Clinical Nursing Research recent issues

Puerto Rican Women's Perceptions of Heart Disease Risk

Thu, 08 Oct 2009 13:41:38 PDT

Women frequently fail to recognize that coronary heart disease (CHD), not breast cancer, is the primary cause of female mortality. CHD mortality among U.S. mainland Puerto Rican (PR) women is second only to African American women. It is unknown what PR women understand about their risk, what factors they believe contribute to CHD, or whether they know the atypical symptoms often experienced by women. Most CHD studies exclude Hispanic women. Those that do often aggregate their results, making subgroup variations invisible. This study explored awareness of CHD symptoms, risks, and help-seeking behaviors among 12 PR women. Focus group methodology revealed that participants were unaware of their risk and had misconceptions about CHD symptoms and contributing factors. Barriers to early recognition and treatment included lack of knowledge, gender role conflict (caregiver vs. care recipient), and fears of falsely alarming family members or the embarrassment of feeling "dismissed" by health care providers.

Patient Demographics and Learning Needs: Examination of Relationship

Fredericks, S., Guruge, S., Sidani, S., Wan, T. — Thu, 08 Oct 2009 13:41:38 PDT

Background: Limited research has examined differences in patients’ learning needs in relation to demographic characteristics, such as age, gender, level of education, and culture. Yet such knowledge is essential to develop postoperative educational interventions that are tailored to patients’ needs. Study purpose: The purpose of this study was to examine the relationship between learning needs and the demographic characteristics of patients who have undergone coronary artery bypass graft (CABG) surgery. Method: A descriptive design was used.The sample of convenience included 38 patients who met eligibility criteria. Major results: Statistically significant relationships were found between the patients’ age, gender, and cultural background, and learning needs (p < .05) and not between the learning needs and level of education. Application: These preliminary highlight the importance of attending to learning needs of patients with different backgrounds in order to improve self-management following CABG surgery.

Women and Their Partners' Perceptions of the Key Roles of the Labor and Delivery Nurse

Thu, 08 Oct 2009 13:41:38 PDT

This descriptive qualitative study examined the perspectives of women and their partners regarding the key roles of the labor and delivery nurse during labor and birth.Ten couples were interviewed separately.The data analysis, conducted through independent and team analysis, was both iterative and interpretive. Participants identified four key roles of the labor and delivery nurse: support person, educator, patient advocate, and provider of continuity. Nurses provided both physical and emotional support.As an educator, they normalized the birth experience and served as a coach for the couple. Nurses advocated on behalf of the woman in labor, particularly when there was an adverse event. The continuity of care provided by the nurses wove the above roles into a cohesive whole. Findings provide important information for nursing educators, supervisors, and hospital administrators to reinforce the meaningful roles nurses serve in the labor and birth experiences of women and their partners.

Behavioral Indicators of Postoperative Pain in Older Adults With Delirium

Decker, S. A. — Thu, 08 Oct 2009 13:41:38 PDT

The undertreatment of postoperative pain in older adults with delirium is attributed, in part, to the inability to complete self-report pain assessment instruments. Patients’ loss of verbal skills to self-report pain and the lack of reliable and valid postoperative pain assessment instruments for use in older adults with delirium prompted the design of a study to identify common and subtle behavioral indicators of pain. Sixteen experienced registered nurses participating in four focus groups identified behavioral indicators of pain.Transcript analysis resulted in 89 behaviors indicative of pain. Seven researchers with expertise in pain and cognitive impairment in older adults reached 80% agreement on 22 behavioral indicators. The behavioral indicators were classified within one of four pain behavior categories (nonverbal cues/behaviors, vocalizations, facial expressions, and change in usual behavior), and each behavioral indicator was identified as common or subtle. Findings provide evidence of content validity for the pain behaviors.

