bluuebunny/crossref_metadata_2025 huggingface dataset:
Nursing and Health Policy
Authors: Gebbie Kristine M. , Wakefield Mary , Kerfoot Karlene
Published: April 2004

Purpose: To describe ways nurses are and are not effective in the development of health policy in the United States today, and to provide useful information for those interested in making nursing a more vital part of the policy arena.

Design: Qualitative examination of the career experiences and observations of a purposive sample of 27 American nurses currently active in health policy at the national, state, local, or organizational level.

Method: Semi‐structured interviews regarding career path, contributing resources improvement of resources available to nurses, and the strengths and weaknesses of currently available information for policy work.

Findings: For nurse participants, policy involvement meant speaking for patients in arenas where those need of care have limited voice. Participation occured after assessment, diagnosis, and planning revealed the need for change in the way resources were allocated. Strong belief in the capacity and importance of people caring for themselves distinguished nurses in their policy roles. Policy makers responded to the experiences and determinants of health and illness as presented by nurses.

Conclusion: Once engaged, nurses seldom turned their backs on the world of policy‐making. However, they did not report significant use of nursing research or information in policy making. Further investigation and testing of systems to connect nurse policymakers with nurse scholars are recommended.
Effects of Home Visits to Vulnerable Young Families
Authors: Kearney Margaret H. , York Ruth , Deatrick Janet A.
Published: April 2004

Purpose:Nurses' home visits to new parents have been replaced in many high‐need communities by nonprofessional visits without clear evidence of effectiveness. Previous reviews of home visiting research have combined nurse and non‐nurse interventions and have pooled studies from the US, where home visiting is mainly limited to low‐income families, with those from nations where home visiting is a universal service. This integrative review was focused on nurse‐delivered interventions in the US and Canada to identify the nursing‐specific models with the greatest effect in this cultural context. Evaluation of support for social ecology theory was a secondary aim.

Design:The sample consisted of 20 experimental and quasi‐experimental studies of home nursing interventions for families of newborn infants who were vulnerable because of poverty, social risks, or prematurity.

Methods:Each report was examined systematically using specific rules of inference and a scoring system for methodological quality. Intervention effects on five outcome domains were described.

Findings:Maternal outcomes, maternal‐infant interaction, and parenting were more often influenced than was child development, except in preterm infants. Well‐child health care did not improve. Effective programs generally began in pregnancy, included frequent visits for more than a year, had well‐educated nurses, and were focused on building a trusting relationship and coaching maternal‐infant interaction. Social ecology theory was partially supported.

Conclusions:Future nurse home‐visiting research should test a combination of these effective components. Nurses can use this information to seek funding of nurse‐delivered interventions for vulnerable families.
Diffusion of the Concept of Patient Advocacy
Authors: Mallik Maggie , Rafferty Anne Marie
Published: April 2004

Purpose: To examine the growth and diffusion through the USA and UK literature of nurses' claims to patient advocacy.

Design: A bibliometric analysis of articles cited under the key descriptor “patient advocacy” in the International Nursing Index (INI) was undertaken. Analysis included output in 5‐year accumulations from 1976 to 1995, and was focused on quantity of output and exposition of concerns through interpretation of the titles. Citation mapping was undertaken to trace dominant influences in the diffusion process.

Methods: Titles and countries of origin of the journal along with year of publication were organized into a database to provide quantitative material on comparative output from the USA and the UK. Citation profiles of key influencing authors were examined.

Findings: A role in patient advocacy was proposed in the American nursing literature in the late 1970s and in the British literature a decade later. Support for the role was evident in its use in professional organizations and schools. The pattern of dissemination illustrates the influence of American nursing on the professional role of nurses in the UK.

Conclusions: On the basis of a stages model for diffusion of an innovation, patient advocacy has reached only preliminary stages of acceptance as an innovation in nursing.
Recognizing and Labeling Sex‐based and Sexual Harassment in the Health Care Workplace
Authors: Madison Jeanne , Minichiello Victor
Published: April 2004

Purpose: To explore how registered nurses (RNs) recognized and labeled incidents of sex‐based and sexual harassment in the Australian health care workplace.

Design: Qualitative, using 16 unstructured interviews with registered nurses in Australia.

Methods: Verbatim transcripts were analyzed largely by inductive analysis. Key categories were identified as themes or concepts for analysis.

