Publications

Abstract

The aim of this paper is to expand concepts of gender and explore how behaviours associated with sexual identity affect health risks, as well as the right to sexual expression for sexual minorities and persons with disabilities, to promote safe sexual behaviour and reduce the incidence of sexually transmitted diseases, through the internationally sanctioned Sexual and Reproductive Health concept. During the XX century the multiple meanings of sexuality have been progressively recognized and its physical and psychological health dimension have become a reality, enshrined in United Nations (UN) documents. Countries have begun to adapt their legislations to this new reality and Conventions today guarantee equal sexual and reproductive rights to persons with disabilities, while the nature of variant sexual behaviours is being debated. Sexual and reproductive health is today an acknowledged goal for every individual and the right to equality for persons with variant behaviours and disabilities, as well as the coexistence of diverse meanings of sexuality an established fact. Healthy and safe sexual behaviour should become an important goal for all societies and cultures.

Abstract

The association between social network and health in older Chinese immigrants in the USA and their counterparts in China was examined using data from 177 Chinese immigrants in Boston, USA and 428 respondents in Shanghai, China. The results showed that Chinese immigrants had a significantly better self-rated health status but also that they reported a greater number of functional limitations. Although the level of the social network differed among respondents in Shanghai and in Boston, the impact of the social network on health status was similar for the two samples. The impact of the social network diminished when covariates such as health behaviors and health problems were added to the models. The conclusion, therefore, is that much of the association between a strong social network and better self-reported health in later life may be explained by other factors such as socio-economic status, health behaviors, health status, and access to health care.

Abstract

Aims and objective. To examine attitudes towards research and perceived barriers and facilitators of research utilisation in clinical practice in a broad cross-section of Spanish nurses. Background. Nurses' attitudes towards research are critical in determining whether study findings are used to improve practice. Design. Cross-sectional comparative survey in Hospitals, Primary Care Centres and University-affiliated schools of nursing. Methods. Surveys were completed by 917 nurses: 69 who received funding from the Spanish national agency (1998-2004) and a nationally representative sample of 848 nurses who did not have the same research experience (the Comparison group). Two instruments (BARRIERS and Attitudes towards nursing research) were translated and culturally adapted for use in Spain. A descriptive analysis of demographic and practice characteristics was performed. Total scale scores, as well as subscale scores, were computed and compared across the two groups using one-way analysis of variance (anova) and multivariate analysis of variance (manova) with post hoc tests. Pearson product-moment correlation coefficients were computed between the total tool scores and subscales measuring barriers and attitudes in both groups. Results. The investigators differed from other nurses on several demographic and work characteristics (more males, older age and more likely to work a fixed day shift schedule). On the whole, investigators showed more favourable attitudes but perceived several elements as posing greater barriers to research utilisation than the Comparison groups. Across all respondents, issues related to the quality of research were rated as the greatest barriers to research utilisation, followed by organisational barriers, barriers involving the communication of findings and finally, those related to nurses' values, awareness and skills. Conclusions. Very similar profiles of perceptions and attitudes regarding research were found in these samples of Spanish nurses relative to those from other countries in earlier reports. Nurses who had experience conducting research demonstrated more favourable research-related attitudes and perceived barriers differently than those without such experience. Relevance to clinical practice. Understanding different organisational and experience perspectives is important to identify challenges and opportunities to ensure research utilisation in clinical practice.

Abstract

Purpose: The mission of the California Maternal Quality Care Collaborative is to eliminate preventable maternal death and injury and to promote equitable maternity care in California. This article describes California Maternal Quality Care Collaborative's (CMQCC's) statewide multistakeholder quality improvement initiative to improve readiness, recognition, response, and reporting of maternal hemorrhage at birth and details the essential role of nurses in its success. Project Design and Approach: In partnership with the State Department of Maternal, Child, and Adolescent Health, CMQCC identified maternal hemorrhage as a significant quality improvement opportunity. CMQCC organized a multidisciplinary, multistakeholder task force to develop a strategy for addressing obstetric (OB) hemorrhage. Project Description: The OB Hemorrhage Task Force, co-chaired by nurse and physician team leaders, identified four priorities for action and developed a comprehensive hemorrhage guideline. CMQCC is using a multilevel strategy to disseminate the guideline, including an open access toolkit, a minimal support-mentoring model, a county partnership model, and a 30-hospital learning collaborative. Clinical Implications: In participating hospitals, nurses have been the primary drivers in developing both general and massive hemorrhage policies and procedures, ensuring the availability of critical supplies, organizing team debriefing after a stage 2 (or greater) hemorrhage, hosting skills stations for measuring blood loss, and running obstetric (OB) hemorrhage drills. Each of these activities requires effort and leadership skill, even in hospitals where clinicians are convinced that these changes are needed. In some hospitals, the burden to convince physicians of the value of these new practices has rested primarily upon nurses. Thus, the statewide initiative in which nurse and physician leaders work together models the value of teamwork and provides a real-time demonstration of the potential for effective interdisciplinary collaboration to make a difference in the quality of care that can be achieved. Nurses provide significant leadership in multidisciplinary, multistakeholder quality projects in California. Ensuring that nurses have the opportunity to participate in formal leadership of these teams and are represented at all workgroup levels is critical to the overall initiative. Nurses brought key understanding of operational issues within and across departments, mobilized engagement across the state through the regional perinatal programs, and developed innovative approaches to solving clinical problems during implementation. Nursing leadership and integrated participation was especially critical in considering the needs of lower-resource settings, and was essential to the toolkit's enthusiastic adoption at the unit/service level in facilities across the state.

