Applied Nursing Research - Articles in Press

Validity of the Braden and Waterlow subscales in predicting pressure ulcer risk in hospitalized patients - Corrected Proof

2010-07-26

Abstract: The aim of this study was to evaluate the validity of the Braden and Waterlow subscales in predicting pressure ulcer risk in hospitalized patients. This is a secondary analysis of a prospective cohort study. Braden sensory perception and friction/shear subscales and Waterlow mobility and appetite subscales were the most relevant predictors.

The validity of self-report weight and height as a surrogate method for direct measurement - Corrected Proof

Yolanda M. Powell-Young — 2010-07-26

Abstract: Bland-Altman analysis used to determine the extent of bias, agreement, and precision between self-report and the “gold standard” of actual weight and height measurement revealed significant discrepancies between methods. Use of self-report data by health care providers and researchers should be made based on the clinical situation, patient safety, and research goals.

Evaluation of the Tiredness Management Guide: a pilot study - Corrected Proof

Megan Shepard Varcho, Pamela D. Hill, MaryAnn Anderson — 2010-06-30

Abstract: The Tiredness Management Guide (TMG), developed by N. W. Troy and P. Dialgas-Pelish (1995), consists of 59 interventions that may be helpful in decreasing maternal fatigue in the postpartum period. The purpose of this pilot study was to evaluate which interventions mothers perceived as most helpful and thus reduce the length of the TMG and update its relevance. A convenience sample of 30 Women, Infants, and Children Program (WIC) participants between the ages of 18 and 35 years completed a demographic tool and the TMG. The 25 most helpful interventions can be placed into the following broad categories: rest and relaxation, time management, rearranging usual activities, relief/prevention of hemorrhoids/constipation, signs of infection, and emotional support.

Abstracting pain management documentation from the electronic medical record: comparison of three hospitals - Corrected Proof

Joanne G. Samuels — 2010-06-30

Abstract: Background: Pain management science results are derived from research conducted using medical record.Approach: This article describes methodological issues arising from abstracting pain management documentation (PMD) from the electronic medical record in three hospitals. After approval, PMD data were collected from the patient's history and physical, discharge summary, operative care notes, computerized nursing flow sheets, progress notes, and medication records.Results: Each acute care facility required a different approach to abstract data. Inconsistent documentation in pain management assessments, interventions, and reassessments were identified across hospitals.Discussion: Inconsistencies pose measurement threats and hinder benchmarking efforts. Work to standardize PMD across propriety computer systems is warranted.

Comparison of oxygen saturation values and measurement times by pulse oximetry in various parts of the body - Corrected Proof

Gülendam Hakverdioğlu Yönt, Esra Akin Korhan, Leyla Khorshid — 2010-05-31

Abstract: The aim of this study, which included 40 patients, was to compare the values pulse oximetry and the measurement times in various regions of the body. Data were analyzed using intraclass correlation coefficient test and paired-sample test. The confidence power value was found to be .81 for the comparison of oxygen saturation values by arterial blood gas analysis and measurement by the forehead probe. It was found that the time for oxygen saturation measurement using the forehead probe was shorter than those using the finger and toe probes.

The effects of psychoeducation and telephone counseling on the adjustment of women with early-stage breast cancer - Corrected Proof

2010-05-07

Abstract: Background: Throughout the illness trajectory, women with breast cancer experience issues that are related to physical, emotional, and social adjustment. Despite a general consensus that state-of-the-art treatment for breast cancer should include educational and counseling interventions to reduce illness or treatment-related symptoms, there are few prospective, theoretically based, phase-specific randomized, controlled trials that have evaluated the effectiveness of such interventions in promoting adjustment.Purpose: The aim of this study is to examine the physical, emotional, and social adjustment of women with early-stage breast cancer who received psychoeducation by videotapes, telephone counseling, or psychoeducation plus telephone counseling as interventions that address the specific needs of women during the diagnostic, postsurgery, adjuvant therapy, and ongoing recovery phases of breast cancer.Design: Primary data from a randomized controlled clinical trial.Setting: Three major medical centers and one community hospital in New York City.Methods: A total of 249 patients were randomly assigned to either the control group receiving usual care or to one of the three intervention groups. The interventions were administered at the diagnostic, postsurgery, adjuvant therapy, and ongoing recovery phases. Analyses were based on a mixed model analysis of variance.Main Research Variables and Measurement: Physical adjustment was measured by the side effects incidence and severity subscales of the Breast Cancer Treatment Response Inventory (BCTRI) and the overall health status score of the Self-Rated Health Subscale of the Multilevel Assessment Instrument. Emotional adjustment was measured using the psychological well-being subscale of the Profile of Adaptation to Life Clinical Scale and the side effect distress subscale of BCTRI. Social adjustment was measured by the domestic, vocational, and social environments subscales of the Psychosocial Adjustment to Illness Scale.Findings: Patients in all groups showed improvement over time in overall health, psychological well-being, and social adjustment. There were no significant group differences in physical adjustment, as measured by side effect incidence, severity, or overall health. There was poorer emotional adjustment over time in the usual care (control) group as compared to the intervention groups on the measure of side effect distress. For the telephone counseling group, there was a marked decline in psychological well-being from the adjuvant therapy phase through the ongoing recovery phase. There were no significant group differences in the dimensions of social adjustment.Conclusion: The longitudinal design of this study has captured the dynamic process of adjustment to breast cancer, which in some aspects and at various phases has been different for the control and intervention groups. Although patients who received the study interventions improved in adjustment, the overall conclusion regarding physical, emotional, and social adjustment is that usual care, which was the standard of care for women in both the usual care (control) and intervention groups, supported their adjustment to breast cancer, with or without additional interventions.Implications for Nursing: The results are important to evidence-based practice and the determination of the efficacy and cost-effectiveness of interventions in improving patient outcomes. There is a need to further examine adjustment issues that continue during the ongoing recovery phase.Key Points: Psychoeducation by videotapes and telephone counseling decreased side effect distress and side effect severity and increased psychological well-being during the adjuvant therapy phase. All patients in the control and intervention groups improved in adjustment. Adjustment issues are still present in the ongoing recovery phase.