Findings: RNs reported several indicators of sexual harassment, including the invasion of space, confirmation from others, lack of respect, the deliberate nature of the behavior, perceived power or control, overly friendly behavior, and a sexualized workplace. RNs rarely labeled harassing behaviors as sex‐based or sexual harassment.

Conclusions: Many forces reduce the likelihood that RNs will correctly recognize and label unwelcome sexualized behavior as sexual harassment. Recognition is associated with a variety of workplace behaviors that sometimes precede harassment. Implications for the health care workplace are discussed.
Issues in Cross‐cultural Quality‐of‐Life Research
Authors: Corless Inge B. , Nicholas Patrice Kenneally , Nokes Kathleen M.
Published: April 2004

Purpose: To examine cross‐cultural measurement of quality of life (QOL) and issues to consider in adapting quality‐of‐life instruments.

Organizing Construct: Health‐related quality of life.

Methods: Review of the literature on cross‐cultural QOL using the Cumulative Index to Nursing & Allied Health Literature (CINAHL), 1982 to February 2000, and Medline, 1966 to May 2000, databases.

Findings: Use of research instruments beyond the samples with which they were initially tested, particularly if the new samples are cross‐cultural, presents considerable challenges. The findings indicate consideration of these problems: phenomenon of interest, cross‐cultural versus cross‐national, salience, conceptual equivalence, cultural hegemony versus cultural validity, cultural equivalence versus verbal equivalence, fidelity versus appropriateness, privacy versus disclosure, appropriateness of format, and resource utilization for translation. Although the literature indicates increased discussion of theoretical, conceptual, and operational approaches to measuring cross‐cultural QOL, problems continue in adapting instruments from one culture to another.

Conclusions: Many issues about cross‐cultural QOL were identified. By addressing these issues, researchers can develop appropriately translated and validated quality‐of‐life instruments to advance knowledge about cross‐cultural QOL.
Unresolved Feelings of Guilt and Shame in the Maternal Role With Substance‐Dependent African American Women
Authors: Ehrmin Joanne T.
Published: April 2004

Purpose: To identify care needs of African American women residing in an inner‐city transitional home for substance abuse, with the goal of facilitating their ability to move successfully through treatment and recovery.

Design: Ethnography. The convenience sample consisted of 12 key participants and 18 general participants. Data were collected 1996–1998.

Method: Participant observation and focused interviews were used to collect data. Participants were asked open‐ended questions designed to determine their care needs as they experienced treatment and recovery for substance abuse.

Findings: Unresolved feelings of guilt and shame associated with perceptions of failure in the maternal role during their active addiction were discovered to be critical issue and possible barrier to successful treatment for African American women in a residential program for treatment of substance abuse.

Conclusions: Unresolved feelings of guilt and shame associated with consequences of the use and abuse of substances, particularly with perceptions of failure in the maternal role, could serve as barriers to successful treatment and recovery for substance‐dependent African American women. Nursing actions designed to facilitate healing with these women could offer the potential for improved maternal and child health and well being.
Application of Leventhal's Self‐Regulation Model to Chinese Immigrants With Type 2 Diabetes
Authors: Jayne Rae L. , Rankin Sally H.
Published: April 2004

Purpose and Background: To demonstrate the application of Leventhal's Self‐Regulation Model with a group of Chinese immigrants with type 2 diabetes.

Design and Methods: Using qualitative methods and a convenience sample of 30 Chinese immigrants, interviews were analyzed by categorizing data according to the components of the Leventhal model. Participants were recruited from a U.S. West Coast Chinatown health center and were interviewed to identify beliefs about health and illness that are shaped by cultural factors.

Findings: Application of the self‐regulation model indicated that participants were unclear about the etiology and chronicity of diabetes and interpreted the illness as stigmatizing. Coping strategies included wishful thinking, belief in powerful others, keeping diabetes a secret, and avoiding social situations. Participants lacked the ability to appraise the effects of their coping strategies.

Conclusions: Health care providers can help people with type 2 diabetes develop critical‐thinking strategies instead of relying on sets of rules to gain control of blood glucose levels. The self‐regulation model was useful in profiling a vulnerable group whose diabetes management, social environment, and self‐image could be improved through thoughtful patient education strategies.
Ethics in Qualitative Research
Authors: Orb Angelica , Eisenhauer Laurel , Wynaden Dianne
Published: April 2004

Purpose: To critically examine ethical issues in qualitative research.

Organizing Construct: The ethical principles of autonomy, beneficence, and justice are guides for researchers to address initial and ongoing tensions between the needs and goals of the research and the rights of participants.

