Publications

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.

Abstract

OBJECTIVES: To review the quality of adverse event reporting for published randomized controlled trials (RCTs) focusing on acupuncture for pain reduction. With the release of the Consolidated Standards of Reporting Trials (CONSORT) in 2001, the quality of published RCTs has improved. To improve reporting on adverse events, CONSORT expanded the section on harms (adverse events) in 2004. This paper evaluates whether the updated harms guidelines have been implemented in RCTs evaluating acupuncture for pain relief. METHODS: Systematic searches were conducted using the following databases: MEDLINE, Allied & Complementary Medicine, Cumulative Index to Nursing & Allied Health Literature, and All EBM Reviews. Each database was searched from 2005 through 2008, corresponding to the availability of the updated harms guideline. RESULTS: Ten studies met the inclusion criteria of this review. Six of the 10 studies mentioned or discussed adverse events. Four of the 6 studies did not detail how adverse events were collected. Only 2 studies discussed how adverse events were assessed. DISCUSSION: On the basis of our findings, acupuncture clinical trials for pain reduction have yet to comprehensively meet CONSORTs guidelines for adverse event reporting. Acupuncture is commonly used by patients experiencing pain and although typically viewed as a benign and minimally invasive therapy, serious adverse events have been reported in the literature. To effectively and comprehensively document and understand these events, routine reporting according to ONSORT s harms guidelines should become the norm. Both science and patients are served by accuately evaluating the safety of acupuncture for patient populations experiencing pain.

Abstract

Alcohol-related problems are especially common among opioid treatment program (OTP) patients, suggesting that educating OTP patients about alcohol and its harmful effects needs to be a priority in OTPs. Using data collected in interviews with a nationwide U.S. sample of OTP directors (N = 200) in 25 states, we identified factors that differentiate OTPs that provided this education to all OTP patients from those that did not. Findings indicate that these factors include (1) providing this education in a greater variety of ways, (2) having a larger percent of staff knowledgeable about alcohol-related issues, (3) having a director who views alcohol issues as a high priority, and (4) having a written OTP policy.

Abstract

Consequences of the use of tobacco products claim the lives of 443,000 Americans and 5.4 million persons worldwide every year. Persons with diagnosed psychiatric illnesses, including addiction, have the highest prevalence of smoking of any population, and smoke more intensely and heavily than others. In preparation for developing a step-wide protocol for a nursing intervention, recent literature on smoking cessation with smokers and those with psychiatric diagnoses was searched. A total of 16 related or specific studies and reviews were identified and critiqued, seeking support for interventions specific to the needs and attributes of this population. Few studies either included or focused on the smoking cessation with those having diagnoses of addiction and/or other psychiatric disorders, although study populations may have included such individuals. The results of research critiques suggest that standard approaches to smoking cessation have comparable success with the general population and persons with psychiatric disorders. The need to tailor interventions to achieve continued smoking cessation, however, remains an important need. The protocol steps are supported by the evidence drawn from the research literature and best practice guidelines.

Abstract

Background. Overweight and obesity have become a global epidemic. The prevalence of overweight and obesity among U.S. adolescents has almost tripled in the last 30 years. Results from recent systematic reviews demonstrate that no single, particular intervention or strategy successfully assists overweight or obese adolescents in losing weight. An understanding of factors that influence healthy weight-loss behaviors among overweight and obese female adolescents promotes effective, multi-component weight-loss interventions. There is limited evidence demonstrating associations between demographic variables, body-mass index, and weight perception among female adolescents trying to lose weight. There is also a lack of previous studies examining the association of the accuracy of female adolescents' weight perception with their efforts to lose weight. This study, therefore, examined the associations of body-mass index, weight perception, and weight-perception accuracy with trying to lose weight and engaging in exercise as a weight-loss method among a representative sample of U.S. female adolescents. Methods. A nonexperimental, descriptive, comparative secondary analysis design was conducted using data from Wave II (1996) of the National Longitudinal Study of Adolescent Health (Add Health). Data representative of U.S. female adolescents (N = 2216) were analyzed using STATA statistical software. Descriptive statistics and survey weight logistic regression were performed to determine if demographic and independent (body-mass index, weight perception, and weight perception accuracy) variables were associated with trying to lose weight and engaging in exercise as a weight-loss method. Results. Age, Black or African American race, body-mass index, weight perception, and weight perceptions accuracy were consistently associated with the likeliness of trying to lose weight among U.S. female adolescents. Age, body-mass index, weight perception, and weight-perception accuracy were positively associated (p < 0.05) with trying to lose weight. Black/African American subjects were significantly less likely than their White counterparts to be trying to lose weight. There was no association between demographic or independent variables and engaging in exercise as a weight-loss method. Conclusions. Findings suggest that factors influencing weight-loss efforts, including age, race, body-mass index, weight perception, and weight-perception accuracy, should be incorporated into existing or new multi-component weight-loss interventions for U.S. adolescent females in order to help reduce the national epidemic of overweight and obesity among U.S. female adolescents.