Tai Chi for older nurses: A workplace wellness pilot study - Corrected Proof

Mary Val Palumbo, Ge Wu, Hollie Shaner-McRae, Betty Rambur, Barbara McIntosh — 2010-04-14

Purpose: The purpose of this pilot study was to assess the feasibility of a Tai Chi workplace wellness program as a cost effective way of improving physical and mental health, reducing work related stress, and improving work productivity among older nurses in a hospital setting Design A randomized control trial of two groups (control and Tai Chi group).Design: A randomized control trial of two groups (control and Tai Chi group).Settings: Northeastern academic medical center.Subjects: A convenience sample of eleven female nurses (mean age 54.4 years).Intervention: The Tai Chi group (n = 6) was asked to attend Tai Chi classes once a week offered at their worksite and to practice on their own for 10 minutes each day at least 4 days per week for 15 weeks. Controls (n = 5) received no intervention.Measures: SF-36 Health Survey, Nursing Stress Scale (NSS), Perceived Stress Scale (PSS), Sit-and-Reach test, Functional Reach test, the Work Limitations Questionnaire, workplace injury and unscheduled time off.Analysis: The two study groups were compared descriptively and changes across time in the intervention versus control were compared.Results: The Tai Chi group took no unscheduled time-off hours, whereas, the control group was absent 49 hours during the study period. There was also a 3% increase in work productivity and significant improvement in functional reach (p=0.03) compared to the control group. Other outcomes were not statistically significant.Conclusion: This pilot study demonstrates the feasibility of Tai Chi with older female workers as a cost effective wellness option in the workplace; thus encouraging replication with a larger sample. Methodological implications were also addressed.

Recruiting Chinese American adolescents to HIV/AIDS-related research: A lesson learned from a cross-sectional study - Corrected Proof

Yi-Hui Lee, Ali Salman, Fan Wang — 2010-04-12

Abstract: The purpose of this article was to report identified barriers and challenges experienced in the recruiting process of Chinese American adolescents to a cross-sectional HIV/AIDS-related study. Snowball sampling method was used to recruit Chinese American adolescents from Chinese American communities in a U.S. Midwestern state. Barriers and challenges to recruitment were reviewed and analyzed from Chinese cultural perspectives in the hope of aiding researchers and health care providers understand and facilitate future recruitment of Chinese Americans for HIV/AIDS prevention studies. Barriers to recruitment were found related to the taboo topic of sexual issues in Chinese culture, unawareness and denial of HIV/AIDS risks, authoritarian parenting style in Chinese culture, and the required active consents. Facilitating factors of recruiting Chinese American adolescents to future HIV/AIDS prevention research or intervention programs are discussed. Information provided in this article may increase nurses' awareness of various barriers that they might encounter when they conduct research or address HIV/AIDS-related topics of Chinese American adolescents.

Strategies to recruit difficult-to-reach home health care nurses for research - Corrected Proof

Linda W. Samia, Carol Hall Ellenbecker — 2010-04-12

Abstract: Strategies to access a stratified random sample of New England home health care agencies and nurses are described. The combined strategies resulted in a sample of 123 home health care agencies and 2,459 home healthcare nurses from the six New England states. The results will inform researchers aiming to achieve data representativeness and clinicians critiquing the rigor of evidence.

Challenges and strategies for recruitment and retention of vulnerable research participants: Promoting the benefits of participation - Corrected Proof

Robin Gemmill, Anna Cathy Williams, Liz Cooke, Marcia Grant — 2010-04-12

Abstract: The purpose of this article was to describe recruitment and retention of vulnerable hematopoietic cell transplant patients participating in a longitudinal intervention study. Utilizing Swanson's theory of caring model, nurse researchers facilitated patients' visualization of how study participation could enable them to share their experience and further clinical insights.

