Western Journal of Nursing Research recent issues

Basic Science Is Not Nursing Research?: If It Isn't, What Is?

Holden, J. E. — Mon, 26 Oct 2009 17:01:39 PDT

Hypothalamic--Pituitary-- Adrenal Axis Dysregulation in Women With Irritable Bowel Syndrome in Response to Acute Physical Stress

FitzGerald, L. Z., Kehoe, P., Sinha, K. — Mon, 26 Oct 2009 17:01:39 PDT

Irritable bowel syndrome (IBS) supports the concept of a dysregulated hypothalamic—pituitary—adrenal (HPA) axis. This study investigates the neuroendocrine and psychological responses to the acute physical stress of a lumbar puncture (LP) in women with diarrhea-predominant IBS by assessing central and peripheral HPA activity and affective measures. Blood samples have been collected at baseline and immediately post- and 1 hr following LP from 13 women with IBS and 13 controls. Plasma adrenocorticotropic hormone (ACTH), cortisol, epinephrine, and norepinephrine levels are analyzed. A single measure of cerebrospinal fluid (CSF) concentrations of corticotropin-releasing factor (CRF_CSF) and norepinephrine_CSF is noted. Affective assessments are used to rate anxiety and depression with the Hospital Anxiety and Depression Scale (HADS) and acute mood state is rated using the Stress Symptom Rating questionnaire (stress, anxiety, anger, arousal). The women with IBS display blunted ACTH and cortisol responses to the LP along with a profile of affective responsiveness suggestive of chronic psychosocial stress, although no CRF_CSF differences between groups are observed.

Transforming Verbal Counts in Reports of Qualitative Descriptive Studies Into Numbers

Chang, Y., Voils, C. I., Sandelowski, M., Hasselblad, V., Crandell, J. L. — Mon, 26 Oct 2009 17:01:39 PDT

Reports of qualitative studies typically do not offer much information on the numbers of respondents linked to any one finding. This information may be especially useful in reports of basic, or minimally interpretive, qualitative descriptive studies focused on surveying a range of experiences in a target domain, and its lack may limit the ability to synthesize the results of such studies with quantitative results in systematic reviews. Accordingly, the authors illustrate strategies for deriving plausible ranges of respondents expressing a finding in a set of reports of basic qualitative descriptive studies on antiretroviral adherence and suggest how the results might be used. These strategies have limitations and are never appropriate for use with findings from interpretive qualitative studies. Yet they offer a temporary workaround for preserving and maximizing the value of information from basic qualitative descriptive studies for systematic reviews. They show also why quantitizing is never simply quantitative.

Academic, Social, and Behavioral Outcomes at Age 12 of Infants Born Preterm

Mon, 26 Oct 2009 17:01:39 PDT

The effects of gradient levels of perinatal morbidity on school outcomes have been investigated at age 12 in four preterm groups, classified as healthy (no medical or neurological illness), medical morbidity, neurological morbidity, and small-for-gestational-age (SGA), and a full-term comparison group. Teachers report on academic competence, social skills, and problem behaviors. Data on school type, classroom setting, and school service use are gathered from school records. Preterm groups are found to be equivalent to full-term peers in social skills and problem behavior. Preterm groups with neurological and SGA morbidity have the lowest academic competence scores. Unexpectedly, preterm infants with medical morbidity have higher academic competence scores compared with the other preterm groups. School service use increases with greater perinatal morbidity and is contingent on multiple rather than single indicators of perinatal morbidity. Continued monitoring of preterm infants through early adolescence will ensure that appropriate school services and resources are available to maximize their school success.

The Relationship Between RN Job Satisfaction and Accountability

Sorensen, E. E., Seebeck, E. D., Scherb, C. A., Specht, J. P., Loes, J. L. — Mon, 26 Oct 2009 17:01:39 PDT

The purpose of this descriptive correlational secondary data analysis is to describe the relationship between job satisfaction and accountability among registered nurses with clinical responsibilities employed by a rural health care network in the Midwest. The response rate from the primary study is 39%, with 337 RN respondents. The sample for this secondary analysis is 299. The instruments used to measure accountability and job satisfaction are the Specht and Ramler Accountability Index—Individual Referent and the McCloskey—Mueller Satisfaction Scale (MMSS). The results indicate that accountability is perceived to be relatively high and job satisfaction is moderate. Accountability and job satisfaction are significantly correlated at a moderate level. The correlations between the subscales of the MMSS and accountability are all statistically significant but low. The subscales with the highest correlations (e.g., control and responsibility, praise and recognition, professional opportunities, scheduling) provide direction for nurse administrators about important target areas for improvement.