Methods: Research literature, ethics literature, and researcher experiences.

Conclusions: Ethical principles can be used to guide the research in addressing the initial and ongoing issues arising from qualitative research in order to meet the goals of the research as well as to maintain the rights of the research participants.
African American Women's Experiences with Breast Cancer Screening
Authors: Phillips Janice M. , Cohen Marlene Zichi , Tarzian Anita J.
Published: April 2004

Purpose: To describe the experience and meaning of breast cancer screening for African American women. Breast cancer screening offers the greatest hope of reducing breast cancer mortality and improving breast cancer outcomes. Despite the proliferation of initiatives targeting African American women, they continue to be first diagnosed only when they have late‐stage disease.

Design and Methods: Using hermeneutic phenomenological research methods, 23 low‐and middle‐income African American women were interviewed to gain an understanding of their experiences with breast cancer screening.

Findings: Participants varied in their experiences with breast cancer screening. Women spoke of a desire for a holistic approach to health that did not separate the breast from the rest of the body. This desire is indicated in the theme of minding the body, self, and spirit, along with themes of relationships and spreading the word about breast health issues.

Conclusions: Interventions for African American women should include a focus on minding the body, self, and spirit to promote breast cancer screening, and should indicate the importance of relationships and spreading the word about breast cancer screening.
Are Nurses Adequately Prepared for End‐of‐Life Care?
Authors: White Kenneth R. , Coyne Patrick J. , Patel Urvashi B.
Published: April 2004

Purpose: To determine end‐of‐life (EOL) care core competencies and educational needs from practicing oncology nurses and to describe the characteristics of the respondents that are associated with selection of the leading core competencies.

Design and Methods: A researcher‐developed mailed descriptive survey to members of the Oncology Nursing Society in Georgia, Virginia, Washington, and Wisconsin in late 1999.

Findings: Nearly all respondents indicated that EOL care was a part of their practice and that continuing education was important, but one‐third of the respondents had less than 2 hours of continuing education in 2 years. How to talk to patients and families about dying was the top‐rated core competency, consistent across age, educational level, practice role, and practice setting. Pain control and comfort care were also frequently selected as important EOL care issues about which more education is needed.

Conclusions: Results show guidelines for improving educational curricula and considering characteristics of nurses when planning EOL educational programs.
A Representational Approach to Patient Education
Authors: Donovan Heidi Scharf , Ward Sandra
Published: April 2004

Purpose: To describe the theoretical basis for a representational approach to patient education and the application of this approach to the development, implementation, and preliminary evaluation of a representational intervention for pain management.

Organizing Construct: Leventhal's common sense model (CSM) was a guide for this approach to patient education. The CSM is based on the idea that people have common sense beliefs, or representations, that guide how they cope with health problems. Theoretically based interventions derived from the CSM have not been reported.

Methods: Steps included: (a) designing a general approach to educational interventions, centered on illness representations; (b) specifying an intervention (RIDPAIN) to facilitate coping with cancer pain; (c) pilot‐testing and revising the intervention; and (d) testing feasibility and acceptability of the intervention with 61 patients in a Midwestern American city.

Findings: The RIDPAIN intervention was useful in eliciting misconceptions of pain and pain management from patients experiencing cancer pain. Many patients found RIDPAIN to be meaningful and useful, and they perceived it to have an effect on pain‐related beliefs and behaviors.

Conclusions: This theory‐driven approach should be effective and widely applicable because it includes patients as active participants in all phases of the learning continuum, from information acquisition to behavior change.
A Conceptual Framework of Nursing in Native American Culture
Authors: Lowe John , Struthers Roxanne
Published: April 2004

Purpose: To depict the phenomenon of nursing in the Native American culture.

Design: At the 1997 annual Native American Nursing Summit held on the Flathead Reservation in Montana, 203 Native American nurses, nursing students, and others who provide health care to Native American people attended and participated in focus groups that provided the data for this qualitative study. The participants represented many tribes from across the United States. Follow‐up in 1998 included a similar group of 192 participants.

Methods: Native American nurses facilitated focus groups. The facilitators provided direction for the focus groups and supervised the data collection. Native American nurses with advanced degrees in nursing performed the data analysis utilizing theme, taxonomic, and componential analysis methods.

Findings: Seven dimensions were identified in the data: (a) caring, (b) traditions, (c) respect, (d) connection, (e) holism, (f) trust, and (g) spirituality. Each dimension is essential to the practice of nursing in Native American culture. Together they provide the basis for a systematic approach to Native American nursing practice, education, research, and administration.