Research strategies that result in optimal data collection from the patient medical record - Corrected Proof

Katherine E. Gregory, Lucy Radovinsky — 2010-04-12

Abstract: Data obtained from the patient medical record are often a component of clinical research led by nurse investigators. The rigor of the data collection methods correlates to the reliability of the data and, ultimately, the analytical outcome of the study. Research strategies for reliable data collection from the patient medical record include the development of a precise data collection tool, the use of a coding manual, and ongoing communication with research staff.

Qualitative data collection with children - Corrected Proof

Regena Spratling, Sallie Coke, Ptlene Minick — 2010-04-12

Abstract: Qualitative researchers have clear methods to guide them in data collection with adult participants, but little is known about effective interview techniques with children. The findings from this methodological study on qualitative interviews with children indicate that children are able to articulate their experiences in interviews.

The effectiveness of an osteoporosis prevention program among women in Taiwan - Corrected Proof

Chiu-Mieh Huang, Chao-Yu Su, Li-Yin Chien, Jong-Long Guo — 2010-04-12

Abstract: The purpose of this study was to develop an osteoporosis prevention program based on the Health Belief Model. This study found that the prevention program improved osteoporosis preventive behaviors among women in Taiwan. Health professionals could use this model to plan and evaluate their osteoporosis prevention programs.

Effects of patient teaching, educational materials, and coaching using telephone on dyspnea and physical functioning among persons with heart failure - Corrected Proof

Apinya Wongpiriyayothar, Ubolrat Piamjariyakul, Phoebe D. Williams — 2010-04-12

Abstract: Heart failure (HF) is a major cause of death in Thailand and other developing countries. This study shows that a coaching using telephone program is an accessible and feasible strategy that helps patients with HF to self-manage HF symptoms, decrease dyspnea, and improve physical functioning at home.

Perceptions of informed consent for care practices: hospitalized patients and nurses - Corrected Proof

Rouhangiz Mahjoub, Dana N. Rutledge — 2010-02-11

Abstract: In a descriptive comparative survey study, nurse and patient perceptions differed regarding the practices of information giving, allowing decision making, and informed consent for nursing procedures during hospitalization. Nurses should consider giving patients more information about primary physical needs and activities related to nursing care (e.g., bowel/bladder needs, wound, and hygiene).

Measurement of cognitive function in chronic heart failure: a feasibility study - Corrected Proof

Lisa Bauer, Bunny Pozehl — 2010-02-11

Abstract: Assessment of cognition is critical to providing optimal care to individuals with heart failure. Traditional neuropsychological batteries are time consuming. This pilot study obtained feasibility data for a brief neuropsychological battery. Mean administration time was 40 ± 7.5 minutes, averting subject fatigue, and the battery was sensitive to cognitive impairments.

Familismo: influence on Hispanic health behaviors - Corrected Proof

Yolanda R. Davila, Elizabeth Reifsnider, Irma Pecina — 2010-02-11

Abstract: This study explored the impact of hepatitis C infection among a convenience sample of adult Hispanic men and women. Data were collected through a demographic form and audiotaped responses to a vignette. Krueger's transcription-based focus group method of analysis was used to analyze the qualitative data. The major theme, familismo (importance of family), emerged from the data with individual health behavior defined by family needs and expressed by “doing right” by the family. Therefore, health promotion and disease treatment framed within a “healthy family” philosophy and health intervention message may be more culturally acceptable and effective among Hispanic populations.

Nursing staffing, nursing workload, the work environment and patient outcomes - Corrected Proof

2010-02-11

Abstract: Nurse staffing (fewer RNs), increased workload, and unstable nursing unit environments were linked to negative patient outcomes including falls and medication errors on medical/surgical units in a mixed method study combining longitudinal data (5 years) and primary data collection.

Health disparities or data disparities: sampling issues in hepatitis B Virus infection among Asian American Pacific Islander studies - Corrected Proof

Haeok Lee, Seong-Yi Baik — 2010-02-11

Abstract: Hepatitis B virus (HBV) infection in Asian American Pacific Islanders (AAPIs) is an important health problem that must be recognized and addressed by the U.S. public health policy. However, AAPIs have been to a large degree invisible in public health data and debates and their interests have been disregarded. Moreover, an estimation of HBV infection rates reported from the National Nutritional and Health Survey Examinations III was 1.25 million; however, an estimate based on AAPI-targeted studies places the number at almost 2 million. This article discusses the perils of application of textbook methods of sampling coverage, selection, and nonresponse in studies related to AAPIs and the importance to note that some rapidly increasing racial/ethnic groups such as AAPIs have linguistic and cultural differences and these differences often cause such groups to be omitted from data collection.