Predictors of Self-Efficacy to Use Condoms Among Seropositive Middle-Aged African American Men

Coleman, C. L., Ball, K. — Mon, 26 Oct 2009 17:01:40 PDT

Condom use during sexual encounters continues to be a challenge for seropositive individuals. Hence, the influence of personal characteristics, AIDS knowledge, and religious well-being on perceived self-efficacy to use condoms has been examined in a convenience nonprobabilistic sample of 130 middle-aged seropositive African American men from the Mid-Atlantic region. AIDS knowledge and religious well-being are strongly related to self-efficacy to use condoms. These findings indicate that it is critical to explore further the relationship of AIDS knowledge and religious well-being with self-efficacy to use condoms.

Women in Substance Abuse Recovery: Measures of Resilience and Self-Differentiation

Sutherland, J. A., Cook, L., Stetina, P., Hernandez, C. — Mon, 26 Oct 2009 17:01:40 PDT

The National Institute of Drug Abuse has promoted drug abuse research in the past two decades focusing on women and gender differences. One hundred twenty-eight Hispanic and White women have participated in this comparative descriptive study that has examined the differences between chemically dependent (CD) women in recovery and non—chemically dependent (non-CD) women in regard to resilience and self-differentiation—demographic variables associated with resilience and self-differentiation and recovery variables associated with resilience and self-differentiation in the CD women. Findings indicate that the CD women and Hispanic women have scored significantly lower on measures of resilience and self-differentiation. Among the recovery variables, resilience and self-differentiation are significant for children support but community support is not significant. The finding that Hispanic and White women in recovery score lower on resilience and self-differentiation is important for designing treatment strategies supportive of women in recovery.

A Review of Discharge Planning Research of Older Adults 1990-2008

Popejoy, L. L., Moylan, K., Galambos, C. — Mon, 26 Oct 2009 17:01:40 PDT

This integrative review of the literature analyzed the research about hospital discharge planning within the historical timeline of public policy changes that affected service utilization. There were 36 articles reviewed that represented a variety of disciplines, nursing (n = 21), social work (n = 6), medicine (n = 5), and sociology (n = 4). The review revealed several interesting findings. Though the family is the first line of defense against problems, little work done has been done that focuses on building partnerships between patients, families, and health care providers. The costs of care drive the health care system; yet costs of interventions were rarely described. Intensive case management of at-risk populations has neither been widely adopted nor is it reimbursed through public funding, even though it has been found to be cost effective.

Using Generalized Estimating Equations to Analyze Longitudinal Data in Nursing Research

Liu, S., Dixon, J., Qiu, G., Tian, Y., McCorkle, R. — Mon, 26 Oct 2009 17:01:40 PDT

Although use of GEE has become widespread for analyzing longitudinal data in many fields, much research in nursing still uses only the traditional statistical methods. This article illustrates use of GEE, using a data set describing symptoms of women with gynecological cancers, with eight data collection times across a period of 6 months. Three research questions are analyzed: (a) Did number of symptoms in women with gynecological cancer change within 6 months after surgery? (b) Did individual symptom (e.g., pain) in women with gynecological cancers change within 6 months after surgery? (c) Were psychosocial and disease variables (age, cancer site, new diagnosis or recurrence, treatment, emotional distress, and use of symptom management toolkit) associated with individual symptoms (e.g., fatigue) in women with gynecological cancers? For each research question, SAS code and explanation of SAS instructions are described in detail. Missing data and time intervals for longitudinal studies are also discussed.