Research Participation Among Older Adults With Mobility Limitation

Schlenk, E. A., Ross, D., Stilley, C. S., Dunbar-Jacob, J., Olshansky, E. — Thu, 08 Oct 2009 13:41:38 PDT

The purpose of this qualitative descriptive study was to examine reasons for participation in clinical research among older adults with mobility limitation. A purposive sample of 20 men and 20 women aged 70 years or older was recruited. Data were collected by audiotaped telephone interviews using a semistructured interview guide and transcribed verbatim. Participants expect privacy, professionalism by research staff, and respectful treatment. Benefits to protocol adherence include personal education, comparison of their health status with that of others, opportunity to maintain vitality, and altruism. Barriers to protocol adherence are apprehension, in particular a negative impact on their health care, randomization to the control group, and experimental drugs; and inconvenience. Factors promoting study completion are obligation, reciprocity, receipt of test results, health promotion, and socialization. Implications include meeting expectations, providing health education and study results to participants, reducing barriers to participation, and presenting opportunities for interaction with others.

Transitions for Clinical Nursing Research: An International Journal

Cacchione, P. Z. — Wed, 15 Jul 2009 09:34:35 PDT

Measuring the Oral Health of Nursing Home Elders

Jablonski, R. A., Swecker, T., Munro, C., Grap, M. J., Ligon, M. — Wed, 15 Jul 2009 09:34:35 PDT

The primary purposes of this descriptive and prospective pilot study was to test the feasibility of a nursing and dental hygiene team to measure specific oral health indices in a sample of older adults residing in nursing homes (NHs). The secondary purpose was to determine the relationship between plaque and dentate status. Oral health indicators, functional status scores, and behavioral scores were collected and analyzed from 38 female NH residents from two geographically, organizationally, and economically diverse NHs. Persons with dentures had significantly lower plaque scores than those with natural dentition. Rural NH residents and African American NH residents had fewer filled teeth, indicating a potential lack of access to dental care. Oral health indicators were collected safely and efficiently from NH residents using a nursing and dental hygiene collaborative approach. Nursing and dental hygiene collaborations hold promise for improving the oral health in institutionalized elders.

Commentary by Lorenz

Lorenz, R. A. — Wed, 15 Jul 2009 09:34:35 PDT

Evaluation of Statistical Approaches in Quantitative Nursing Research

Gross Cohn, E., Haomiao Jia, , Larson, E. — Wed, 15 Jul 2009 09:34:35 PDT

The purposes of this study were to (a) develop a tool to assess statistical methods and (b) use the tool to evaluate recently published quantitative research. We rated the statistical approaches used in 152 studies published in the 5 top impact-factor nursing research journals from September 2005 to August 2007. Studies were generally of high quality; 45% scored between 80% and 100%, and 22% achieved a score of 100%. Predictors of high scores were interdisciplinary authorship, a statistician coauthor, and the number of aims. The authors conclude that studies published in high impact-factor nursing journals are statistically sound and provide a solid foundation for evidence-based practice.

Test--Retest Reliability of the Geriatric Institutional Assessment Profile

Boltz, M., Capezuti, E., Kim, H., Fairchild, S., Secic, M. — Wed, 15 Jul 2009 09:34:35 PDT

The Geriatric Institutional Assessment Profile (GIAP) is a self-administered survey of hospital nurses designed to assess a hospital's readiness to implement geriatric programs. The GIAP measures nurses' knowledge and attitudes toward older adults as well as the organizational attributes that support or constrain geriatric best practices. Test—retest reliability estimates of the GIAP were conducted with a sample of 166 direct care nurses in three urban, university-affiliated hospitals over a 3-week time period. Intraclass correlation coefficients of GIAP scales and subscales ranged between .82 and .92, demonstrating good to very good reliability. The GIAP is a reliable measure of organizational attributes of the hospital relevant to geriatric care.

