Nursing Research
Updated: 21 hours 52 min ago
The Role of Optimism in Health-Promoting Behaviors in New Primiparous Mothers
Background: Perceived stress has been associated with fewer health-promoting behaviors in new primiparous mothers, but less is known about the mechanisms responsible for such effects.
Objective: The objective of this study was to examine the hypothesis that the relationship between perceived stress and health-promoting behaviors is mediated partially by a primiparous mother's sense of optimism. The transactional model of stress and coping and the model of behavioral self-regulation were used as the theoretical framework for the study.
Methods: An ex post facto cross-sectional design was used for this study. Participants consisted of 174 primiparous mothers who had given birth within the previous 12 months. Participants completed a self-reported online questionnaire consisting of the Perceived Stress Scale, the Health-Promoting Lifestyle Profile II, and the revised Life Orientation Test.
Results: Results indicated that perceived stress predicted less health-promoting behaviors in new primiparous mothers (p < .001). Importantly, this relationship was mediated partially by the optimism displayed by the mother (p < .001).
Conclusions: The findings indicated that optimism partially mediated the relationship between perceived stress and health-promoting behaviors in new primiparous mothers. The implications for psychological practice are discussed.
(C) 2010 Lippincott Williams & Wilkins, Inc.
Categories: Nursing
Maintenance of Activity and Eating Change After a Clinical Trial of Tailored Newsletters With Older Rural Women
Background: In the Wellness for Women Project, a randomized-by-site 1-year controlled clinical trial, the efficacy of generic newsletters and newsletters tailored on Health Promotion Model behavior-specific cognitions, eating behavior, and activity behavior were compared among 225 women aged 50 to 69 years.
Objectives: The purpose of this study was to compare the maintenance of change in healthy eating and physical activity over the 12 months following the tailored versus generic mailed newsletter intervention.
Methods: Outcomes at 18 and 24 months included behavioral markers and biomarkers of physical activity and eating. Data were analyzed using the multivariate approach to repeated measures analysis of variance and generalized estimating equations ([alpha] < .05).
Results: At 18 months, the tailored group maintained levels of all eating and activity behaviors, whereas the generic group maintained levels of fruit and vegetable servings, a moderate or greater activity, stretching exercise, lower body strength and flexibility but increased saturated fat intake and declined in weekly strength exercise and cardiorespiratory fitness. At 24 months, both groups maintained or returned to 12-month levels of all eating behaviors, moderate or greater activity, stretching exercise, and flexibility but declined in cardiorespiratory fitness; the tailored group maintained levels of strength exercise and lower body strength, whereas the generic group decreased in both. A greater proportion of women who received tailored newsletters continued to achieve most Healthy People 2010 criteria for eating and activity.
Discussion: Mailed tailored print newsletters were more efficacious than generic newsletters in facilitating maintenance of change in eating and activity for 6 months postintervention. Both tailored and generic newsletters facilitated the maintenance of change in eating behaviors and in moderate or greater physical activity and stretching exercise, whereas tailored newsletters were more efficacious in maintaining change in strength exercise for 12 months postintervention.
(C) 2010 Lippincott Williams & Wilkins, Inc.
Categories: Nursing
Shared Risk Factors for Distinct Geriatric Syndromes in Older Taiwanese Inpatients
Background: Identifying shared common risk factors of geriatric syndromes is clinically useful in designing a unified approach to optimizing geriatric care.
Objectives: The purpose of this study was to identify older Taiwanese inpatients' common shared risk factors among seven distinct geriatric syndromes: malnutrition, depression, cognitive impairment, functional dependence, incontinence, pressure ulcers, and dehydration.
Method: A cross-sectional, hospital-wide survey was conducted to enroll inpatients (N = 455) older than 65 years and admitted to 24 medical and surgical units in a 2,200-bed urbanacademic medical center in northern Taiwan. Malnutrition was defined as a Mini-Nutritional Assessment score less than 17.5, depression was defined as a Geriatric Depression Scale score more than 10, cognitive impairment was considered a Mini-Mental State Examination score less than 20, and functional dependence was defined as a Barthel Index score less than 50. Incontinence, pressure ulcers, and dehydration were extracted from patients' medical records.