Midwest Nursing Research Society News: October

Rawl, S. M., Lusk, S. L. — Mon, 26 Oct 2009 17:01:40 PDT

Midwest Nursing Research Society News: November

Rawl, S. M., Lusk, S. L. — Mon, 26 Oct 2009 17:01:40 PDT

What Is in a Name?: Research About Case Management

Popejoy, L. — Thu, 24 Sep 2009 12:59:33 PDT

The Evidence Base for Case Management Practice

Park, E.-J., Huber, D. L., Tahan, H. A. — Thu, 24 Sep 2009 12:59:34 PDT

Little is known about the role performance of case managers, who come from a variety of professional disciplines. The purpose of this secondary analysis is to identify and compare case management (CM) activities and knowledge elements by professions and by work settings. In an online field survey conducted by the Commission for Case Manager Certification in 2004, 4,419 case managers rated the frequency and importance of 103 activities (8 domains) and 64 knowledge statements (6 domains). Nursing and social work showed a relatively similar pattern as to their role activities and knowledge factors for CM practice. Similar patterns were seen in work settings: between hospitals and rehabilitation facilities; health insurance companies and managed care organizations; and CM companies, workers’ compensation agencies, and third-party administrators. These results indicate that there is evidence for how to develop CM programs consistent with both organizational characteristics and strengths of the nursing profession.

Reducing Risk Factors for Childhood Obesity: The Tommie Smith Youth Athletic Initiative

Topp, R., Jacks, D. E., Wedig, R. T., Newman, J. L., Tobe, L., Hollingsworth, A. — Thu, 24 Sep 2009 12:59:34 PDT

This study has sought to determine if the Tommie Smith Youth Athletic Initiative (TSYAI) intervention could decrease the risk factors for childhood obesity among children 5 to 10 years of age. The TSYAI intervention is a 14-week after-school intervention for students in Grades K-5 that was started during the spring of 2008. It serves 63 children in a predominantly African American elementary school. The intervention consists of supervised after-school sessions 3 days per week. These sessions include 2 days of physical activity (flexibility, resistance, and track-and-field training) and 1 day of 45 min of nutrition education modules based on the Transtheoretical Model of behavior change followed by 45 min of group physical activity. Ninety-two percent of the participants are African American and 60% are overweight or obese (>85th percentile BMI for age and gender). The findings indicate that the TSYAI intervention significantly improves the participant’s cardiovascular fitness, body composition, and dietary habits.

Psychological and Biological Correlates of Fatigue After Mild-to-Moderate Traumatic Brain Injury

Bay, E., Xie, Y. — Thu, 24 Sep 2009 12:59:34 PDT

Relationships between chronic perceived stress, cortisol response (area under the curve) and posttraumatic brain injury fatigue were examined with persons from outpatient settings. Seventy-five injured persons with traumatic brain injury and their relatives/significant others participated in this cross-sectional study. Using interviews and self-reported data from the Neurofunctional Behavioral Inventory, the Perceived Stress Scale, the Profile of Mood States-Fatigue subscale, the McGill Pain Scale, as well as self-collection of salivary cortisol over a 12-hour period ( N = 50), we found that perceived chronic stress explained 40% of the variance in fatigue until depressive symptoms and pain were in the model. Hypocortisolemia was evident. Somatic symptom frequency and perceived chronic stress represented 50% of the variability in post-TBI fatigue. Fatigue and stress management interventions, as suggested in the Centers for Disease Control Acute Concussion guidelines, may be beneficial in reducing this common symptom.

Male Adolescent Sexual Behavior: What They Know and What They Wish They Had Known

Collins, J. L., Champion, J. D. — Thu, 24 Sep 2009 12:59:34 PDT

There is a need to involve sexual partners when addressing sexual behavior of high-risk adolescent women. This study explored men’s perceptions of their role in sexual relationships with adolescent women with a history of sexually transmitted infection (STI) and abuse. The AIDS risk reduction model was used to assess sexual risk behaviors of these men for development of cognitive behavioral risk reduction interventions for themselves and partner. Qualitative interviews were conducted with African and Mexican American men (n = 14; ages 18 to 21 years), recruited via adolescent women enrolled in a control-randomized trial of behavioral interventions for reduction of unintended pregnancy, abuse, substance use, and STI. Participants varied in their perceptions of personal susceptibility to STI or HIV, access to informational resources regarding sexual behavior, and level of adult support for safer sexual behavior. These men shared perceptions of inadequate sexual health preparation, including education concerning risk, ultimately contributing to adverse outcomes of sexual behavior.