Suicide Risk Screening in an Emergency Department: Engaging Staff Nurses in Continued Testing of a Brief Instrument

Folse, V. N., Hahn, R. L. — Wed, 15 Jul 2009 09:34:35 PDT

A study was conducted to detect suicide risk in adolescents and adults seeking treatment in an emergency department (ED) in the Midwest as well as to continue testing reliability and validity of the 4-item Risk of Suicide Questionnaire (RSQ) developed by Horowitz et al. This study included ED staff nurses in a Level II Trauma Center who administered the RSQ to adolescent, adult, and geriatric patients, regardless of chief complaint or psychiatric history. Participants consisted of a convenience sample of 202 patients composed of 59 adolescents and 143 adults, including 36 geriatric patients. Psychometric analysis demonstrated a lower-than-expected degree of reliability and an adequate level of criterion-related validity for the RSQ in this sample. Interrater reliability was established. Approximately 42% of all patients who participated screened positive for suicide risk using the RSQ. Results support screening by nurses as part of the admission assessment to determine suicide risk in patients who present to the ED.

Management of Aggression Among Demented or Brain-Injured Patients

Finfgeld-Connett, D. — Wed, 15 Jul 2009 09:34:35 PDT

Nurses' responses to aggression among patients with dementia or brain injury are not fully informed by evidence-based interventions. For this reason, the primary purpose of this investigation was to delineate a conceptual framework of optimal therapeutic interventions to manage verbal and behavioral aggression among these individuals. Meta-synthesis methods were used, and findings from seven reports of qualitative research were synthesized. Therapeutic management of aggression among patients with dementia or brain injury was captured by the metaphor entering the patient's world. This process involves getting to know the patient behind the aggression and normalizing their experiences. Nurses are encouraged to become a part of the patient's world and to strive for mutual understanding and action. Patient negativity is downplayed and interactions are shaped in thoughtfully creative ways. Therapeutic management of aggression results in positive outcomes for nurses as well as patients.

Health-Related Quality of Life After Stroke: Reliability of Proxy Responses

Muus, I., Petzold, M., Ringsberg, K. C. — Fri, 17 Apr 2009 12:43:59 PDT

A Danish version of the Stroke-Specific Quality of Life Scale (SSQOL-DK) has been developed for self-reporting; it contains 12 physical and psychosocial domains. The purpose of this study was (a) to assess the reliability of the proxy version of the SSQOL-DK and (b) to evaluate the influence of frequency of proxy contact on agreement. In all, 143 patients completed the SSQOL-DK 1 to 5 years post-stroke. A patient chosen proxy completed a proxy version of the same questionnaire. The proxy version showed satisfactory internal consistency (Cronbach's = .85-.95). Agreement was generally high. Proxies rated the amount of trouble significantly smaller (higher score) than the patients only in the domain Social Roles. The amount of trouble in the domain Family Roles received significantly higher ratings from noncohabitant proxies when compared with patients (lower score). The proxy version of the SSQOL-DK appears to be reliable for use with stroke patients up to a few years following a stroke.

Adaptation Positions and Behavior Among Post--Myocardial Infarction Patients

Brink, E. — Fri, 17 Apr 2009 12:43:59 PDT

This study explores myocardial infarction patients' experiences of adaptation to illness consequences after one year, focusing on experiences of "the self." The study sample consisted of 19 respondents (10 women, 9 men) who have suffered a first-time myocardial infarction. They were interviewed 1 year after the acute heart attack. A constant comparative method for grounded theory provided the strategies used for data collection and analysis. Codes emerged and memos clarified theoretical reflections. The resulting model was able to illustrate possible mechanisms underlying two different behaviors: self-modifying and self-protecting behavior. Four different adaptation positions were identified: put up with current health, struggle for health, ignore illness , and struggle against illness. These categories were related to two core categories: self-agency and coping with illness consequences . This model may clarify the different adaptive behavior observed among post—myocardial infarction patients.

