun, D. A. — 2008-07-10

A descriptive study examining the relationship of denial of illness and compliance with inhaled controller asthma medications is conducted with 51 adults taking inhaled asthma controller medications. Affective and cognitive denial are assessed with the Levine Denial of Illness Scale. Severity is determined by portable spirometry; compliance is measured for 2 weeks with DOSER, a microelectronic monitor. The mean percent compliance rate for inhaled controller medications is 36%, with only 10.4% of the participants demonstrating optimal compliance (>80%). Although cognitive denial is not significantly associated with compliance, those in the suboptimal compliance group do have significantly higher information avoidance subscale scores (M = 1.88; p = .02). Affective denial is inversely correlated with compliance (r = —.31; p = .05) and is significantly higher in the suboptimal compliance group (M = 11.51; p =.05). These study findings suggest that affective denial may be a contributor to suboptimal compliance.

Commentary by Luyster

Luyster, F. — 2008-07-10

Peak Flow Values by Gestation in Women With Asthma

Beckmann, C. A. — 2008-07-10

Asthma is one of the most common medical complications of pregnancy. Asthma control is associated with improved perinatal outcomes. Peak flow measures have been recommended to determine the status of asthma, yet norms for peak flow values in women with asthma are missing from the literature. The purpose of this study was to determine average peak flow values in pregnant women with asthma. Forty-three women were recruited into the study prior to the 20th week of pregnancy. Demographic data, including age, ethnic background, and number of pregnancies, were collected. Type and severity of asthma, medications used for asthma, and past hospitalizations for asthma were recorded. Peak flow values increased across the three trimesters. Significant differences were found in peak flow values between the first and third trimesters (>.001) and the second and third trimesters (>.007). Findings from the present study contradict those of studies on pregnant women without asthma.

Impact of Telehealth on Clinical Outcomes in Patients With Heart Failure

Dansky, K. H., Vasey, J., Bowles, K. — 2008-07-10

The purpose of this randomized field study was to determine the effects of telehomecare on hospitalization, emergency department (ED) use, mortality, and symptoms related to sodium and fluid intake, medication use, and physical activity. The sample consists of 284 patients with heart failure. The authors used logistic regression to study the effects of telehomecare on health services utilization and mortality and a general linear model to analyze changes in self-reported symptoms. On average, patients in the telehomecare groups had a lower probability of hospitalizations and ED visits than did patients in the control group. Differences were statistically significant at 60 days but not 120 days. Results show a greater reduction in symptoms for patients using telehomecare compared to control patients. The technology enables frequent monitoring of clinical indices and permits the home health care nurse to detect changes in cardiac status and intervene when necessary.

Patients' Perceptions of Hospital Discharge Informational Content

Maloney, L. R., Weiss, M. E. — 2008-07-10

Ensuring that patients' informational needs have been met prior to hospital discharge sets the stage for successful self-management of recovery at home. This secondary analysis study aims to identify differences in the amount of discharge teaching content needed and received by adult medical-surgical patients on the basis of their sociodemographic characteristics and hospitalization-related factors. The Quality of Discharge Teaching Scale (QDTS) is used to measure patients' perceptions of the amount of discharge-related informational content they needed and received. Eighty-nine percent of patients receive more informational content than they perceived they needed. Nonwhite patients report more content needed than White patients. Patients with prior hospitalizations and cardiac patients report greater amounts of content received. The QDTS content subscales provide a mechanism for assessing patient perceptions of discharge informational needs and discharge content received that can be used for clinical practice and quality monitoring.

Care Dependence: A Struggle Toward Moments of Respite

Eriksson, M., Andershed, B. — 2008-07-10

The purpose of this study was to describe people's experiences of being dependent on others for care in their final stage of life, as well as what they felt made their experience of being dependent easier or more difficult. The phenomenological-hermeneutical method was chosen, where data collection consisted of open-ended interviews with nine people undergoing palliative care at a hospice unit or at home. The meaning of being care dependent is described via the following themes: changed relationship with oneself and with others, striving to adapt oneself to the situation, obstacles, and opportunities along the way while dependent. The result is described as an effort, a journey from independence to moments where it was possible to rest and recuperate while struggling with care dependency. Nursing staff require knowledge and understanding of experiences with care dependency to make life easier for people during increasing dependency in the final stage of life.