The Effects of Integrative Reminiscence on Depressive Symptoms in Older African Americans

Shellman, J. M., Mokel, M., Hewitt, N. — Thu, 24 Sep 2009 12:59:34 PDT

The purpose of this pilot study was to evaluate the effect of integrative reminiscence on depressive symptoms in older African Americans. Fifty-six community-dwelling participants from a northeast urban setting were randomized into a reminiscence intervention group (n = 19), attention control group (health education; n = 19), or true control group (n = 18). Data were collected pre- and posttest using the Center for Epidemiological Studies Depression Scale. Significant differences were found between groups, F(2, 52) = 8.6, p = .001, ² = .10. Using Holm’s method of post hoc analysis, the mean score for the reminiscence group was 6.8 (SD = 4.7), significantly different from the control group 14.6 (SD = 10.1) and the health education group 11.7 (SD = 7.1). Findings demonstrate that integrative reminiscence has a positive effect on decreasing depressive symptoms in older African Americans.

Correlates of Heavy Smoking Among Alcohol-Using Methadone Maintenance Clients

Nyamathi, A. M., Sinha, K., Marfisee, M., Cohen, A., Greengold, B., Leake, B. — Thu, 24 Sep 2009 12:59:34 PDT

This cross-sectional study examines predictors of heavy smoking among 256 male and female methadone maintenance therapy (MMT) clients from five MMT clinics in the Los Angeles area. The authors find that women report lower rates of heavy smoking than men (47% vs. 54%, respectively), in concordance with current literature pointing to gender differences in smoking behaviors. In particular, men who report heavy drinking, fair or poor health, and recent heroin use are more likely to report heavy smoking compared with men not reporting these factors. Women who report recent heroin use, a lifetime history of sex trade, and who have been ill enough to require a blood transfusion also have greater odds of reporting heavy cigarette smoking. Findings from this study may aid not only in designing gender-based smoking cessation programs for MMT clients but also in addressing the gender-based issues related to smoking in such a population.

Factor Structure of the Denyes Self Care Practice Instrument (DSCPI-90(C))

Andrews, D. R., Richard, D., Aroian, K. — Thu, 24 Sep 2009 12:59:34 PDT

This study evaluates the factor structure and concurrent validity of a measure of self-care, the Denyes Self Care Practice Instrument (DSCPI-90©), when used with adults. Three hundred eight participants complete the 18-item DSCPI-90© and a measure of general health status. Data are examined using descriptive statistics, exploratory factor analysis, and correlation. An efficient 12-item, two-factor model is identified. Reducing the number of items from 18 to 12 does not have an untoward effect on either scale reliability or the amount of variance explained. Correlations with a measure of health status are modest, lending validity to the construct of self-care as being distinct from, yet related to, health status. It is concluded that the 12-item version of the DSCPI© is reliable and valid when used with adults.

Getting to the Heart of the Matter: Gender Differences in Cardiac Disease

Conn, V. S. — Wed, 29 Jul 2009 09:46:17 PDT

Influence of Assessment Methods on Reports of Gender Differences in AMI Symptoms

Ju Young Shin, , Martin, R., Bryant Howren, M. — Wed, 29 Jul 2009 09:46:17 PDT

The purpose of this secondary analysis was to compare gender differences in retrospective reports of acute myocardial infarction (AMI) symptoms resulting from two different assessment methods: the open-ended inquiry and the combined assessment approach. Women reported more atypical symptoms in their responses to the open-ended inquiry and a greater number of typical, atypical, and total symptoms in the combined assessment approach in which the open-ended inquiry was followed by a series of closed-ended questions. Women reported more jaw/neck pain, dyspnea, and palpitations in response to the open-ended inquiry. In the combined assessment, men reported more chest pain/discomfort than women, whereas women were more likely to report jaw/neck pain, dyspnea, back pain, fatigue, paroxysmal nocturnal dyspnea, and palpitations. The data suggest that careful attention to the type of questions used to assess AMI symptoms could lead to more definitive conclusions regarding gender differences in AMI symptoms.