Abstract

PURPOSE. This case study demonstrates use of standardized nursing languages in he care of new mothers in community settings. DATA SOURCES. The author collected data from clinical practice as an instructor in a baccalaureate nursing program and from the research literature. DATA SYNTHESIS. The appropriate nursing diagnoses, outcomes, and interventions were identified in partnership with the new mother. CONCLUSIONS. This case shows that NANDA International (NANDA-I), the Nursing Outcomes Classification (NOC), and the Nursing Interventions Classification (NIC) are useful to direct nursing care in community settings. IMPLICATIONS FOR NURSING. When teaching nursing students in a baccalaureate program, nurse faculty can use NANDA-I, NOC, and NIC classifications to guide the growing practice of nursing students in community settings.

Abstract

This paper is an abridged version of a knowledge synthesis undertaken to inform the proceedings of a collaborative forum of nurse leaders convened under the auspices of Health Canada, the Academy of Canadian Executive Nurses, the Canadian Nurses Association and Canada Health Infoway for the purpose of discussing the development of a nursing report card for Canada. The synthesis summarized the state of the science in the measurement of nursing-sensitive outcomes and the utilization of nursing report cards - information that informed forum participants' dialogue and planning. This condensed version of the synthesis focuses on initiatives related to outcomes and performance monitoring in nursing, including specific indicators and reporting systems and the development, implementation and utilization of nursing report cards.

Abstract

Peripheral neuropathy is one of the most common neurological complications of human immunodeficiency virus (HIV) infection and continues to impact people living with HIV/AIDS. The pain associated with peripheral neuropathy can be severe and debilitating. Most pharmacological agents are inadequate in symptom management and are accompanied by adverse side-effects. Acupuncture and moxibustion offer treatment approaches that can reduce HIV symptoms and/or the side-effects of anti-retroviral therapy and improve patients' quality of life.

Abstract

This study explored perceptions of HIV following local introduction of antiretroviral therapy (ART), among 30 HIV-positive and -negative female sex workers (FSWs) and 10 male bar patrons in Mombasa, Kenya. Semistructured interviews were analyzed qualitatively to identify determinants of sexual risk behaviors. ART was not perceived as a barrier to safer sex and in some cases led to decreased high-risk behaviors. Barriers to safer sex included economic pressure and sexual partnership types. Many women reported that negotiating condom use is more difficult in long-term partnerships. These women favored short-term partnerships to minimize risk through consistent condom use. For women living with HIV, concern about maintaining health and avoiding HIV super infection was a strong motivator of protective behaviors. For HIV-negative women, a negative HIV test was a powerful motivator. Incorporation of context- and serostatus-specific factors (e.g., self-protection for HIV-positive women) into tailored prevention counseling may support high-risk women to reduce risk behaviors.

Abstract

Background: West Virginia has the worst oral health in the United States, but the reasons for this are unclear. This pilot study explored the etiology of this disparity using culture-independent analyses to identify bacterial species associated with oral disease.Methods: Bacteria in subgingival plaque samples from twelve participants in two independent West Virginia dental-related studies were characterized using 16S rRNA gene sequencing and Human Oral Microbe Identification Microarray (HOMIM) analysis. Unifrac analysis was used to characterize phylogenetic differences between bacterial communities obtained from plaque of participants with low or high oral disease, which was further evaluated using clustering and Principal Coordinate Analysis.Results: Statistically different bacterial signatures (P < 0.001) were identified in subgingival plaque of individuals with low or high oral disease in West Virginia based on 16S rRNA gene sequencing. Low disease contained a high frequency of Veillonella and Streptococcus, with a moderate number of Capnocytophaga. High disease exhibited substantially increased bacterial diversity and included a large proportion of Clostridiales cluster bacteria (Selenomonas, Eubacterium, Dialister). Phylogenetic trees constructed using 16S rRNA gene sequencing revealed that Clostridiales were repeated colonizers in plaque associated with high oral disease, providing evidence that the oral environment is somehow influencing the bacterial signature linked to disease.Conclusions: Culture-independent analyses identified an atypical bacterial signature associated with high oral disease in West Virginians and provided evidence that the oral environment influenced this signature. Both findings provide insight into the etiology of the oral disparity in West Virginia.