Results: Participants had a mean age of 75.3 years (SD = 6.1 years, range = 65-92 years). The prevalence of geriatric syndromes ranged from 5% (pressure ulcers) to 33% (malnutrition). The selected geriatric syndromes were shown through logistic regression analysis to be predicted by female gender (odds ratio [OR] = 1.57-2.75), functional status (OR = 0.94-0.99), cognitive status (OR = 0.82-0.95), nutritional status (OR = 0.74-0.93), and depressive symptoms (OR = 1.07-1.26), supporting the notion of shared risk factors in geriatric syndromes.
Conclusions: The findings support the theory that common geriatric syndromes have a shared set of risk factors-female gender, depressive symptoms, and functional, cognitive, and nutritional status. Revising care to target these shared risk factors in preventing common geriatric syndromes is theoretically sound.
(C) 2010 Lippincott Williams & Wilkins, Inc.
Categories: Nursing
The Contribution of Hospital Nursing Leadership Styles to 30-day Patient Mortality
Background: Nursing work environment characteristics, in particular nurse and physician staffing, have been linked to patient outcomes (adverse events and patient mortality). Researchers have stressed the need for nursing leadership to advance change in healthcare organizations to create safer practice environments for patients. The relationship between styles of nursing leadership in hospitals and patient outcomes has not been well examined.
Objective: The purpose of this study was to examine the contribution of hospital nursing leadership styles to 30-day mortality after controlling for patient demographics, comorbidities, and hospital factors.
Methods: Ninety acute care hospitals in Alberta, Canada, were categorized into five styles of nursing leadership: high resonant, moderately resonant, mixed, moderately dissonant, and high dissonant. In the secondary analysis, existing data from three sources (nurses, patients, and institutions) were used to test a hypothesis that the styles of nursing leadership at the hospital level contribute to patient mortality rates.
Results: Thirty-day mortality was 7.8% in the study sample of 21,570 medical patients; rates varied across hospital categories: high resonant (5.2%), moderately resonant (7.4%), mixed (8.1%), moderately dissonant (8.8%), and high dissonant (4.3%). After controlling for patient demographics, comorbidities, and institutional and hospital nursing characteristics, nursing leadership styles explained 5.1% of 72.2% of total variance in mortality across hospitals, and high-resonant leadership was related significantly to lower mortality.
Conclusions: Hospital nursing leadership styles may contribute to 30-day mortality of patients. This relationship may be moderated by homogeneity of leadership styles, clarity of communication among leaders and healthcare providers, and work environment characteristics.
(C) 2010 Lippincott Williams & Wilkins, Inc.
Categories: Nursing
Allostatic Load and Delirium in the Hospitalized Older Adult
Background: Delirium is a state of acute confusion and iscommon in hospitalized older adults. Risk factors for delirium have been described; however, less clearly defined are the pathophysiological mechanisms that lead to the development of delirium.
Objectives: The purpose of this study was to investigate the relationship of allostatic load (AL), a cumulative measure of physiological dysregulation resulting from adaptation to acute and chronic stress, and delirium in the hospitalized older adult.
Method: In this descriptive study, participants 65 years and older admitted to the hospital were included. Participants were excluded if they had severe cognitive dysfunction or had prevalent delirium. Ten parameters reflecting physiological activity across a range of regulatory systems were measured on admission. Separate scores were calculated for primary mediators and secondary outcomes, subsets of overall AL. Incident delirium was assessed 48 to 72 hours after admission.
Results: Mean age was 75.7 years (range = 66 to 93 years). The incidence of delirium was 29%. The AL score derived from primary mediators, urinary cortisol, epinephrine and norepinephrine, and serum dehydroepiandrosterone sulfate predicted the incidence of delirium (odds ratio = 2.54, 95% confidence interval = 1.12-5.79, p <.05). The overall AL score, the score derived from secondary outcomes, and the individual AL measures were not related significantly to the incidence of delirium.