Nursing staff perceptions of physical function in hospitalized older adults - Corrected Proof

Marie Boltz, Elizabeth Capezuti, Nina Shabbat — 2010-02-11

Abstract: Physical function is a common complication of hospitalized older adults, resulting in increased morbidity, mortality, institutionalization, and cost. Nursing staff play a central role in the hospital experience for older adults, including the promotion of physical function. Although quality geriatric care requires an organizational approach, there are no empirically based guidelines to promote the physical function of hospitalized older adults. A first step to develop an organizational intervention is to identify nursing staff perceptions of physical function, defined as basic activities of daily living (eating, dressing, toileting, transferring, bathing, and continence), in hospitalized older adults, including their beliefs about prevalence, risk factors, onset, effective interventions, and institutional barriers and facilitators to promoting physical function. Using purposive sampling, six focus groups yielding 55 participants were conducted at one of two sites, a suburban community hospital in New Jersey and an urban teaching hospital in New York, using a semistructured interview. Each site provided three focus groups composed of nursing staff cohorts as follows: two groups of registered nurses (staff nurses, managers, advanced practice nurses, and educators) and one group of patient care associates. There were important similarities identified in the themes of each group. Participants identified a system-level approach to preventing functional decline, including multimodal interventions and system-level enablers.

Participation of elder persons, families, and health care teams in hospital discharge destination decisions - Corrected Proof

Lori Popejoy — 2010-01-15

Abstract: This study identified that hospitalized elder persons and their family preferred active or collaborative level of participation (LOP) in discharge destination decisions, whereas health care team members (HCTMs) preferred passive LOP. Recognition of preferred LOP by HCTMs is instrumental to developing discharge plans that are tailored to the individual's need and are realistic and achievable.

The Barthel Index: comparing inter-rater reliability between Nurses and Doctors in an older adult rehabilitation unit - Corrected Proof

Irene Hartigan, Denis O'Mahony — 2010-01-15

Abstract: Objective: To ensure accuracy in recording the Barthel Index (BI) in older people, it is essential to determine who is best placed to administer the index. The aim of this study was to compare doctors' and nurses' reliability in scoring the BI.Methods: Sixty-five consecutive patients admitted to an older adult rehabilitation unit were assessed using the BI. Four raters recorded the BI on all patients. BI scores were compared for equivalence on the level of agreement between raters.Results: Near-perfect correlation in the total scores between raters indicated that the final score is reliable. There was a statistically significant bias by doctors who gave a higher BI score than nurses with a mean difference of 1.2 (95% confidence interval). Nurses demonstrated good and very good agreement on all 10 items, whereas doctors demonstrated good agreement on only 5 items.Conclusion: The BI is highly reliable when recorded by nurses with low interrater variation, whereas between doctors, there is greater variation. When assessing older adult's activities of daily living, there is greater interrater reliability in the BI score when the patient is observed performing the activities of daily living compared to the self-report method.

The effect of a double-regression hospital bed on interface pressure - Corrected Proof

Ricardo Ros-Mar, Marino Martínez-Gamarra — 2010-01-15

Abstract: This study examines, for the first time, the differences of interface pressure in different positions on a standard hospital bed and a double-regression hospital bed. For both beds, the interface pressure was recorded in four supine positions and three lateral positions in 49 healthy volunteers (30 men and 19 women). The results demonstrate, independently of the bed type, that when a supine and lateral position is indicated, the 0° and 30° positions, respectively, are preferable. We also show that patients requiring prolonged upper body elevation may benefit from the use of a double-regression hospital bed that reduces the maximum pressure and the pressure surface greater than 32 mm Hg at the sacrum and heel sites.

Relationship between job stress level and coping strategies used by Hong Kong nurses working in an acute surgical unit - Corrected Proof

Wenru Wang, Amelia Wai Man Kong, Sek Ying Chair — 2009-10-26

Abstract: Objective: The aim of this study is to explore the relationship between job stress and coping strategies of Hong Kong nurses working in an acute surgical unit.Method: This is a descriptive correlational study. Data were collected from 98 Hong Kong surgical nurses using the Nursing Stress Scale and the Jalowiec Coping Scale.Results: Results showed that workload (M = 15.36), lack of support (M = 13.32), and inadequate preparation (M = 12.33) are the most common stressors for Hong Kong surgical nurses. The most frequent strategies used by nurses to cope with stress can be characterized as evasive (M = 19.23), confrontive (M = 17.46), and optimistic (M = 15.81), all of which are also rated as the most effective strategies in reducing stress levels. Only the confrontive, optimistic, supportant, and emotive coping strategies reveal significant correlations (p < .05) with the stress levels of nurses, whereas the evasive, fatalistic, palliative, and self-reliant strategies showed no significant correlation with stress levels (p > .05).Conclusion: Recognizing the impacts of job-related stress and making use of effective coping methods play a vital role in reducing nurse's stress. A change in leadership styles from the managerial level and reallocation of manpower may help reduce job stress. The use of confrontive and optimistic coping strategies in reducing job-related stress for surgical nurses should be advocated and promoted in their daily work.