Conclusions: The conceptual framework of nursing in the Native American culture, with its seven dimensions, shares dimensions with mainstream nursing, yet it differs in many important ways. This model can be used by Native American nurses to provide a structure for engaging in the profession of nursing. Further, it can be used by nurses of other cultures to understand nursing in the Native American culture and to provide health care to Native American people.
An International Imperative for Gender‐Sensitive Theories in Women's Health
Authors: Im Eun‐Ok , Meleis Afaf Ibrahim
Published: April 2004

Purpose: To propose gender‐sensitive theories as a future direction for theoretical development of women's health. Few theories pertain to women's health and illness experiences, with gender issues embedded in social, cultural, and historical contexts.

Organizing Construct: Significance, definition, and philosophical bases of gender‐sensitive theories.

Findings: Six major components should be incorporated in the development of gender‐sensitive theories: (a) gender as a major feature, (b) women's own words and experiences, (c) nature of women's experiences, (d) theorists' perspectives, (e) contexts, and (f) guidelines for actions.

Conclusions: We believe that the development of gender‐sensitive theories in nursing could enable researchers to transcend androcentric and ethnocentric views on women's health, decrease gender inequity in health care, enhance women's well being, and ultimately contribute to knowledge development in nursing.
Physical Activity Research in Nursing
Authors: Robbins Lorraine B. , Pender Nola J. , Conn Vicki S. , Frenn Marilyn D. , Neuberger Geri B. , Nies Mary A. , Topp Robert V. , Wilbur JoEllen
Published: April 2004

Purpose: To present exemplars of physical activity research in nursing, illustrate the importance of physical activity research across the lifespan, and recommend directions for theory development and research.

Methods: Studies of physical activity and exercise currently being conducted by nurse investigators were reported and critiqued by attendees of the Midwest Nursing Research Society 2000 Preconference session entitled “Promoting Physical Activity Among Diverse Groups Across the Health Continuum.” Physical activity and exercise literature during the past decade was reviewed. Databases searched included Medline, CINAHL, Wilson, and ERIC.

Findings: Investigators have emphasized the need to evaluate the effects of theory‐based physical activity interventions designed to alter key correlates of physical activity identified through descriptive research.

Conclusions: Regular physical activity is necessary for health promotion and disease prevention for all populations. Continued research in this important area of health behavior is critical to identify the most effective interventions to increase physical activity among diverse populations.
The Relationship of Social Norms to Use of Services and Caregiver Burden in Japan
Authors: Asahara Kiyomi , Momose Yumiko , Murashima Sachiyo , Okubo Noriko , Magilvy Joan K.
Published: April 2004

Purpose: To develop an improved measure of ‘sekentei’ (a social‐psychological process that restricts behaviors that do not conform to social norms such as family caregiving) among family caregivers in Japan, and to describe the relationships among sekentei and caregiver's actual use of services, a reluctance to use services, and care burden.

Design: Descriptive correlational study. Family caregivers (N=260) of impaired elders responded to a structured questionnaire.

Methods: Exploratory and confirmatory factor analyses were used to assess the construct validity of the sekentei scale for caregivers (SSC). With the SSC, the relationships among main variables were verified.

Findings: The SSC showed satisfactory reliability and validity. Sekentei was significantly correlated with care burden, but not to actual use or reluctance to use services.

Conclusions: Sekentei is an important factor related to caregiver burden in Japan. Further research might include the extent to which sekentei is a factor in care burden in other cultures.
Historical Analysis of Siderail Use in American Hospitals
Authors: Brush Barbara L. , Capezuti Elizabeth
Published: April 2004

Purpose: To explore the social, economic, and legal influences on siderail use in 20th century American hospitals and how use of siderails became embedded in nursing practice.

Design: Social historical research.

Methods: Numerous primary and secondary sources were collected and interpreted to illustrate the pattern of siderail use, the value attached to siderails, and attitudes about using siderails.

Findings: The persistent use of siderails in American hospitals indicates a gradual consensus between law and medicine rather than an empirically driven nursing intervention. Use of siderails became embedded in nursing practice as nurses assumed increasing responsibility for their actions as institutional employees.