Discussion: AL has been shown to be an important construct inthe early identification of physiological dysfunction related toexposure to psychosocial and environmental stress. The findings from this study suggest that AL, particularly the primary mediators score, may be a useful measure in determining delirium risk in hospitalized older adults, leading to improved surveillance and prevention of delirium. A better understanding of AL may lead to interventions focused on reducing the impact of AL on the older adult's physiological function.
(C) 2010 Lippincott Williams & Wilkins, Inc.
Categories: Nursing
An Application of Longitudinal Analysis With Skewed Outcomes
Background: Longitudinal designs are indispensable to the study of change in outcomes over time and have an important role in health, social, and behavioral sciences. However, these designs present statistical challenges particularly related to accounting for the variance and covariance of the repeated measurements on the same participants and to modeling outcomes that are not normally distributed.
Objectives: The purpose of this study was to introduce a general methodology for longitudinal designs to address these statistical challenges and to present an example of an analysis conducted with data collected in a randomized clinical trial. In this example, the outcome of interest-monthly health-related out-of-pocket expenses incurred by breast cancer survivors-had a skewed distribution.
Methods: Common statistical approaches are for longitudinal analysis using linear and generalized linear mixed models are reviewed, and the discussed methods are applied to analyze monthly health-related out-of-pocket expenses.
Discussion: Although standard statistical software is available to conduct longitudinal analyses, training is necessary to understand and to take advantage of the various options available for model fitting. However, knowledge of the basics of the methodology allows assimilation and incorporation into practice of evidence from the numerous studies that use these designs.
(C) 2010 Lippincott Williams & Wilkins, Inc.
Categories: Nursing
The Active Balance Childhood Program for Improving Coping and Quality of Life in Chinese American Children
Background: Interventions to teach children healthy and effective coping skills could help reduce their risk of becoming overweight. However, few studies have examined whether an intervention that teaches coping strategies in weight management can influence children's coping behavior and psychosocial well-being.
Objective: The purpose of this study was to examine the efficacy of an interactive, a child-centered, and a family-based program in promoting effective coping, behavioral health, and quality of life in Chinese American children.
Methods: This study used a randomized controlled study of behavioral intervention in 67 Chinese American children (ages 8-10 years, normal weight and overweight) and their families. At baseline and 2, 6, and 8 months after baseline, children had anthropometric measurements and completed questionnaires related to coping skills and quality of life, and parents completed the Child Behavior Checklist.
Results: Children in the intervention group reported using more active coping strategies and having a higher quality of life in the physical and emotional health domains than did children in the control group during the 8-month study. Children's behavioral problems did not differ between the intervention and the control groups. Changes in coping and psychosocial well-being were not related to change in body mass index in the entire group, except increased body mass index is associated with decreased emotional quality of life.
Discussion: This culturally appropriate behavioral intervention was effective in promoting healthy coping and in improving quality of life in Chinese American children. Its utility for both optimal weight and overweight children suggests potential application of the intervention in a broad range of populations.
(C) 2010 Lippincott Williams & Wilkins, Inc.
Categories: Nursing
Testing Mediation in Nursing Research: Beyond Baron and Kenny
Background: R. M. Baron and D. A. Kenny (1986) defined mediation and described how to perform statistical tests of mediation hypotheses. Their approach to testing mediation has been used extensively in the nursing literature. However, many statisticians have identified problems with the Baron and Kenny approach.
Purpose: The aim of this paper is to critically evaluate alternative approaches to testing mediation.
Approach: The Baron and Kenny approach and its shortcomings are briefly reviewed. A critical analysis of 17 alternate methods in three categories is then presented: (a)causal steps, (b) difference in coefficients, and (c) product of coefficients. The evaluation focuses on Type I error rate control, power, ease of computation, and versatility of use.