Online research in older adults: lessons learned from conducting an online randomized controlled trial - Corrected Proof

2009-10-26

Abstract: The Internet has revolutionized health care delivery. With the increasing number of online users and the advancement of eHealth technologies, many health care studies have been conducted online. However, online research is still a relatively new field, and many methodological issues still need to be investigated. Over the years, the authors have conducted studies on various aspects of online health intervention research, including development and usability testing of online health interventions, Web surveys, and an online randomized controlled trial employing older adult online users. The purpose of this article was to describe lessons learned from conducting an online randomized controlled trial designed to improve older adults' health behaviors focusing on methodological issues and strategies to overcome them.

Rural Black women's thoughts about exercise - Corrected Proof

Laura K. Evans — 2009-10-26

Abstract: This ethnographic study explored 20 southern rural Black women's thoughts about and practices of exercise. Qualitative analysis revealed four factors: (a) exercise and the heart, (b) barriers to exercise, (c) reasons to exercise, and (d) taking action. Findings may assist clinicians and researchers to develop prevention interventions for this population.

Risk factors associated with unplanned endotracheal self-extubation of hospitalized intubated patients: a 3-year retrospective case-control study - Corrected Proof

Li-Chun Chang, Pei-Fen Liu, Yu-Lu Huang, Sien-Sing Yang, Wen-Yin Chang — 2009-10-22

Abstract: This 3-year retrospective case-control study aimed to identify risk factors associated with unplanned endotracheal self-extubation (UESE) of hospitalized intubated patients and to compare unplanned and planned extubation groups' characteristics of patients and nurses, vital signs, serum laboratory values, Glasgow Coma Scale scores, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, and use of physical restraints and sedatives. The study found that most UESEs occurred during evening or night shifts or during shifts staffed by nurses with less experience and less education. Most of the self-extubated patients (80%) were physically restrained. Pulse rate and APACHE II score were both significant predictors of UESE. Efforts to prevent UESEs should include identification of patients at higher risk.

Psychometric testing of the Inner Strength Questionnaire: women living with chronic health conditions - Corrected Proof

Kristi L. Lewis, Gayle Roux — 2009-10-16

Abstract: The purpose of this article is to report the third phase of psychometric testing on the Inner Strength Questionnaire. The instrument is a comprehensive gender-specific measure of inner strength in women living with chronic health conditions. The study sample was composed of 281 women with self-reported chronic health conditions. The four-factor structure was supported with a total of 27 items with loadings 0.50 or greater. The reliability for the entire instrument (Version 4) was .91. The instrument takes approximately 10–12 minutes to complete and is at the Flesch-Kincaide reading level of fourth grade. Results can be used to plan or test interventions used to enhance strength-building health outcomes in women.

Elective Cesarean births: are women making emancipated decisions? - Corrected Proof

Ruth A. Wittmann-Price, Rosemary Fliszar, Anand Bhattacharya — 2009-10-16

Abstract: This mixed method study investigated the extent to which women used emancipated decision making when selecting a birth method, whether they perceived they had a choice, and if they were satisfied with their decision. Findings suggest that vaginal birth is still the preferred method of delivery for these study participants.

A self-directed adherence management program for patients' with heart failure completing combined aerobic and resistance exercise training - Corrected Proof

Kathleen Duncan, Bunny Pozehl, Joseph F. Norman, Melody Hertzog — 2009-10-16

Abstract: This study measured the impact of the Exercise Adherence Management Program (EAMP) provided to 20 patients with heart failure (HF) who participated in a combined resistance and aerobic exercise training program during two 12-week phases. The EAMP included strategies designed to support exercise self-efficacy and adherence. Results indicate that an improvement in exercise self-efficacy occurred during the study period, whereas exercise adherence declined during the unsupervised phase. The highest rated adherence strategy for helpfulness and self-efficacy was group sessions. The study supports the use of adherence strategies based on self-efficacy in exercise programs for patients with HF.

Nursing Student Research Assistant Program: A strategy to enhance nursing research capacity building in a Magnet status pediatric hospital - Corrected Proof

Patricia A. Jamerson, Anne F. Fish, Geralyn Frandsen — 2009-10-16

Abstract: For busy clinicians, time to conduct research is scarce. A novel solution, the Nursing Student Research Assistant Program (NS-RAP), was designed in collaboration with area nursing schools to build research capacity at a pediatric hospital. Undergraduate and graduate nursing students participated in a variety of research experiences that, in turn, aided the conduct of clinician-initiated research at the pediatric hospital. In this article, conceptualization, implementation, outcomes, challenges, and future directions of NS-RAP are discussed.