Abstract

BACKGROUND: Hospices are now mandated to perform routine quality assessment under the final Medicare Hospice Conditions of Participation, creating an opportunity to explore standardized approaches to monitoring hospice quality. OBJECTIVE: We report hospice staff experiences using a standardized symptom assessment instrument, the Edmonton Symptom Assessment System (ESAS), in a pilot study designed to develop and test quality measures on symptom management. Use of the ESAS illustrates the benefits and challenges arising with standardized symptom assessment for quality monitoring in hospice. METHODS: We interviewed 24 individuals representing 8 hospices involved with the National Association for Home Care & Hospice Quality Assessment Collaborative, which pilot tested the ESAS as a source of standardized data for quality assessment. Transcripts were analyzed using the constant comparative method. RESULTS: Participants reported benefits and challenges with the ESAS. Benefits were that the ESAS was a brief and easy tool that identified areas of concern, engaged patients in symptom assessment, and monitored symptom changes over time. Additionally, the ESAS was viewed as a useful teaching tool for less experienced staff. Challenges included lack of clarity about inclusion rules and frequency of assessments; difficulty interpreting the numeric symptom rating scale, difficulty incorporating patient preferences with symptoms, and a sense that the use of standard assessment instruments was "unnatural." DISCUSSION: Recommendations to promote effective use of ESAS data for quality monitoring of hospice care include standardizing implementation procedures, adding patients' preferences to the ESAS form, and staff education to enhance comfort with the instrument before implementation.

Abstract

Purpose/Objectives: To describe the percentages of men with and without changes in sexual function from the beginning to end of radiation therapy and evaluate for differences in demographic and clinical characteristics, mood states, and quality of life (QOL) among patients who did and did not experience changes in sexual function. Design: Descriptive, longitudinal. Setting: Two radiation therapy departments in northern California. Sample: 70 men with prostate cancer who underwent primary or adjuvant radiation therapy. Methods: Self-report questionnaires, medical record reviews, and repeated measures analysis of variance. Main Research Variables: Changes in sexual function; depression, anxiety, and QOL. Findings: Patients were categorized into one of four sex groups (No Problem X 2, Problem-No Problem, No Problem-Problem, and Problem X 2) based on their responses to "Is your sexuality impacted by your illness?" at the beginning and end of radiation therapy. About 50% had a problem with sexual function either at the beginning or end of radiation therapy. Overall, men without sexual problems at both the beginning and end of radiation therapy had significantly less anxiety and depression and higher QOL scores than patients who developed a problem at the end and patients who had a problem at both time points. Conclusions: Changes in sexual function during the course of radiation therapy affect patients' mood and QOL. Implications for Nursing: Clinicians should evaluate the effects of radiation therapy on sexual function and monitor patients with prostate cancer for depression and anxiety as well as for changes in QOL.

Abstract

Injection drug use is especially risky for new injectors. To understand the social and environmental contexts in which risks occur, we interviewed individuals who had initiated injection within the past 3 years (n = 146, 69.2% male) about the circumstances and rationales for their initial injection events. Respondents typically initiated injection due to tolerance (49.3%) and/or for experimentation (61.1%). Most (86.2%) did not possess the technical skills required to self-inject, and relied on the assistance of someone older (58.5%). While low levels of syringe sharing (5.8%) were reported, a majority of respondents (60.5%) engaged in at least one type of behavioral risk. Female injectors were more likely than male injectors to rely on another individual (95.5 vs. 82.2%), often a sex partner (40.5 vs. 7.2%), for assistance. The diversity seen in early injection practices highlights the need for tailored prevention messages to reach this population prior to the onset of injection risk.

Abstract

The objective of this study was to explore infected Koreans' perceptions, knowledge, and experiences of living with a hepatitis B virus (HBV)-positive diagnosis. The qualitative, descriptive study with a purposive sampling method was utilized. Participants were recruited from hepatology outpatient clinics at an urban Korean university hospital. The findings of this study illustrate the complexity and uncertainty of living with an invisible virus once that one's HBV positive status is known. The themes highlight misunderstanding, confusion, uncertainty, and various perceptions of health management with which the patients have been living. Education of both the general public and people with HBV infection is necessary to reduce HBV infection by preventing transmission of the virus and protecting the livers of infected patients from further damage.

