Publications

Abstract

BACKGROUND: Self-care is an integral component of successful heart failure (HF) management. Engaging patients in self-care can be challenging. METHODS: Fifteen patients with HF enrolled during hospitalization received a motivational intervention designed to improve HF self-care. A mixed method, pretest posttest design was used to evaluate the proportion of patients in whom the intervention was beneficial and the mechanism of effectiveness. Participants received, on average, 3.0 ± 1.5 home visits (median 3, mode 3, range 1-6) over a three-month period from an advanced practice nurse trained in motivational interviewing and family counseling. Quantitative and qualitative data were used to judge individual patients in whom the intervention produced a clinically significant improvement in HF self-care. Audiotaped intervention sessions were analyzed using qualitative methods to assess the mechanism of intervention effectiveness. RESULTS: Congruence between quantitative and qualitative judgments of improved self-care revealed that 71.4% of participants improved in self-care after receiving the intervention. Analysis of transcribed intervention sessions revealed themes of 1) communication (reflective listening, empathy); 2) making it fit (acknowledging cultural beliefs, overcoming barriers and constraints, negotiating an action plan); and, 3) bridging the transition from hospital to home (providing information, building skills, activating support resources). CONCLUSION: An intervention that incorporates the core elements of motivational interviewing may be effective in improving HF self-care, but further research is needed.

Abstract

This article provides an introduction to the field of art therapy and the potential it can offer to address the emotional needs of the frail elderly. Two case studies are discussed, and examples of artwork are provided. The case studies and artwork were created under the guidance of an art therapist at a Program of All-Inclusive Care for the Elderly (PACE) site in an urban African American community. This article explores how art making addresses the specific developmental tasks of the elderly in a culturally competent manner. Included are practical considerations in the choice of art media and directives for working with elderly clients, as well as resources for further information on the use of art in therapy.

Abstract

Objective: To evaluate the relationship between dietary lutein plus zeaxanthin and intermediate age-related macular degeneration (AMD). Design: Women aged 50 to 79 years in Iowa, Wisconsin, and Oregon with intake of lutein plus zeaxanthin above the 78th (high) and below the 28th (low) percentiles at baseline in the Women's Health Initiative Observational Study were recruited 4 to 7 years later into the Carotenoids in Age-Related Eye Disease Study (CAREDS), when the presence of AMD was determined by fundus photographs. Logistic regression analyses examined the prevalence of AMD in 1787 CAREDS participants, after accounting for potential covariates. Results: The prevalence of intermediate AMD was not statistically different between the high and low lutein plus zeaxanthin intake recruitment groups after adjusting for age (odds ratio, 0.96; 95% confidence interval, 0.75-1.23). Limiting analyses to women younger than 75 years with stable intake of lutein plus zeaxanthin, without a history of chronic diseases that are often associated with diet changes, substantially lowered odds ratios (0.57; 95% confidence interval, 0.34-0.95). Exploratory analyses of advanced AMD in 34 participants resulted in protective, but statistically nonsignificant, associations in the overall sample and in women younger than 75 years. Conclusion: Diets rich in lutein plus zeaxanthin may protect against intermediate AMD in healthy women younger than 75 years.

Abstract

Four of the five John A. Hartford Foundation Centers of Geriatric Nursing Excellence (HCGNEs) have been involved in efforts designed to improve the quality of nursing care to older adults through evidence-based Best Practice Initiatives. This article describes the important role these initiatives play in building academic geriatric nursing capacity. Building on the work of other nurse researchers, these projects attend to organizational and individual aspects of change theory, the scientific basis for practice innovations, and the role of expert consultation to support change. Best practice examples from the HCGNE demonstrate how the science involved in translating research into gerontological nursing practice has evolved, creating important educational opportunities for nursing students at all levels. In order to build academic geriatric nursing capacity, it is essential that schools of nursing help undergraduate and advanced practice nursing students develop an appreciation for how research and education can improve the care of older adults.

Abstract

OBJECTIVES: To review the available scientific literature on cancer care in nursing homes and recommendations for clinical practice and further research are offered. DATA SOURCES: Research studies and review articles. CONCLUSION: Overlooked issues for older adults with cancer in nursing homes include screening, treatment, and symptom management. Cancer care and survivorship in nursing homes receives little direct attention. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses can improve cancer care and survivorship in nursing homes by considering nursing homes as a practice venue.