Abstract

Objective: The relationship between serum 25-hydroxyvitamin D (25[OH]D) concentrations (nmol/L) and the prevalence of early age-related macular degeneration (AMD) was investigated in participants of the Carotenoids in Age-Related Eye Disease Study. Methods: Stereoscopic fundus photographs, taken from 2001 to 2004, assessed AMD status. Baseline (1994-1998) serum samples were available for 25(OH)D assays in 1313 women with complete ocular and risk factor data. Odds ratios (ORs) and 95% confidence intervals (CIs) for early AMD (n=241) of 1287 without advanced disease were estimated with logistic regression and adjusted for age, smoking, iris pigmentation, family history of AMD, cardiovascular disease, diabetes, and hormone therapy use. Results: In multivariate models, no significant relationship was observed between earlyAMDand 25(OH)D (OR for quintile 5 vs 1, 0.79; 95% CI, 0.50-1.24; P for trend=.47). A significant age interaction (P=.002) suggested selective mortality bias in women aged 75 years and older: serum 25(OH)D was associated with decreased odds of early AMD in women younger than 75 years (n=968) and increased odds in women aged 75 years or older (n=319) (OR for quintile 5 vs 1, 0.52; 95% CI, 0.29-0.91; P for trend=.02 and OR, 1.76; 95% CI, 0.77-4.13; P for trend=.05, respectively). Further adjustment for body mass index and recreational physical activity, predictors of 25(OH)D, attenuated the observed association in women younger than 75 years. Additionally, among women younger than 75 years, intake of vitamin D from foods and supplements was related to decreased odds of early AMD in multivariate models; no relationship was observed with self-reported time spent in direct sunlight. Conclusions: High serum 25(OH)D concentrations may protect against early AMD in women younger than 75 years.

Abstract

Group prenatal care (GPNC) is an innovative alternative to individual prenatal care. In this longitudinal study we used ethnographic methods to explore African American and Hispanic women's experiences of receiving GPNC in two urban clinics. Methods included individual, in-depth, semistructured interviews of women and group leaders in GPNC, participant observation of GPNC sessions, and medical record review. GPNC offered positive experiences and met many of women's expressed preferences regarding prenatal care. Six themes were identified, which represented separate aspects of women's experiences: investment, collaborative venture, a social gathering, relationships with boundaries, learning in the group, and changing self. Taken together, the themes conveyed the overall experience of GPNC. Women were especially enthusiastic about learning in groups, about their relationships with group leaders, and about having their pregnancy-related changes and fears normalized; however, there were also important boundaries on relationships between participants, and some women wished for greater privacy during physical examinations.

Abstract

Former Soviet Union (FSU) nurses in Israel and Filipino registered nurses (RNs) in the United States of America (USA) play significant roles in the delivery of health-care services in their host countries. However, little is known about how they acculturate in a different culture.Objectives:The purposes of this study were to determine the levels of and the difference in acculturation of FSU nurses in Israel and Filipino RNs in the USA.Methods:Acculturation was assessed using A Short Acculturation Scale for Filipino Americans and t-test was conducted to determine the difference in acculturation between these two groups of immigrant nurses.Findings:Results revealed that Filipino RNs have an acculturation level that leaned towards their host culture while FSU nurses have an acculturation level that was closer to their original culture than the Israeli culture and that there was a significant difference in acculturation between these two groups of immigrant nurses.Conclusions:Differences in acculturation between two predominant groups of immigrant nurses in Israel and the USA exist. Understanding the differences and the factors that affect their integration into their host cultures could be used to develop strategies to assist Filipino and FSU immigrant nurses achieve positive personal and work-related outcomes.

Abstract

Purpose: An essential component of asthma management is education. Parents often turn to the Internet, a 24-hour source of health information. Design And Methods: In this descriptive study, two researchers evaluated websites using eight core educational concepts developed by the National Heart, Blood, and Lung Institute (NHLBI) to determine the accuracy of the health information regarding asthma on the Internet. Results: Of the 68 websites reviewed, only 6 (8.8%) had accurate and complete information regarding asthma according to NHBLI recommendations. Practice Implications: Nurses must be educated regarding the selection of accurate websites on asthma so that in turn, they may educate patients and their families.

Abstract

Distal sensory peripheral neuropathy is a common neurological complication experienced by people living with the human immunodeficiency virus (HIV). Traditional Chinese medicine (TCM) may offer effective interventions in the management of its symptoms. To improve the quality and transparency of reporting acupuncture clinical trials, the Consolidated Standards of Reporting Trials (CONSORT) guidelines were developed in 1996 and the Standards for Reporting Interventions in Controlled Trials of Acupuncture (STRICTA) recommendations were introduced in 2001. Incorporating international guidelines, this paper describes the development of a RCT including rationale, design, methods, procedures and logistics for a pilot study aimed at evaluating acupuncture and moxibustion for neuropathy associated with HIV. Using STRICTA guidelines as a template, aspects of clinical research design are explored to further optimise future studies of TCM.