Results: Of the methods that control Type I error rate adequately, the joint significance test of [alpha] and [beta], the asymmetric distribution of products test, and the test of the products using the percentile bootstrap method are the most powerful tests of mediation. Of these three, the joint significance test of [alpha] and [beta] is superior due to its computational ease and versatility of use.
Discussion: Knowledge development in nursing will benefit from continued research testing mediation models. Nurse researchers could move beyond the Baron and Kenny approach to utilize more robust tests of mediation.
(C) 2010 Lippincott Williams & Wilkins, Inc.
Categories: Nursing
Instrument Development Measuring Critical Care Nurses' Attitudes and Behaviors with End-of-life Care
Background: Although critical care nurses are expected to focus on providing life-sustaining measures, many intensive care patients actually receive end-of-life care.
Objectives: The aim of this study was to develop an instrument to measure nursing attitudes and behaviors regarding end-of-life care.
Method: Phase 1 was focused on item development from a content analysis of the literature and qualitative interviews of critical care nurses. Phase 2 consisted of content validity assessment and pilot testing. Phase 3 included field testing, factor analysis, and reliability estimation.
Results: The Values of Intensive Care Nurses for End-of-Life (n = 695) was found to have four factors: Self-appraisal, Appraisal of Others, Emotional Strain, and Moral Distress. Reliability estimates ([alpha]) were acceptable at .59-.78, but the interitem range (.12-.78) was wider than desirable. Test-retest reliability was deemed adequate based on Pearson's correlations (.68-.81) and intraclass correlation coefficients (.65-.79) but less so when considering [kappa] (.05-.30). The Behaviors of Intensive Care Nurses for End-of-Life (n = 682) was found to have two factors: Communication and Nursing Tasks. Reliability estimates were adequate when considering internal consistency ([alpha] = .67 and .78, respectively), item total correlations (.30-.61), and test-retest as judged by Pearson's and intraclass correlations (.77-.81) but not when [kappa] was considered (.02-.40). The interitem correlations (.20-.35) were also lower than desirable.
Discussion: Both the Values of Intensive Care Nurses for End-of-Life and the Behaviors of Intensive Care Nurses for End-of-Life were found to have conceptually linked factors and acceptable internal consistency estimates ([alpha]). However, test-retest estimates were inconsistent, suggesting that further work needs to be done on the stability of these instruments.
(C) 2010 Lippincott Williams & Wilkins, Inc.
Categories: Nursing
Supplementing Relaxation and Music for Pain After Surgery
Background: Most postoperative patients have unrelieved pain despite the use of patient-controlled analgesia. Nurses need additional effective modalities. Relaxation and music (RM), in addition to analgesics, have been shown to reduce pain more than do analgesics alone.
Objectives: The objectives of the study were to test an intervention of patient teaching for pain management (PT) and compare it with RM for immediate and general effects on postoperative pain.
Methods: Patients having abdominal surgery and receiving patient-controlled analgesia aged 18-75 years (n = 517) were randomized to four groups: PT, RM, a combination (PTRM), and a control. A 2 x 2 factorial design was used to assess PT-Effects and RM-Effects. Immediate effects on pain were measured on visual analogue sensation and distress scales before and after five 20-min tests in the first 2 days. Because participants also listened independently, general nonimmediate effects were examined at eight other times.
Results: Using multivariate analysis of covariance with contrasts and pretest control, immediate RM-Effects on pain were found at Day 1 a.m. (p < .001), Day 1 p.m. (p = .04), and Day 2 a.m. (p = .04). No PT-Effects or nonimmediate RM-Effects were found.
Discussion: Patient teaching did not result in less pain and did not support the theoretical proposition that PT reduces pain. However, the immediate RM-Effects supported the proposition that nonpharmacological adjuvants to analgesics can ease pain without adding side effects.
(C) 2010 Lippincott Williams & Wilkins, Inc.