Abstract

Objective: Examine coping as a mediator in the relationships of spiritual well-being to mental health in Black women with type 2 diabetes (T2DM). Methods: Using a cross-sectional design, data were collected from a convenience sample of 45 Black women with T2DM. Measures of coping strategies, spiritual well-being (religious and existential well-being), and mental health, as measured by diabetes-specific distress (DSED), were collected. Bivariate findings informed mediational, trivariate model development. Results: Religious well-being was significantly related to cognitive reframing (CR) coping strategies (p = 0.026) but not DSED (p = 0.751). Existential well-being was significantly related to CR (ß = 0.575, p < 0.001), direct assistance (DA) coping (ß = 0.368, p = 0.006) and DSED (ß = -0.338, p = 0.023). Although CR (ß = -0.305, p = 0.021) and DA (ß = -0.262, p = 0.041) had significant bivariate associations with DSED, the relationships were not significant when existential well-being was controlled. However, the relationship of existential well-being to DSED was mediated by specific CR and DA strategies that were associated with DSED to varying degrees -"I came up with a couple different solutions to the problem" (ß = -0.301, p = 0.049); "I came out of the experience better than I went in" (ß = -0.308, p = 0.061); and "I talked to someone who could do something concrete about the problem" (ß = -0.272, p = 0.078). Conclusion: Findings indicate that diabetes care address spiritual well-being, both its religious and existential components, in Black women with T2DM.

Abstract

Stalking is a serious public health and societal concern affecting the college population. Although numerous studies illustrate the physical and mental effects of stalking, literature addressing how individuals cope with this phenomenon is lacking. The purpose of this study was to describe stalking experiences of college students and the coping strategies used to manage stalking. In this descriptive study, 262 college students completed an online survey that included a stalking questionnaire and coping survey. Slightly more than one-fourth of the sample (n=69) reported experiencing stalking victimization. Results indicated that the most common coping strategies employed were: ignoring the problem, minimizing the problem, distancing, detaching or depersonalizing, using verbal escape tactics, attempting to end the relationship, controlling the interaction, and restricting accessibility. Implications for refining current practice and research on coping strategies and stalking are suggested.

Abstract

Delirium affects approximately 20% to 25% of patients undergoing cardiac surgery and is particularly common in older adults. This article reviews the etiology and risk factors for delirium associated with cardiac surgery in older adults. Delirium screening, prevention, and treatment strategies, including both pharmacological and nonpharmacological therapies, are presented. Interventions appropriate in both the intensive care unit and ward settings after cardiac surgery are outlined.

Abstract

The purpose of this study is to provide an overview of development of dementia caregiving models for Chinese Americans in the U. S. This study reviewed some existing programs and interventions for Chinese dementia caregivers that were provided by service organizations and academic institutions. The recommendations for development of dementia care models include: 1) Collaborating with local community agencies that work with the Chinese population; 2) Create, maintain, and expand existing Chinese-language help-lines with individualized counseling, skills training, and support system-building services; 3) Increase caregiving information available in the Chinese language; 4) Sustain adequate funding for existing programs and services; 5) Raise public awareness through ongoing publications, media outlets, and workshops in senior housing and centers; 6) Raise health care and social service providers' awareness; and 7) Increase program evaluation effort.

Abstract

Objectives: Researchers speculate that depression tends to be more prevalent among immigrant elders due to their lack of resources, acculturation stress, language problems, and social isolation. However, other characteristics of elderly immigrants, such as the healthy immigrant effect, may counteract these potential risk factors. This study examined whether depressive symptoms differed between Chinese immigrant elders and their counterparts in China and whether health conditions were similarly associated with depressive symptoms in these two samples. Methods: Depression and health information was collected from 177 Chinese immigrant elders in Boston, the US in 2000 and from 428 education and gender-matched elders in Shanghai, China in 2003. Results: Chinese immigrants had a significantly lower score on the modified Center for Epidemiologic Studies Depression Scale (CES-D) and its subscales: somatic symptoms and depressive affect. The association remained for the subscale depressive affect in multivariate analyses. Arthritis and back or neck problems were associated with a higher level of depressive symptoms among Chinese immigrants, while problems in walking were associated with depression among their counterparts in China. Pain was an underlying contributor to the association between depression and these health problems in both the groups. Conclusions: This study suggests that Chinese immigrant elders might be more resilient than their counterparts despite many challenges they face after moving abroad. With the growing number of older Chinese immigrants in the US, a better understanding of depressive symptoms is essential to provide culturally competent services to better serve this population.

Abstract

Depressive symptoms in adolescent mothers have been associated with a variety of negative outcomes for both the adolescent mother and her child. The purpose of this article is to describe the dimensions of the Beck Depression Inventory®-II and to provide a discussion of how depression may appear in adolescent mothers. This descriptive study involved 45 adolescent mothers in a high school-based parent support program. The average score on the depression inventory for the adolescent mothers was 12.27 (SD = 8.57). One third (n = 15) of the adolescent mothers displayed depressive symptoms. All of the adolescent mothers reported experiencing increased symptoms related to loss of energy, changes in sleep patterns, changes in appetite, and tiredness/fatigue. It is important for nurses working with adolescent mothers to understand that what may be perceived as a normal adaptation to motherhood may in fact be a deeper emotional issue such as depression.