Nurses' perception of how physical environment affects medication errors in acute care settings - Corrected Proof

Atiya Mahmood, Habib Chaudhury, Maria Valente — 2009-10-16

Abstract: The work that nurses perform in hospital environments is physically and psychologically intense, with the potential for burnout and stress. This issue is compounded by crowded and poorly designed work spaces in nursing units that can contribute to medical mistakes, including medication errors. This article is based on a study that examined the nurses' perception of how the physical environment in hospitals affects medication errors. Literature suggests that reduction of staff stress can be achieved through physical environmental considerations, such as improved air quality, acoustics, and lighting. However, there is no empirical study specifically exploring the relationship between aspects of the physical environment and medication errors. In this study, a cross-sectional survey was conducted with nursing staff (N = 84) in four hospitals in the Pacific Northwest region of the United States. The survey included questions on nursing unit design, medication room configurations, perceived incidence of errors, and adverse events. Respondents noted several physical environmental factors that are potentially problematic in the nursing station area and can lead to medication, documentation, and other types of nursing errors. These factors include inadequate space in charting and documentation area, lengthy walking distances to patient rooms, insufficient patient surveillance opportunity/lack of visibility to all parts of the nursing unit, small size of the medication room, inappropriate organization of medical supplies, high noise levels in nursing unit, poor lighting, and lack of privacy in the nursing stations. As administrators in acute care facilities consider strategies for organizational and staff interventions to reduce medication errors, it is important to consider physical environmental factors to have a comprehensive understanding of the issue.

Raising stroke awareness among rural dwellers with a Facts for Action to Stroke Treatment-based educational program - Corrected Proof

2009-09-22

Abstract: Stroke is the third leading cause of death in the United States with 780,000 new and/or recurrent strokes each year. Interventions aimed at the onset of stroke symptoms have been successful in decreasing long-term neurological deficits; however, providing the prompt medical interventions in rural areas involves unique challenges. To decrease time-to-treatment in rural areas, education about symptoms of stroke and the need for immediate medical attention are critical. The objective of this study was to measure the effectiveness of the Facts for Action to Stroke Treatment (FAST)-based educational intervention program focused on the improving knowledge about stroke of 402 rural-dwelling adults. Using a paired means t test, the participants had a significant increase in knowledge from pretest to posttest (p = .000). Of those, 215 subjects participated in 2-month follow-up testing with the paired t test showing that the increased score from pretest to 2-month follow-up remained significant (p = .000). The authors concluded that the FAST-based program was an effective tool to use when teaching recognition of stroke symptoms and the need for immediate medical intervention to rural adults.

Satisfaction and use of a spiritually based mantram intervention for childbirth-related fears in couples - Corrected Proof

2009-09-22

Abstract: This study assessed patient satisfaction with the use of a spiritually based (mantram/sacred word) intervention in expecting couples. A mixed-methods design, experimental repeated measures with interviews at 6-month follow-up was conducted. Satisfaction was moderate to high. Mantram was used for labor pains and uncertainty. Implications include scheduling flexible classes earlier in pregnancy. A larger randomized study is needed to assess intervention effectiveness.

Personality traits and chronic illness: a comparison of individuals with psychiatric, coronary heart disease, and HIV/AIDS diagnoses - Corrected Proof

2009-09-22

Abstract: This secondary analysis used the five-factor model of personality to examine personality traits in four samples of patients with chronic disorders. Profiles of personality traits differed across disorders. Although participants with psychiatric disorders and participants with HIV/AIDS had similar patterns of personality traits, patients with psychiatric disorders were more extreme on all traits except agreeableness. Patients with hyperlipidemia and those who had cardiothoracic transplants had similar patterns. Nurses and researchers need to consider personality traits that drive patterns of behavior in designing more effective ways to promote better health and manage disease.

Perceptions and experiences after radical prostatectomy in Turkish men: a descriptive qualitative study - Corrected Proof

Emine Iyigun, Hatice Ayhan, Sevinc Tastan — 2009-09-22

Abstract: Radical prostatectomy (RP) can significantly influence men's quality of life. Data from the Ministry of Health's Fight With Cancer Office Directorate in 2003 show that prostate cancer is third among the 10 most common types of cancer in men, with an incidence of 5.97% in the population. The objectives of this study were to define the experiences and perceptions of Turkish men who have undergone RP and to determine the views and suggestions of men who had undergone RP as to their discharge training content. Following the RP, urinary incontinence (UI) and erectile dysfunction (ED) negatively affect the daily life of men. It has been determined that men need support to deal with these problems they met. Being discharged without obtaining information from the health care staff regarding home catheter care and UI and ED management causes men to experience difficulties and find it difficult to cope when faced with these problems.

Validation and testing of the Acceptability E-scale for Web-based patient-reported outcomes in cancer care - Corrected Proof

Joseph D. Tariman, Donna L. Berry, Barbara Halpenny, Seth Wolpin, Karen Schepp — 2009-09-22

Abstract: The performance of the Acceptability E-scale was tested in a sample of 627 adult and older adult patients from various oncology clinics who completed an electronic symptoms survey. The revised Acceptability E-scale has strong psychometric properties and can be useful in assessing the acceptability and usability of computerized health-related programs in oncology and other health population.

Health care professionals' attitudes about obesity: An integrative review - Corrected Proof

Geraldine M. Budd, Megan Mariotti, Diane Graff, Kathleen Falkenstein — 2009-09-22

Abstract: Stigma and discrimination against obese people are common and related to individual attitudes about obesity. Despite a robust field of study on attitudes related to obesity, no integrative review of health providers' beliefs exist. Fifteen studies (1990–2007) on various health care providers are examined along with practice implications. Analysis indicates that attitudes toward overweight patients, although primarily still negative, have improved over time. Findings indicate that care dispensed to obese patients is not as likely to be affected by health care providers' attitudes as in the past. Implications include the need for additional research, awareness education, and practice guidelines.