Conclusions: New federal guidelines, based on reports of adverse consequences associated with siderails, are limiting siderail use in hospitals and nursing homes across the United States. Lowering siderails and using alternatives will depend on new norms among health care providers, hospital administrators, bed manufacturers, insurers, attorneys, regulators, and patients and their families.
Patients, Nurses, and Physicians Have Differing Views of Quality of Critical Care
Authors: Shannon Sarah E. , Mitchell Pamela H. , Cain Kevin C.
Published: April 2004

Purpose: To compare patient, nurse, and physician assessments of quality of care and patient satisfaction in selected critical care units.

Design: As part of a study of patient outcomes from critical care, data were collected between December 1991 and March 1993 from 489 patients, 518 nurses, and 515 physicians in 25 critical care units located in 14 hospitals in the U.S. Pacific Northwest.

Methods: Views of patient satisfaction and quality of care were measured using standardized instruments. All data were aggregated to the unit level (N=25) and were normalized to a common scale for analysis.

Findings: Physicians rated quality of care higher than did either patients or nurses within the same critical care unit, and nurses had the lowest perceptions of quality. Nurses and patients had similar views of patient satisfaction, but physicians tended to overestimate patients' satisfaction. However, physicians', nurses', and patients' scores varied considerably within and between units. Physicians' and nurses' views of quality and patient satisfaction were strongly related to processes such as MD‐RN collaboration and outcomes such as nurses' job satisfaction.

Conclusions: Patients, nurses, and physicians viewed quality of care and patient satisfaction differently. Nurses' and physicians' perspectives were more related to their views of the work environment than to organizational factors, patient characteristics, or commonly used outcome measures.
How Nurses Learn Advocacy
Authors: Foley Barbara Jo , Minick M. Ptlene , Kee Carolyn C.
Published: April 2004

Purpose: To describe how nurses develop the skill of advocating for patients.

Design & Methods: Hermeneutic phenomenological research methods. Both reserve and active U.S. Army nurses who cared for patients associated with the military operation in Bosnia were individually interviewed to gain an understanding of their experiences of advocating for patients and how they developed their advocating practices.

Findings: The constitutive pattern identified was Developing Advocating Practices. The themes comprising this constitutive pattern were Who I Am, Watching Other Nurses Interact with Patients, and Gaining Confidence.

Conclusions: For the nurses in this study, developing advocating practices was more haphazard and situationally dependent than methodically taught in their nursing education programs. Nurses would have a stronger foundation in advocacy if nurse educators consciously teach advocacy and if nurse administrators support new graduates' advocacy in the work environment.
Chronic Stress, Sense of Belonging, and Depression Among Survivors of Traumatic Brain Injury
Authors: Bay Esther , Hagerty Bonnie M. , Williams Reg A. , Kirsch Ned , Gillespie Brenda
Published: April 2004

Purpose: To test whether chronic stress, interpersonal relatedness, and cognitive burden could explain depression after traumatic brain injury (TBI).

Design: A nonprobability sample of 75 mild‐to‐moderately injured TBI survivors and their significant others, were recruited from five TBI day‐rehabilitation programs. All participants were within 2 years of the date of injury and were living in the community.

Methods: During face‐to‐face interviews, demographic information, and estimates of brain injury severity were obtained and participants completed a cognitive battery of tests of directed attention and short‐term memory, responses to the Perceived Stress Scale, Interpersonal Relatedness Inventory, Sense of Belonging Instrument, Neurobehavioral Functioning Inventory, and Center for Epidemiological Studies Depression Scale;.

Findings: Chronic stress was significantly and positively related to post‐TBI depression. Depression and postinjury sense of belonging were negatively related. Social support and results from the cognitive battery did not explain depression.

Conclusions: Postinjury chronic stress and sense of belonging were strong predictors of post‐injury depression and are variables amenable to interventions by nurses in community health, neurological centers, or rehabilitation clinics. Future studies are needed to examine how these variables change over time during the recovery process.
Postpartum Depressed Women's Explanation of Depression
Authors: Ugarriza Doris Noel
Published: April 2004

Purpose: To gain empirically derived knowledge of postpartum depression upon which to base detection and intervention strategies.

Design: From 1997 through 2000, a sample of 30 nonhospitalized women, self‐identified as postpartum depressed was recruited by network and “snowball sampling” to discuss their beliefs about postpartum depression. With reference to the Kleinman explanatory model of illness, their beliefs about postpartum depression and its treatment were contrasted to the biomedical model of postpartum depression.

Methods: Content analysis was done to classify data into cause, effect, severity, expectations, fears, and suggestions for treatment. Results were compared with DSM‐IV diagnostic criteria.