Statistical Versus Clinical Significance for Infants With Brain Injury: Reanalysis of Outcome Data From a Randomized Controlled Study

Lina Kurdahi Badr, — Fri, 17 Apr 2009 12:43:59 PDT

By adopting more appropriate statistical methods to appraise data from a previously published randomized controlled trial, the statistical and clinical significance of an intervention on the 18-month neurodevelopmental outcome of infants with suspected brain injury is evaluated. The intervention group (n = 32) receives extensive, individualized cognitive/sensorimotor stimulation by public health nurses while the control group (n = 30) receives standard follow-up care. At 18 months, 43 infants remain in the study (22 intervention and 21 control). The results indicate that there is a significant statistical change within groups and a clinical significance whereby more infants in the intervention group improve in mental, motor, and neurological functioning at 18 months compared to the control group. The benefits of looking at clinical significance from a meaningful aspect for practitioners are emphasized.

Predisposing Factors Associated With Delirium Among Demented Long-Term Care Residents

Voyer, P., Richard, S., Doucet, L., Carmichael, P.-H. — Fri, 17 Apr 2009 12:43:59 PDT

This was a cross-sectional study to investigate predisposing factors associated with delirium among demented long-term-care residents and to assess the cumulative effect of these factors on the likelihood of having delirium. Of the 155 participants, 109 (70.3%) were found delirious according to the confusion assessment method. Among these individuals, age (OR = 1.07; 95% CI = 1.05-1.10) and severity of dementia (OR = 1.05; 95% CI = 1.03-1.07) were the most associated factors of delirium. The likelihood of being in delirium increased with the number of associated predisposing factors present (OR = 1.67; 95% CI = 1.11-2.51). Associated factors identified were level of functional autonomy, pain, depression, behavioral disturbances, number of medications, dehydration, fever, and malnutrition. Identification of predisposing factors will help nurses in detecting those residents in long-term care settings who are at high-risk for delirium, as well as in designing preventive intervention strategies for delirium, based on these factors.

Marijuana Effectiveness as an HIV Self-Care Strategy

Fri, 17 Apr 2009 12:43:59 PDT

Persons living with HIV/AIDS use self-care for symptom management. This study assesses the use of marijuana as a symptom management approach for six common symptoms for persons living with HIV/AIDS--anxiety, depression, fatigue, diarrhea, nausea, and peripheral neuropathy. This sub-analysis of the efficacy of a symptom management manual encompasses the experiences of participants from sites in the U.S., Africa, and Puerto Rico. Baseline data are analyzed to examine differences in the use and efficacy of marijuana as compared with prescribed and over-the-counter medications as well as the impact on adherence and quality of life.

The Ethics of Writing for Publication

Wood, M. J. — Tue, 10 Feb 2009 09:25:22 PST

Testing Protocols: Care of Biological Samples in a Rural Setting

Stepans, M. B. F., Wilhelm, S. L., Rodehorst, T. K., Smith, D., Weinert, C. — Tue, 10 Feb 2009 09:25:22 PST

The purpose of this study is to evaluate collection, transport, and storage protocols of urine and air allergen samples from infants in a rural setting. Infant urine and aeroallergen samples (n = 21) are collected in the home setting in rural areas where time and distance to the central laboratory is a consideration. Urine samples are analyzed using ELISA tests after being transported using three different techniques: (a) ambient temperature, (b) dry ice, and (c) packaged on dry ice and shipped commercially. Following initial ELISA testing for levels of cytokines, urine samples are frozen at -70 degrees Celsius for 6 months. Samples are then reanalyzed for levels of cytokines. Dust samples are analyzed for levels of aeroallergens, stored at 4 degrees for 6 months, and reanalyzed. The integrity of samples varies by biomarker, shipment temperature, and storage time, creating a high degree of variability in results.

