Clinical Nursing Research recent issues

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.

The State of Evidence-Based Practice

Wood, M. J. — 2008-04-02

Effect of a Noise Reduction Program on a Medical-- Surgical Unit

Taylor-Ford, R., Catlin, A., LaPlante, M., Weinke, C. — 2008-04-02

This quasi-experimental study tested an intervention to reduce sound levels in an acute care hospital. A parallel pre- and posttest design with control group was used; patients and employees completed the Topf Adapted Sound Disturbance Scales, and environmental sound levels were recorded on a Quest 2900 Sound Level Meter. Treatment interventions included an educational PowerPoint presentation for employees, minor environmental acoustical alterations, and the use of a Quest 261 Sound Detector/Controller for behavioral modification. None of these interventions produced statistically significant changes in sound levels. Patients and employees reported slightly less disturbance due to noise postintervention on the treatment unit. The findings of this study support Philbin and Gray's suggestion that the use of sound-absorbing materials in the hospital's physical structure may be the most effective measure to reduce sound levels in the hospital setting.

Use of Electronic Monitoring in Clinical Nursing Research

Ailinger, R. L., Black, P. L., Lima-Garcia, N. — 2008-04-02

In the past decade, the introduction of electronic monitoring systems for monitoring medication adherence has contributed to the dialog about what works and what does not work in monitoring adherence. The purpose of this article is to describe the use of the Medication Event Monitoring System (MEMS) in a study of patients receiving isoniazid for latent tuberculosis infection. Three case examples from the study illustrate the data that are obtained from the electronic device compared to self-reports and point to the disparities that may occur in electronic monitoring. The strengths and limitations of using the MEMS and ethical issues in utilizing this technology are discussed. Nurses need to be aware of these challenges when using electronic measuring devices to monitor medication adherence in clinical nursing practice and research.

Health-Related Hardiness in Individuals With Chronic Illnesses

Brooks, M. V. — 2008-04-02

The aims of this study were to (a) describe health stressors, health-related hardiness, perception of illness impact, self-perception of health status, and psychosocial adjustment to illness in individuals living with an inherited bleeding disorder; (b) determine relationships between health stressors, health-related hardiness, perception of illness impact, self-perception of health status, and psychosocial adjustment to illness; and (c) determine if perception of illness impact had a direct and/or mediating effect on the relationship between health stressors, health-related hardiness, and self-perception of health status and psychosocial adjustment to illness. A cross-sectional survey design was used. Sixty participants composed the sample. Participants completed five questionnaires. Higher health stressors were associated with higher perception of illness impact, lower perception of health status, and poorer psychosocial adjustment to illness. Individuals with higher perception of illness impact were associated with lower self-perception of health status and poorer psychosocial adjustment to illness.

Spirituality: A Cultural Strength for African American Mothers With HIV

Polzer Casarez, R. L., Miles, M. S. — 2008-04-02

The purpose of this study was to describe how spirituality affected the lives of African American mothers with Human Immunodeficiency Virus (HIV) in the context of coping. This qualitative descriptive study used secondary data of interviews from a larger longitudinal study of parental caregiving of infants seropositive for HIV. Participants were 38 African American mothers with HIV. Data from longitudinal semi-structured interviews were analyzed using content analysis. The women dealt with the stresses of HIV through a relationship with God. Two domains explain this relationship: God in control and God requires participation. The benefits of their relationship with God were a decrease in stress and worry about their own health and that of their infants. It is important for nurses working with mothers with HIV to acknowledge their spirituality and assess how spirituality helps them cope with and manage their illness.

Mixed-Methods Exploration of Parents' Health Information Understanding

Lehna, C., McNeil, J. — 2008-04-02

Health literacy—the ability to read, understand, and use health information to make health care decisions—affects health care outcomes, hospitalization costs, and readmission. The purpose of this exploratory mixed-methods study is to determine how two different parent groups (English speaking and Spanish speaking) understand medical care for their children and the procedural and research consent forms required by that care. Quantitative and qualitative data are gathered and compared concurrently. Differences between groups are found in age, grade completed, Short Test of Functional Health Literacy in Adults scores, and ways of understanding health information. Identifying how parents understand health information is the first step in providing effective family-centered health care education.

Interprofessional Nursing Research: Lost in Translation?