A theory-based problem-solving approach to recruitment challenges in a large randomized field trial - Corrected Proof

2009-09-22

Abstract: Despite best-laid plans, recruitment problems arise in large field trials. Research teams must work hard on problem solving and push comfort zones to sustain recruitment and accrual levels. A systematic theory-based problem-solving approach helped us look deeply for challenges and implement strategies continuously to sustain accrual to our target enrollment.

Triangulating the extrinsic risk factors for inpatient falls from the fall incident reports and nurse's and patient's perspectives - Corrected Proof

Huey-Ming Tzeng — 2009-09-22

Abstract: This study triangulated the extrinsic risk factors for inpatient falls from incident reports and nurse's and patient's perspectives. Similar perspectives were shared on the patient-room-design-associated factors. Patients' concerns focused on their needs not being met in time. Fall prevention should have a priority on addressing patients' needs.

Posttraumatic stress among mothers of very low birthweight infants at 6 months after discharge from the neonatal intensive care unit - Corrected Proof

2009-09-22

Abstract: This correlational study examined how mother's posttraumatic stress disorder (PTSD) symptoms are related to characteristics of the mother and her infant, as well as to mother–infant interaction and infant development, in 21 mothers of very low birthweight infants. Twenty-three percent of mothers scored in the clinical range on a measure of PTSD. How ill the infant was during the NICU hospitalization was related to mothers' PTSD symptoms. Mothers with greater PTSD symptoms were less sensitive and effective at structuring interaction with their infant.

An exploration of nurses' perceptions regarding the implementation of a best practice guideline on the assessment and management of foot ulcers for people with diabetes - Corrected Proof

Linda Ritchie, Dawn Prentice — 2009-09-22

Abstract: The aim of this qualitative study was to explore nurses' perceptions regarding the implementation of a best practice guideline (BPG) on the assessment and management of foot ulcers for people with diabetes. Fourteen nurses from a community care setting and three hemodialysis units participated in five focus groups and one individual interview. The findings focus on key points regarding the impact of BPG implementation in the areas of patient outcomes, nursing practice, and interdisciplinary teamwork.

Precipitating factors associated with delirium among long-term care residents with dementia - Corrected Proof

Philippe Voyer, Sylvie Richard, Lise Doucet, Nancy Cyr, Pierre-Hugues Carmichael — 2009-09-22

Abstract: This cross-sectional study (N = 155) investigated precipitating factors associated with delirium among long-term-care residents with dementia and assessed their cumulative effect on the likelihood of having delirium. Use of physical restraints (odds ratio [OR] = 4.64, 95% confidence interval [CI] = 2.61–8.27) was the factor most associated, and the likelihood of being in delirium increased with the number of associated precipitating factors present (OR = 2.53, 95% CI = 1.42–4.49). Given their frailty, only a few precipitating factors need be present to increase the likelihood of these residents being in delirium, hence the need for increased nurse awareness of the risks posed by use of physical restraints with respect to the cognitive function of elderly residents with dementia.

Measuring illness uncertainty in men undergoing active surveillance for prostate cancer - Corrected Proof

2009-09-22

Abstract: Background and purpose: Uncertainty is an aversive experience and plays an important role in the lives of men undergoing active surveillance (AS; earlier referred to as watchful waiting) for early-stage prostate cancer. Yet reliable and valid measures of uncertainty have not been fully tested in this population. This secondary analysis therefore tested the reliability of the Mishel Uncertainty in Illness Scale Community Form (MUIS-C; M.H. Mishel, 1997b) for use with men undergoing AS for prostate cancer.Methods: Item–Total correlations were conducted on the 23 items of the MUIS-C with four samples of men undergoing AS.Results: Cronbach's alpha for the full MUIS-C was .908; 22 of 23 items showed significant positive correlations with the total score. Removing the item without a significant correlation from the reliability analysis increased Cronbach's alpha to .913.Conclusions: The Mishel Uncertainty in Illness Scale—Community Form for Active Surveillance is a reliable and valid tool for measuring uncertainty with men undergoing AS for prostate cancer.

Symptom management strategies used by elderly patients after coronary artery bypass surgery - Corrected Proof

Paula S. Schulz, Lani Zimmerman, Bunny Pozehl, Sue Barnason, Janet Nieveen — 2009-08-13

Abstract: The purpose of this secondary analysis was to describe symptom management strategies used by elderly patients (n = 236) 3 and 6 weeks after coronary artery bypass surgery (CABS). Three weeks after surgery, the most frequently used strategies were rest to manage shortness of breath (53%) and fatigue (53%), medications for incision pain (24%), and repositioning for swelling (35%) and sleep disturbance (18%). Overall, fewer patients experiencing sleep disturbances (39%), incision pain (39%), swelling (46%), and appetite problems (17%) reported using a strategy to manage their symptom. Nurses must assist patients in symptom identification and problem solving to accomplish effective symptom management.