Abstract

Background. African American older adults have higher rates of self-reported disability and lower physical performance scores compared with white older adults. Measures of physical performance are used to predict future morbidity and to determine the effect of exercise. Characteristics of performance measures are not known for African American older adults. Objective. The purpose of this study was to estimate the standard error of measurement (SEM) and minimal detectable change (MDC) for the Short Physical Performance Battery (SPPB), Timed "Up & Go" Test (TUG) time, free gait speed, fast gait speed, and Six-Minute Walk Test (6MWT) distance in frail African American adults. Design. This observational measurement study used a test-retest design. Methods. Individuals were tested 2 times over a 1-week period. Demographic data collected included height, weight, number of medications, assistive device use, and Mini-Mental Status Examination (MMSE) scores. Participants then completed the 5 physical performance tests. Results. Fifty-two participants (mean age=78 years) completed the study. The average MMSE score was 25 points, and the average body mass index was 29.4 kg/m2. On average, participants took 7 medications, and the majority used assistive devices. Intraclass correlation coefficients (ICC [2,1]) were greater than .90, except for the SPPB score (ICC=.81). The SEMs were 1.2 points for the SPPB, 1.7 seconds for the TUG, 0.08 m/s for free gait speed, 0.09 m/s for fast gait speed, and 28 m for 6MWT distance. The MDC values were 2.9 points for the SPPB, 4 seconds for the TUG, 0.19 m/s for free gait speed, 0.21 m/s for fast gait speed, and 65 m for 6MWT distance. Limitations. The entire sample was from an urban area. Conclusions. The SEMs were similar to previously reported values and can be used when working with African American and white older adults. Estimates of MDC were calculated to assist in clinical interpretation.

Abstract

Purpose: Academic service partnerships (ASPs) are structured linkages between academe and service which have demonstrated higher levels of innovation. In the absence of descriptions in the literature on financial frameworks to support ASPs, the purpose of this paper is to present the supporting financial frameworks of a Swiss and a U.S. ASP. Methods: This paper used a case study approach. Results: Two frameworks are presented. The U.S. model presented consists of a variety of ASPs, all linked to the School of Nursing of the University of Pennsylvania. The structural integration and governance system is elucidated. Each ASP has its own source of revenue or grant support with the goal to be fiscally in the black. Joint appointments are used as an instrument to realize these ASPs. The Swiss ASP entails a detailed description of the financial framework of one ASP between the Institute of Nursing Science at the University of Basel and the Inselspital Bern University Hospital. Balance in the partnership, in terms of both benefit and cost between both partners, was a main principle that guided the development of the financial framework and the translation of the ASP in budgetary terms. The model builds on a number of assumptions and provides the partnership management within a simple framework for monitoring and evaluation of the progress of the partnership. Conclusions: In operationalizing an ASP, careful budgetary planning should be an integral part of the preparation and evaluation of the collaboration. The proposed Swiss and U.S. financial frameworks allow doing so. Clinical Relevance: Outcomes of care can be improved with strong nursing service and academic partnerships. Sustaining such partnerships requires attention to financial and contractual arrangements.

Abstract

Purpose: To discuss the etiology, clinical presentation, diagnosis, and management of endometriosis for the advanced practice nurse (APN) in primary care.Data sources: Selected research, clinical studies, clinical practice guidelines, and review articles.Conclusions: Commonly encountered by the APN in primary care, endometriosis is a chronic, progressive inflammatory disease characterized by endometrial lesions, cysts, fibrosis, or adhesions in the pelvic cavity, causing chronic pelvic pain and infertility in women of reproductive age. Because of its frequently normal physical examination findings, variable clinical presentations, and nonspecific, overlapping symptoms with other conditions, endometriosis can be difficult to diagnose. As there currently are no accurate noninvasive diagnostic tests specific for endometriosis, it is imperative for the APN to become knowledgeable about the etiology, clinical presentation, diagnosis, and current treatment options of this disease.Implications for practice: The APN in primary care plays an essential role in health promotion through disease management and infertility prevention by providing support and much needed information to the patient with endometriosis. APNs can also facilitate quality of care and manage treatments effectively to improve quality of life, reduce pain, and prevent further progression of disease. Practice recommendations include timely diagnosis, pain management, infertility counseling, patient education, and support for quality of life issues.

Abstract

This study explored the level of knowledge and attitudes toward hepatitis B virus (HBV) infection and vaccination of adolescents in juvenile detention facilities and in schools in South Korea. A cross-sectional comparison design with a convenient sampling method was used. Participants in the study were 301 delinquent and 410 school adolescents. The results showed that knowledge of HBV infection among juvenile detention adolescents was significantly lower but there was no difference between groups in attitudes toward infection and vaccination.