Cacchione, P. Z. — 2008-01-09

Physiological Correlates of HIV-Related Fatigue

Barroso, J., Pence, B. W., Salahuddin, N., Harmon, J. L., Leserman, J. — 2008-01-09

Our primary aim is to describe the relationship of multiple physiological variables and HIV-related fatigue. We report baseline data collected from 128 human immunodeficiency virus (HIV)-positive individuals. The HIV-Related Fatigue Scale was used to measure several aspects of fatigue. Blood was drawn for the following physiological variables: hepatic function, thyroid function, HIV viral load, immunologic function, gonadal function, hematologic function, serum cortisol, and cellular injury. In bivariable analyses, free testosterone (p = 0.03) and CD8 (p = 0.07) were negatively correlated with fatigue intensity, and nonlinear relationships were observed between fatigue intensity and total testosterone (p = 0.02), thyroxine (p = 0.01), hematocrit (p = 0.06), and total bilirubin (p = 0.06). However, none of these associations persisted in multivariable models. It is possible that fatigue suffered by seropositive people is better predicted by other variables, which must be better understood to develop interventions to successfully ameliorate HIV-related fatigue.

Health Risk Characteristics of Black Female Informal Caregivers on Welfare

Rice, M. C., Wicks, M. N., Martin, J. C. — 2008-01-09

This exploratory study examines differences in health risk characteristics and perceived health by caregiver status in two groups of Black women, 37 informal caregivers and 20 noncaregivers, transitioning from welfare to work. Health risk characteristics were assessed with the Center for Epidemiologic Studies Depression Scale and Healthier People Network Health Risk Appraisal—Version 6. Body mass index (BMI) calculations were based on the standard Centers for Disease Control formula. Perceived health status was assessed using a single-item Cantril ladder. Results show no statistically significant between-group differences in perceived health status, depressive symptoms, frequency of lifestyle behaviors, or BMI. Clinically significant proportions of participants in both groups rated their health as poor or fair; reported mild to severe depressive symptoms; smoked cigarettes; did not perform monthly self-breast exams; were physically inactive, overweight, or obese; and consumed high-fat diets. Black women receiving welfare show increased risk for premature chronic health problems, which warrants development of effective community-based risk-reduction programs.

Women's Experience of Spirituality Within End-Stage Renal Disease and Hemodialysis

Tanyi, R. A., Werner, J. S. — 2008-01-09

The purpose of this descriptive, phenomenological qualitative study is to describe women's lived experiences of spirituality within end-stage renal disease (ESRD) and hemodialysis. The purposive volunteer sample of 16 women regularly attended two outpatient dialysis centers in a large Midwestern city. Audiotaped, transcribed interviews were analyzed using Colaizzi's method. These women affirmed that spirituality was extremely important in living with their illness and necessary treatment regime. Four major clusters of themes pertaining to the women's spiritual experience within their illness emerged: acceptance, understanding, fortification, and emotion modulation. Findings show that spirituality is of great importance in living with ESRD while receiving hemodialysis and suggest that spirituality may be a significant consideration in nursing and interdisciplinary health care. These findings may be used to improve holistic nursing practice and education in related areas.

Bed and Toilet Height as Potential Environmental Risk Factors

Capezuti, E., Wagner, L., Brush, B. L., Boltz, M., Renz, S., Secic, M. — 2008-01-09

Seat height that is too high (> 120% of lower leg length [LLL]) or too low (< 80% of LLL) can impede safe transfer and result in falls. This study examines the difference between LLL of frail nursing home residents and the height of their toilets and beds in the lowest position, compares the patient or environmental characteristics of those able to transfer from the bed or toilet to those who cannot, and determines the relationship of patient or environmental characteristics to bed-related falls. A retrospective observational design using secondary data from 263 nursing home residents finds that bed height of three fourths of participants was greater than 140% of LLL, whereas toilet height of more than half was 100% to 120% of LLL. Increased fall risk is associated with increased age, shorter length of stay, normal lower extremity range of motion, less cognitive impairment, more behavioral symptoms, and no complaints of pain during exam.

Clinical Nursing Research: An International Journal?