Abstract

CARE+ is a tablet PC-based computer counseling tool designed to support medication adherence and secondary HIV prevention for people living with HIV. Thirty HIV+ men and women participated in our user study to assess usability and attitudes towards CARE+. We observed them using CARE+ for the first time and conducted a semi-structured interview afterwards. Our findings suggest computer counseling may reduce social bias and encourage participants to answer questions honestly. Participants felt that discussing sensitive subjects with a computer instead of a person reduced feelings of embarrassment and being judged, and promoted privacy. Results also confirm that potential users think computers can provide helpful counseling, and that many also want human counseling interaction. Our study also revealed that tablet PC-based applications are usable by our population of mixed experience computer users. Computer counseling holds great potential for providing assessment and health promotion to individuals with chronic conditions such as HIV.

Abstract

Background: Stalking is a serious public health and societal concern affecting many college women. Purpose: The purpose of this study was to explore college women's experiences of stalking. The specific aims were to compare victims and nonvictims on physical and mental health indicators and to identify lifestyle changes made in response to being stalked. Methods: In this cross-sectional design, 601 women from two universities completed a stalking questionnaire, a mental health screening tool, and an injury checklist. Data analysis included frequencies, multivariate analysis of variance, analysis of variance, and χ2 analysis. Results: A quarter of the sample reported experiencing stalking, most often by an intimate or dating partner. Individuals who reported experiencing stalking reported significantly more mental health symptoms and lower perceived physical health status than individuals who did not. Victims reported changing routines, behaviors, and activities. Conclusions: Psychiatric nurses must be knowledgeable about stalking and its impact on health. Nurses can provide support, services, and community referrals.

Abstract

OBJECTIVE: To identify evidence on the role of assertiveness and teamwork and the application of aviation industry techniques to improve patient safety for inpatient obstetric care. DATA SOURCES: Studies limited to research with humans in English language retrieved from CINAHL, PubMed, Social Science Abstracts, and Social Sciences Citation Index, and references from reviewed articles. STUDY SELECTION: A total of 13 studies were reviewed, including 5 studies of teamwork, communication, and safety attitudes in aviation; 2 studies comparing these factors in aviation and health care; and 6 studies of assertive behavior and decision making by nurses. Studies lacking methodological rigor or focusing on medication errors and deviant behavior were excluded. DATA SYNTHESIS: Pilot attitudes regarding interpersonal interaction on the flight deck predicted effective performance and were amenable to behavior-based training to improve team performance. Nursing knowledge was inconsistently accessed in decision making. Findings regarding nurse assertiveness were mixed. CONCLUSIONS: Adaptation of training concepts and safety methods from other fields will have limited impact on perinatal safety without an examination of the contextual experiences of nurses and other health care providers in working to prevent patient harm.

Abstract

In the absence of surrogate markers, the evaluation of suspected nonalcoholic fatty liver disease (NAFLD) is highly dependent on histological examination. The extent of sampling variability affecting the reliability of a single liver biopsy in patients with suspected NAFLD is poorly characterized. This prospective study aimed to correlate precise histological findings in paired biopsies - right and left lobe - in the diagnosis of NAFLD in morbidly obese subjects undergoing bariatric surgery employing both Brunt and Matteoni classifications and the NAFLD Activity Score (NAS). We also aimed to determine whether the composite histopathological findings of the two biopsies would improve diagnostic accuracy. Consecutive subjects had an intraoperative biopsy from both right and left lobes, evaluated and scored in a blinded manner. Intraobserver agreement was also assessed. Kappa coefficients of agreement were calculated. Forty-one subjects had acceptable biopsies. Agreement for steatosis was excellent and moderate for fibrosis. Concordance was only fair for most features of necroinflammation. Intraobserver agreement was only moderate for lobular inflammation. Excellent agreement was seen for the diagnosis of NASH using Brunt criteria and good agreement when using Matteoni and NAS scoring systems. Composite biopsy data particularly improved identification of hepatocyte ballooning. The diagnostic accuracy also improved substantially when composite features were compared with single-sided biopsy features, especially for the Matteoni and NAS scoring systems. In conclusion, significant sampling variability occurs in NAFLD, particularly for features of necroinflammation. This should be factored into the design of clinical trials and studies of the natural history of the disease.

Abstract

This article describes the use of nursing art to solve problems related to the management of pain in cognitively impaired persons who live in nursing homes. The result of naturalistic inquiry, the Model of Sequential Trials arose from a qualitative study of the beliefs, experiences, and behaviors of nurses managing pain in this context. The model illustrates a strategic process of evaluation, trials, reevaluation, and repeated trials that demonstrates the rationale and process underlying nursing management of pain. Future research is needed to evaluate the model's usefulness in other practice settings and in teaching clinical decision making.