Categories: Nursing
The Use of Interviews in Q Methodology: Card Content Analysis
Background: Although much has been published in the literature on how to perform a Q methodological study, the use of interviews within this process has received little attention.
Approach: The purpose of this review is to explore the use of interviews in a Q methodological study.
Results: An introduction to Q methodology is provided. The aims of an interview within a Q methodological study are described, and how these aims lend themselves to a particular method of analysis is explored. How to perform this analysis is outlined.
Discussion: The use of interviews can increase the validity of a Q methodological study by providing the participant's rationale for analysis of the factor arrays. When to perform the interviews is still under debate, and further study is required to determine whether the timing affects the results.
(C) 2010 Lippincott Williams & Wilkins, Inc.
Categories: Nursing
Subsequent Childbirth After a Previous Traumatic Birth
Background: Nine percent of new mothers in the United States who participated in the Listening to Mothers II Postpartum Survey screened positive for meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for posttraumatic stress disorder after childbirth. Women who have had a traumatic birth experience report fewer subsequent children and a longer length of time before their second baby. Childbirth-related posttraumatic stress disorder impacts couples' physical relationship, communication, conflict, emotions, and bonding with their children.
Objective: The purpose of this study was to describe the meaning of women's experiences of a subsequent childbirth after a previous traumatic birth.
Methods: Phenomenology was the research design used. An international sample of 35 women participated in this Internet study. Women were asked, "Please describe in as much detail as you can remember your subsequent pregnancy, labor, and delivery following your previous traumatic birth." Colaizzi's phenomenological data analysis approach was used to analyze the stories of the 35 women.
Results: Data analysis yielded four themes: (a) riding the turbulent wave of panic during pregnancy; (b) strategizing: attempts to reclaim their body and complete the journey to motherhood; (c) bringing reverence to the birthing process and empowering women; and (d) still elusive: the longed-for healing birth experience.
Discussion: Subsequent childbirth after a previous birth trauma has the potential to either heal or retraumatize women. During pregnancy, women need permission and encouragement to grieve their prior traumatic births to help remove the burden of their invisible pain.
(C) 2010 Lippincott Williams & Wilkins, Inc.
Categories: Nursing
Exploratory Analysis of Exercise Adherence Patterns With Sedentary Pregnant Women
Background: It is not well understood how sedentary women who wish to engage in regular exercise adhere to interventions during pregnancy and what factors may influence adherence over time.
Objective: The aim of this study was to examine longitudinal patterns of pregnant women's adherence to exercise.
Methods: Exploratory secondary data analyses were carried out with 124 previously sedentary pregnant women (ages 31 +/- 5 years; 85% non-Hispanic White) from a randomized controlled trial. Daily exercise logs (n = 92) from 18 through 35 weeks of gestation were explored using linear regression, functional data, and principal component analyses.
Results: Adherence decreased as gestation week increased (p < .001). The top adherers maintained levels of adherence, and the bottom adherers decreased levels of adherence. And adherence pattern was influenced by types of exercise throughout the study period.
Discussion: Exercise behavior patterns were explored in a randomized controlled trial study, using chronometric data on exercise attendance. A new analytic approach revealed that sedentary pregnant women may adopt exercise habits differently from other populations.
(C) 2010 Lippincott Williams & Wilkins, Inc.
Categories: Nursing
An Interventional Approach for Patient and Nurse Safety: A Fatigue Countermeasures Feasibility Study
Background: Studies indicate that extended shifts worked by hospital staff nurses are associated with higher risk of errors. Long work hours coupled with insufficient sleep and fatigue are even riskier. Although other industries have developed programs to reduce fatigue-related errors and injury, fatigue countermeasures program for nurses (FCMPN) are lacking.
Objectives: The objective of this study was to evaluate the feasibility of an FCMPN for improving sleep duration and quality while reducing daytime sleepiness and patient care errors. Selected sleep variables, errors and drowsy driving, were evaluated among hospital staff nurses (n = 47) before and after FCMPN implementation.