Organizational Traits, Care Processes, and Burnout Among Chronic Hemodialysis Nurses

Flynn, L., Thomas-Hawkins, C., Clarke, S. P. — Wed, 29 Jul 2009 09:46:17 PDT

In light of evidence linking registered nurse (RN) staffing levels to patient outcomes in chronic hemodialysis facilities, U.S. government regulations have set minimum RN staffing requirements during dialysis. Consequently, facility administrators are focused on decreasing nurse attrition in this crucial practice setting. This study used a cross-sectional, correlational design to investigate the effects of workload, practice environment, and care processes on burnout among nurses in U.S. chronic hemodialysis centers and to determine the association between burnout and nurses' intentions to leave their jobs. Findings indicate that predictors were associated with an increased likelihood of nurse burnout and that nurses experiencing burnout were more likely to be planning to leave their jobs. Findings have important implications for retention of nurses, enhancement of patient safety, and adherence to new federal staffing requirements in chronic hemodialysis units.

Using Spirituality to Cope With Early-Stage Alzheimer's Disease

Beuscher, L., Grando, V. T. — Wed, 29 Jul 2009 09:46:17 PDT

Alzheimer's disease (AD) robs persons living with the disease of their independence and self-esteem, which can lead to depression, anxiety, and loneliness. Understanding how people with early-stage AD cope is a critical step in enhancing their adaptive abilities and ultimately improving their quality of life. This qualitative study describes how individuals with early-stage AD use spirituality to cope with the losses of self-esteem, independence, and social interaction that they face. The purposive sample for this focused ethnographic study consisted of 15 participants living at home in central Arkansas. Holding onto faith, seeking reassurance and hope, and staying connected were the global themes. Personal faith, prayer, connection to church, and family support enhanced the ability of people with early-stage AD to keep a positive attitude as they face living with AD.

Severe Fatigue and Depressive Symptoms in Lower-Income Urban Postpartum Women

Doering Runquist, J. J., Morin, K., Stetzer, F. C. — Wed, 29 Jul 2009 09:46:17 PDT

The purpose of this study was to identify whether severe postpartum fatigue at 1 and 3 months postpartum was associated with depressive symptomatology at 6 months in lower-income urban women. A convenience sample of 43 lower-income postpartum women completed the Modified Fatigue Symptoms Checklist and Edinburgh Postpartum Depression scale at 1, 3, and 6 months postpartum. Participants who were severely fatigued at both 1 and 3 months postpartum were significantly more likely to exhibit depressive symptomatology at 6 months. Fatigue and depressive symptoms were moderately to strongly correlated at 1 (r = .68), 3 (r = .74), and 6 (r = .70) months postpartum (p = .001). Severe fatigue and depressive symptomatology often co-exist for months after childbirth. Future research should examine whether interventions to targeting severe postpartum fatigue in lower-income urban women may also effectively reduce depressive symptoms.

Doing What's Best: Decisions by Families of Acutely Ill Nursing Home Residents

Palan Lopez, R. — Wed, 29 Jul 2009 09:46:17 PDT

When nursing home residents experience acute illness, the preference of family members is a major consideration in the choice between aggressive treatment and palliative care. Grounded theory method was used to explore decision making by family members of acutely ill nursing home residents. Analysis of 12 in-depth interviews with family members resulted in a theory, "doing what's best," that describes the basic psychosocial problem and response of family members. The problem was to make treatment decisions in the face of uncertain circumstances, and the response consisted of five subprocesses: protecting life, creating comfort, relying on religion, honoring wishes, and seeking guidance. Application of this theory to nursing practice can help nurses identify sources of uncertainty and support family members to clarify priorities for life prolongation or comfort, rely on religious or spiritual solace, translate resident wishes into individualized care plans, and provide knowledgeable guidance and support throughout the decision-making process.

Health Literacy Self-Management by Patients With Type 2 Diabetes and Stage 3 Chronic Kidney Disease

Sakraida, T. J., Robinson, M. V. — Wed, 29 Jul 2009 09:46:17 PDT

This is a qualitative study report from a parent study that used a concurrent mixed methods design whose aim was to describe the transition and self-management experiences of patients diagnosed with type 2 diabetes mellitus (T2DM) and stage 3 chronic kidney disease (CKD). Six adult men and women recruited from outpatient clinics completed two focus group interviews. Discerned in the ethnographic analysis of interviews and field notes using ATLAS/ti was a pattern of Health Literacy Self-Management with two major threads: (a) transition experience to self-advocacy characterized as seeking useful resources and difficulties in resource use and (b) partnering with the health care provider (HCP) characterized as helpful messaging and messaging confusion. Self-management support includes a shared responsibility and developmental process by the patient and the HCP to achieve quality care. Description of behavioral factors and self-management processes provides a foundation for future study.