Commentary by Hinck

Hinck, S. M. — Tue, 10 Feb 2009 09:25:22 PST

Maternal Health and Child Asthma Health Services Use

Kaiser, K. L., Barry, T. L., Mason, A. — Tue, 10 Feb 2009 09:25:22 PST

The primary purpose of this pilot study was to examine the influence of maternal health status on health services use in children with the diagnosis of asthma. A secondary purpose was to assess both preventive and illness-related child health services use patterns. Fifty-two asthmatic children and 43 mothers met the inclusion criteria. The majority of mothers (72%, n = 31/43) rated their own overall health as good to excellent. Eighty-six percent (n = 38/44) of the children had a medical home, 20% had peak flow meters, 26% had been to see a specialist, and 4% were currently under the care of a specialist. This pilot study raises important questions about the influence of maternal health on child health services use patterns for asthmatic children from low-income families. Understanding the influence of maternal health on health-seeking patterns for children with asthma is important for nursing intervention.

Development of an Intervention Program for Alzheimer's Family Caregivers Following Diagnostic Disclosure

Ducharme, F., Beaudet, L., Legault, A., Kergoat, M.-J., Levesque, L., Caron, C. — Tue, 10 Feb 2009 09:25:23 PST

The purpose of this qualitative study was to develop a pro-active psycho-educational intervention program for Alzheimer's family caregivers following diagnostic disclosure. Based on a theoretical model of role transitions and a participatory approach, the study comprised four steps: (a) exploring caregiver needs; (b) developing and validating a program proposal based on caregiver-expressed needs; (c) formalizing program through intervention mapping; and (d) testing and qualitatively evaluating the program. The psycho-educational program consisted of seven individual sessions aimed at fostering knowledge and skills required to ensure successful transition to the caregiver role. The approach used in this study can serve as a guide for the development of nursing intervention programs. Intervention mapping allowed, in particular, integrating theoretical and empirical elements in a formal intervention model.

Parent and Community Participation in Program Design

Uding, N., Kieckhefer, G. M., Trahms, C. M. — Tue, 10 Feb 2009 09:25:23 PST

Parents of children with chronic illnesses face many challenges not faced by other parents. A family-centered parent support and education program, Building on Family Strengths (BFS), was designed to help parents meet these challenges by gaining new skills and learning new ways to support their children. BFS researchers involved potential participant families in the refinement of the BFS curriculum to make it truly family centered. The article reports major feedback received from parent focus groups, leaders in several cultural communities, and participants in a pilot class as BFS underwent final refinement. This feedback greatly influences the development of the BFS curriculum, as without it the final product going into a randomized clinical trial would be less attuned to the needs of parents of children with chronic illnesses. Other researchers and family educators may find this feedback useful as they improve their own research and program offerings.

Into the Abyss of Someone Else's Dying: The Voice of the End-of-Life Caregiver

Phillips, L. R., Reed, P. G. — Tue, 10 Feb 2009 09:25:23 PST

This study was undertaken to better understand family caregivers' perspectives of providing end-of-life (EOL) care to elders facing expected deaths from life-limiting, chronic illnesses, and the study involved understanding the nature of EOL caregiving using caregivers' own words. The study employed a cross-sectional, exploratory descriptive design. The data source was intensive interviews with 27 EOL caregivers. Eight themes were extracted from data that exemplify the core characteristics of EOL caregiving. The themes intersected at a central idea expressed in the voice of one caregiver as "jumping . . . into the abyss of someone else's dying." Data suggested that caregivers of elders with life-limiting illnesses needed nursing guidance about EOL care earlier than it is usually provided and that all nurses providing care to elders in any setting should be ready to offer early education in the practical, technical, and emotional dimensions of end-of-life caregiving.

Erratum

Thu, 23 Apr 2009 14:17:52 PDT

In the November 2008 issue of Clinical Nursing Research, the sentence in the final paragraph on page 249 read: If the forearm is used as an alternate site for BPM, the technique recommended by the American Heart Association to place the forearm at heart level and auscultate at the brachial artery should be followed. The correct statement should be to auscultate at the radial artery (the wrist), not the brachial artery.