Method: A one-group pretest-posttest repeated-measures approach was used. Participants provided data 2 weeks before the FCMPN, 4 weeks after receiving the intervention, and again at 3 months after intervention.
Results: Most of the nurses experienced poor sleep quality, severe daytime sleepiness, and decreased alertness at work and while operating a motor vehicle. After the FCMPN, significant improvements were noted in sleep duration, sleep quality, alertness, and error prevention. Although significant improvements were not found in daytime sleepiness scores, severity of daytime sleepiness appeared to decrease. Despite improvements in fatigue management, nurses reported feelings of guilt when engaging in FCMPN activities, especially strategic naps and relieved breaks.
Conclusions: Initial findings support the feasibility of using an FCMPN for mitigating fatigue, improving sleep, and reducing errors among hospital staff nurses. In future investigations, the acceptability, efficacy, and effectiveness of FCMPNs can be examined.
(C) 2010 Lippincott Williams & Wilkins, Inc.
Categories: Nursing
Testing Mediation in Nursing Research: Beyond Baron and Kenny
Background: R. M. Baron and D. A. Kenny (1986) defined mediation and described how to perform statistical tests of mediation hypotheses. Their approach to testing mediation has been used extensively in the nursing literature. However, many statisticians have identified problems with the Baron and Kenny approach.
Purpose: The aim of this paper is to critically evaluate alternative approaches to testing mediation.
Approach: The Baron and Kenny approach and its shortcomings are briefly reviewed. A critical analysis of 17 alternate methods in three categories is then presented: (a)causal steps, (b) difference in coefficients, and (c) product of coefficients. The evaluation focuses on Type I error rate control, power, ease of computation, and versatility of use.
Results: Of the methods that control Type I error rate adequately, the joint significance test of [alpha] and [beta], the asymmetric distribution of products test, and the test of the products using the percentile bootstrap method are the most powerful tests of mediation. Of these three, the joint significance test of [alpha] and [beta] is superior due to its computational ease and versatility of use.
Discussion: Knowledge development in nursing will benefit from continued research testing mediation models. Nurse researchers could move beyond the Baron and Kenny approach to utilize more robust tests of mediation.
(C) 2010 Lippincott Williams & Wilkins, Inc.
Categories: Nursing
An Interventional Approach for Patient and Nurse Safety: A Fatigue Countermeasures Feasibility Study
Background: Studies indicate that extended shifts worked by hospital staff nurses are associated with higher risk of errors. Long work hours coupled with insufficient sleep and fatigue are even riskier. Although other industries have developed programs to reduce fatigue-related errors and injury, fatigue countermeasures program for nurses (FCMPN) are lacking.
Objectives: The objective of this study was to evaluate the feasibility of an FCMPN for improving sleep duration and quality while reducing daytime sleepiness and patient care errors. Selected sleep variables, errors and drowsy driving, were evaluated among hospital staff nurses (n = 47) before and after FCMPN implementation.
Method: A one-group pretest-posttest repeated-measures approach was used. Participants provided data 2 weeks before the FCMPN, 4 weeks after receiving the intervention, and again at 3 months after intervention.
Results: Most of the nurses experienced poor sleep quality, severe daytime sleepiness, and decreased alertness at work and while operating a motor vehicle. After the FCMPN, significant improvements were noted in sleep duration, sleep quality, alertness, and error prevention. Although significant improvements were not found in daytime sleepiness scores, severity of daytime sleepiness appeared to decrease. Despite improvements in fatigue management, nurses reported feelings of guilt when engaging in FCMPN activities, especially strategic naps and relieved breaks.
Conclusions: Initial findings support the feasibility of using an FCMPN for mitigating fatigue, improving sleep, and reducing errors among hospital staff nurses. In future investigations, the acceptability, efficacy, and effectiveness of FCMPNs can be examined.
(C) 2010 Lippincott Williams & Wilkins, Inc.
Categories: Nursing
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