Feasibility of an Internet Physical Activity Intervention

Bosak, K. A., Yates, B., Pozehl, B. — Wed, 29 Jul 2009 09:46:17 PDT

The Internet is a relatively new method of delivering strategies for health behavior change. The purpose of this study was to determine the feasibility of delivering a physical activity intervention by the Internet to improve outcomes in adults with the metabolic syndrome. Twenty-two participants (16 males; 6 females) were recruited from a cardiology clinic database, age range 32-66 years. Participants were randomly assigned to the Internet intervention (n = 12) or the usual care ( n = 10) group. The mean total dose, in terms of the time the intervention Web site was accessed was 2 hours over 6 weeks, which was greater than the time spent delivering usual care. Overall, participants' evaluations of the Internet intervention were positive. The costs of development and delivery of the Internet intervention were less than that of a consultation and follow-up in the cardiology clinic for this sample. The Internet intervention appears feasible for testing in a larger study.

Validity of the Nursing Child Assessment Feeding Scale During Toddlerhood

Hodges, E. A., Houck, G. M., Kindermann, T. — Wed, 29 Jul 2009 09:46:18 PDT

This study examined the validity of the Nursing Child Assessment of Feeding Scale (NCAFS) during toddlerhood, using a longitudinal design to assess the scale's convergence with the Toddler Snack Scale (TSS) between 12 and 36 months, and comparing videotaped interactions of 116 mother—toddler dyads. Differences between TSS mutuality classifications were found for the NCAFS subscales at each age. The pattern of mean scores followed expected directions at 12 and 36 months, but only two of the six NCAFS subscales maintained this pattern at 24 months. Significant differences were found between TSS mutuality classifications and NCAFS dyadic scores at each age. With one exception, "connected" and "marginal" dyads had consistently higher dyadic scores than dyads classified as "poor" in mutuality. There were no differences between connected and marginal dyads. The NCAFS does not appear to capture control-autonomy balance as well as the TSS, and a revision for toddlerhood may be needed.

Commentary by Li

Li, C.-Y. — Wed, 29 Jul 2009 09:46:18 PDT

Response by Hawranik, Johnston, and Deatrich

Wed, 29 Jul 2009 09:46:18 PDT

Midwest Nursing Research Society News: The Midwest Nursing Research Society Advances the Scientific Basis of Nursing Practice and Promotes Development of Nurse Scientists

Rawl, S. M., Lusk, S. L. — Wed, 29 Jul 2009 09:46:18 PDT

Celebrity Endorsement of Meta-Analysis?

Conn, V. S. — Thu, 30 Apr 2009 11:08:29 PDT

A Meta-Analysis of Aerobic Exercise Interventions for Women With Breast Cancer

Kim, C.-J., Kang, D.-H., Park, J.-W. — Thu, 30 Apr 2009 11:08:29 PDT

The purpose of this meta-analysis was to examine the effectiveness of aerobic exercise interventions on cardiopulmonary function and body composition in women with breast cancer. Of 24 relevant studies reviewed, 10 studies (N = 588) met the inclusion criteria. The findings indicated that aerobic exercise significantly improved cardiopulmonary function as assessed by absolute VO₂ peak (standardized mean difference [SMD] .916, p < .001), relative VO₂ peak (SMD .424, p < .05), and 12-minute walk test ( SMD .502, p < .001). Similarly, aerobic exercise significantly improved body composition as assessed by percentage body fat (SMD —.890, p < .001), but body weight and lean body mass did not change significantly. Aerobic exercise during or after cancer adjuvant therapy seems to be an effective means of improving cardiopulmonary function and decreasing percentage body fat in women with breast cancer. Further studies are needed to examine the long-term benefits of aerobic exercise.

Reasons for Relocation to Retirement Communities: A Qualitative Study

Bekhet, A. K., Zauszniewski, J. A., Nakhla, W. E. — Thu, 30 Apr 2009 11:08:29 PDT

The purpose of this qualitative study is to understand the reasons why elders move to retirement communities and what living in retirement communities is like from the perspective of relocated elders. Several themes emerged following qualitative analysis. The themes reflect three categories, labeled as "pushing" factors, "pulling" factors, and "overlapping" factors. Pushing factors included own or spouse's failing health, getting rid of responsibilities, not helped, facility closed out, and loneliness. Pulling factors were location, familiarity and reputation of the facility, security, and joining friends. The third category reflected both pushing and pulling factors, which overlapped and constituted their reason for moving. The findings help to inform the planning of tailored interventions to address elders' special needs or concerns associated with relocation.