The effects of an animation distraction intervention on pain response of preschool children during venipuncture - Corrected Proof

Hana Yoo, Sue Kim, Hea-Kung Hur, Hee-Soon Kim — 2009-07-16

Abstract: Objective: The purpose of this study was to identify the effects of an animation distraction intervention on pain response of preschoolers during venipuncture.Method: The research employed a nonequivalent control group pretest–posttest quasi-experimental design. The experimental group (n = 20) was provided with an animation distraction intervention using a laptop computer during their first venipuncture, and the control group (n = 20) received standard treatment.Results: There were statistically significant differences in self-reported pain response, behavioral pain response, blood cortisol, and blood glucose between the experimental group and the control group.Conclusion: This intervention requires minimum effort and time and may be a cost-effective and convenient nursing intervention that could be used easily in clinical settings.

Symptoms experienced by HIV-infected Individuals on antiretroviral therapy in KwaZulu-Natal, South Africa - Corrected Proof

2009-07-10

Abstract: Symptom management in HIV/AIDS is a critical issue that influences the quality of life of those living with the disease. Although the goals of treating the numbers living with HIV/AIDS have not yet been achieved, availability of antiretroviral therapies (ARVs) has been expanded to many clinical settings in KwaZulu-Natal, the epicenter of HIV infection in South Africa. The South African Department of Health (2007) estimates indicate that 5.54 million South Africans are living with HIV/AIDS, whereas UNAIDS (2007) estimates suggest that 18.8% of the population in South Africa is affected. Because the symptom experience may influence adherence to ARVs and quality of life, this study focused on the prevalence of symptoms reported by patients (N = 149) diagnosed with HIV/AIDS and adherence to medications and appointments. Self-report data were obtained from this community-based sample of HIV-infected patients who received care in outpatient clinics in Durban, KwaZulu-Natal, South Africa. With an average of three side effects, the most frequently reported by the study participants were fatigue/tiredness (41%), rashes (40%), headaches (32%), insomnia (31%), sadness (24%), disturbing dreams (23%), numbness (22%), pain (22%), and self-appearance (20%). On a scale of 1 to 10 (10 being worst possible), those with symptoms reported an average intensity of 4.2 (SD = 2.0), and the degree to which symptoms affected activity levels was 3.2 (SD = 2.2). Although intensity of symptoms and effects on activity levels were strongly correlated (r = .78, p < .001), there were no significant relationships between adherence and the intensity of symptoms or the relationship of symptoms with activity levels. Logistic regression analyses indicate that the presence of a greater number of symptoms was not associated with greater adherence (odds ratio = 2.27, 95% confidence interval = 0.60–8.70, ns). However, those who reported higher adherence were 1.5 times more likely to report greater physical health than low adherers (p = .04). High adherers were also 1.6 times more likely to report greater psychological health than low adherers (p = .03). This suggests that further study is needed to investigate adherence motivations for those living with HIV/AIDS in South Africa because adherence seems not to be linked to the frequency of symptoms or limitations on activity related to symptoms.

The professional self-image of registered home nurses in Flanders (Belgium): a cross-sectional questionnaire survey - Corrected Proof

2009-07-10

Abstract: Despite their necessity and relevance, studies examining the professional self-image of nurses and instruments to measure this professional self-image in the homecare setting are scarce. This study highlights both the positive self-image of home nurses and the existence of a delicate balance between the large degree of autonomy that home nurses have and the need to feel supported in their professional role and responsibility. The practice environment, including time pressure, workload, and insufficient support, needs to be addressed to keep it from having a negative impact on the professional self-image of home nurses in the long-term.

Age-related effects on symptom status and health-related quality of life in persons with HIV/AIDS - Corrected Proof

2009-07-10

Abstract: Health-related quality of life (HRQOL) is linked to symptom status and may be related to age in HIV-positive persons. Data were collected in a multisite HIV-positive sample (N = 1,217) using an HIV-specific HRQOL and three symptom status instruments according to the Wilson and Cleary HRQOL model. Multiple stepwise linear regression analysis found that younger age predicted higher sexual function (ΔR2 = .12, p < .01) and older age predicted greater provider trust (ΔR2 = .04, p < .01). No significant differences were found in symptom status or the other seven HRQOL dimensions. Although older HIV-positive persons reported more comorbidities, they did not report more symptoms.

Perspectives of staff nurses toward patient- and family-initiated call light usage and response time to call lights - Corrected Proof

Huey-Ming Tzeng — 2009-07-10

Abstract: This survey study describes nurses' perspectives about call light usage and response time. Staff perceived call lights as being patient safety related (52%) and meaningful (81.6%), and answering calls prevented them from doing the critical aspects of their role (43.8%). Staff's perspectives toward call lights should be surveyed on a regular basis.