Wood, M. J. — 2007-11-08

Breast Cancer Survivors: Information and Support After Treatment

Cappiello, M., Cunningham, R. S., Tish Knobf, M., Erdos, D. — 2007-11-08

Women living with and beyond breast cancer have special health care needs. Persistent physical and psychological symptoms such as fatigue, pain, sleep disturbances, and fear of recurrence as well as quality-of-life outcomes have been described in women during and after breast cancer. Much less information exists on the experience of women completing treatment. This study describes the information and support needs of women following breast cancer treatment. A semistructured interview guide designed by the research team was used to gather data. Major findings indicate that women continue to experience a variety of physical and psychological symptoms and have concrete information and support needs following therapy, including the need for information on persistent treatment effects, emotional distress, and lifestyle changes. Findings illustrate that there is need to provide comprehensive information and support to help women transition from breast cancer therapy. Additional research is needed to optimize approaches to providing posttreatment care.

Commentary by Arnaert

Arnaert, A. — 2007-11-08

Response by Cunningham and Knobf

Cunningham, R. S., Tish Knobf, M. — 2007-11-08

Mediational Models of Health Practices in Early Adolescents

Mahon, N. E., Yarcheski, A., Yarcheski, T. J., Hanks, M. M. — 2007-11-08

The purpose of this study was to examine the relationship between social support and positive health practices in early adolescents and to test two variables, depression and optimism, that mediate this relationship. The final sample included 128 adolescents, ages 12 to 14, who responded to instruments measuring social support, depression, optimism, and positive health practices in classroom settings. Correlational analysis supported the five hypothesized relationships. A series of regression analyses indicated that depression and optimism each were weak mediators of the relationship between social support and positive health practices. The application of findings to nursing is addressed, using the ACE Star Model for evidence-based practice.

An Evaluation of a Monitoring System Intervention: Falls, Injuries, and Affect in Nursing Homes

2007-11-08

This project assessed the extent to which modern technology (Vigil) can augment or substitute for direct staff intervention in nonacute late-evening and nighttime situations in a nursing home setting. Vigil was implemented for dementia residents of a special care unit (SCU) in a large nursing home. An SCU matched in terms of unit-wide case mix and cognition was used for comparison. Results showed that there was no significant reduction in falls and injuries, but there was a significant improvement in affective disorder in the intervention group as contrasted with the comparison group. There was no significant increase in staff-perceived burden, despite the significant increase in the amount of direct care time logged. Additional time spent in staff care was significantly related to decreased affective disorder. The findings related to Vigil are generally mixed. The question remains as to whether the improvement in affect was due to Vigil or vigilance.

Assessing Cognitive Capacity for Participation in a Research Study

Nokes, K. M., Nwakeze, P. C. — 2007-11-08

To give informed consent in research, persons must be mentally capable of understanding the study, risks, and benefits. An objective screening tool may assess cognitive capacity better than brief conversations or clinician input. The purpose is to explore the validity of the Mental Alternations Test (MAT) to assess the cognitive capacity of older (ages 50 years +) HIV+ persons (N = 81). Descriptive correlational quantitative method was used. About 12% of the sample was cognitively impaired. Contrary to expectations, primary language was the only variable with a significant relationship with the MAT (r = -.22, p = .02); there were no significant relationships between the MAT and age, education, alcohol, smoking, injection drug use, street or mind-altering drug use, physical functional status, depressive symptoms, comorbidities, or being diagnosed with AIDS. Our findings suggest caution in using the MAT as an instrument for assessing cognitive impairment in a linguistically diverse population.

Percutaneous Endoscopic Gastrostomy Feeding in Nursing Homes: Relatives' Perceptions

Brotherton, A. M., Carter, B. — 2007-11-08

The aim of this study is to explore the experiences of relatives of nursing home residents receiving percutaneous endoscopic gastrostomy feeding. Qualitative methodology using semistructured interviews explores the experiences and perceptions of eight relatives. Data are analyzed using thematic analysis. Four themes are constructed from the data: dependence and resulting disempowerment, having minimal or no involvement in the decision-making process for PEG placement, betrayal, and the losses associated with the social aspects of eating. There is a need for professional education about the psychosocial implications of feeding and an increased level of support for relatives to assist them to develop coping strategies. This will require an expansion of current professional roles to include assessment of individual need, setting of appropriate goals, and the coordination of the provision of multiagency services, likely to include counseling and social support. Further research is required in this field to inform service developments.