The Nursing Practice Environment and Nurse-Perceived Quality of Geriatric Care in Hospitals

Kim, H., Capezuti, E., Boltz, M., Fairchild, S. — Thu, 30 Apr 2009 11:08:29 PDT

The relationships between general and geriatric-specific nursing practice environments (NPEs) and nurse-perceived quality of geriatric care in hospitals were examined using the Nurses Improving Care for Healthsystems Elders benchmarking database. The overall general NPE was negatively related, but the overall geriatric-specific NPE was positively related to quality of geriatric care. Among five subdomains of the general NPE measured by the Practice Environment Scale of the Nursing Work Index, Nurse Participation in Hospital Affairs was positively related to quality of geriatric care, whereas two subdomains were not significant, and another two were negatively related to quality of geriatric care. All three subdomains of the geriatric-specific NPE measured by the Geriatric Nursing Practice Environment scale were positively related to quality of geriatric care when adjusting for general NPE. These findings suggest geriatric-specific organizational support combined with nurse involvement in hospital decision making is critical for delivering quality geriatric care.

Nursing Roles in End-of-Life Decision Making in Critical Care Settings

Bach, V., Ploeg, J., Black, M. — Thu, 30 Apr 2009 11:08:29 PDT

This study used a grounded theory approach to formulate a conceptual framework of the nursing role in end-of-life decision making in a critical care setting. Fourteen nurses from an intensive care unit and cardio-respiratory care unit were interviewed. The core concept, Supporting the Journey, became evident in four major themes: Being There, A Voice to Speak Up, Enable Coming to Terms, and Helping to Let Go. Nurses described being present with patients and families to validate feelings and give emotional support. Nursing work, while bridging the journey between life and death, imparted strength and resilience and helped overcome barriers to ensure that patients received holistic care. The conceptual framework challenges nurses to be present with patients and families at the end of life, clarify and interpret information, and help families come to terms with end-of-life decisions and release their loved ones.

A Qualitative Examination of the Factors That Influence Women's Quality of Life as They Live With Coronary Artery Disease

Norris, C. M., King, K. — Thu, 30 Apr 2009 11:08:29 PDT

The purpose of this study is understanding women's experiences regarding health-related quality of life (HRQOL) in the context of living with coronary artery disease (CAD). Sampling was purposive and continued until data saturation. The women participated in semistructured interviews that were tape-recorded and completed in less than 1 hour. Conventional content analysis was used to analyze the data. Results indicate that CAD influenced the participants' HRQOL. This occurred through categories the investigators labeled "dealing with one more thing," "surrendering roles and pleasures," "managing the health system," "understanding CAD," and "resolving to be strong." The thoughtful responses of the women in this study suggest that understanding the HRQOL of women who have CAD lies in the context of considering their quality and quantity of social support. Thus, it behooves health care providers to assess patients' levels of social support and intervene as appropriate.

Correlates of Hospitalization for Alcohol-Using Methadone-Maintained Persons With Physical Health Problems

Thu, 30 Apr 2009 11:08:29 PDT

This cross-sectional study (n = 190) examined correlates of hospitalization for physical health problems among methadone maintenance therapy (MMT) clients with a history of alcohol abuse. The study was derived from baseline data collected for a longitudinal trial assessing the effect of motivational interviewing among alcohol-abusing adults undergoing MMT. The sample included clients who were 18-55 years of age, abusing alcohol, and receiving MMT from five large methadone maintenance clinics in the Los Angeles area. A structured questionnaire was used to collect the data. Correlates of hospitalization in logistic regression analysis included lack of social support, recent victimization, age of first alcohol use, chronic severe pain in the previous 6 months, not having children, and ethnicity. Identification of hospitalization risk factors among alcohol-abusing MMT clients is a first step to developing risk-reducing interventions designed to lower hospitalization rates in this population.

Midwest Nursing Research Society News

Lusk, S. L., Rawl, S. M. — Thu, 30 Apr 2009 11:08:29 PDT