Results: Postpartum depressed mothers' explanatory model of depression differed from the DSM‐IV criteria for depression in that mothers' depiction was generally milder in form and consisted of sleep deprivation instead of sleep disorders. Also, mothers were confused, overwhelmed, and guilty about thoughts of hurting their babies. The mothers did not exhibit suicidal ideation. Mothers described the illness as severe and long lasting, causing multiple problems including marital discord.

Implications: Mothers suggested more public education and support for new mothers to prevent and treat the disorder.
Implicit Memory and Familiarity Among Elders with Dementia
Authors: Son Gwi‐Ryung , Therrien Barbara , Whall Ann
Published: April 2004

Purpose: To propose a framework for familiar environment as a cue for maintaining or maximizing functional abilities in elders with dementia.

Organizing Construct: The organizing construct is the sense of familiarity. Although a feeling of familiarity can be processed in both explicit and implicit memory in normal populations, it is retrieved more frequently and efficiently in the implicit memory system than through explicit memory in elders with dementia.

Methods: The model was developed using sources identified through a literature search of relevant topics in Medline, PsycInfo, and CINAHL, as well as through clinical observations and experiences.

Conclusions: Evidence from neuro‐ and cognitive psychology indicates that elders with dementia or Alzheimer's disease (AD) have impaired explicit memory but preserved implicit memory. For initiating an intervention related to spared implicit memory, we propose that implicit memory can be used therapeutically in patients with dementia. The sense of familiarity as a form of implicit memory is used as an exemplar. Producing or introducing the sense of familiarity into a new or strange environment as well as maximizing familiarity in an existing environment is proposed as a viable nursing strategy.
What the Emerging Workforce Wants in Its Leaders
Authors: Wieck K. Lynn , Prydun Margaret , Walsh Terri
Published: April 2004

Purpose: To describe desired traits as perceived by emerging and entrenched workforce members.

Design and Methods: A national sample of nursing students (n=108) and a sample of Midwestern American hospital managers (n=126) were categorized by age and asked to rank the traits desired in their leaders. Participants ranked the most desired and least desired traits of leaders. Rankings were compared between groups as well as with desired traits from leadership studies in the 1990s.

Findings: A high degree of congruency was found between emerging and entrenched health care workforce respondents. However, these findings showed little congruence with previous studies.

Conclusions: Congruence of expectations facilitates mentoring relationships, so finding no difference between the older and younger groups bodes well for the mentoring of young nurse leaders. The key implication is the challenge to recruit and retain such leaders in the nursing profession in a systematic, logical, and generation‐friendly way.
A Review of Nursing Research on Blood Pressure
Authors: Thomas Sue Ann , Liehr Patricia , DeKeyser Freda , Frazier Lorraine , Friedmann Erika
Published: April 2004

Purpose: To provide this second 10‐year review of nursing research on blood pressure (BP) and to focus attention on incorporating biopsychosocial factors affecting BP in nursing research.

Organizing Construct: Blood pressure is a dynamic, multidimensional, cardiovascular indicator of a person's state rather than a one‐dimensional static measurement.

Methods: This 10‐year literature review 1990–1999 included 54 nursing research articles with BP as an outcome measure. Four nursing research journals were reviewed to identify all nurse‐authored articles investigating BP as an outcome variable in adult populations. Inclusion of individual characteristics, environmental factors, dynamic nature of blood pressure, and interpersonal aspects of blood pressure were assessed for each article.

Findings: Age, gender, and health status were mentioned consistently in both decades. Reporting of socioeconomic, occupational, educational, activity, and martial status remained low. Descriptions of environments increased, and automated devices were the most common method for BP assessment. Less than half of the articles included a description of the person measuring the BP. Measurement of BP under multiple conditions increased, but measurement within conditions did not.

Conclusions: Advances in technology and data analysis have increased knowledge of the dynamic nature of BP, but recognition of the complex nature of BP has not progressed rapidly over the last 2 decades.
Negotiating Dyadic Identity Between Caregivers and Care Receivers
Authors: Coeling Harriet V. , Biordi Diana L. , Theis Saundra L.
Published: April 2004

Purpose: To describe the ways in which caregivers (CGs) and their care receivers (CRs) negotiate the dyadic rules that influence how the care experience “fits into” their lives and to suggest theory based on the data.

Design: This qualitative study was part of a larger, NIH‐funded study of 60 care dyads and their use of respite care in the Midwestern United States. The sample for this analysis included 60 informal CGs and CRs in their home settings. Data collection for the larger study began in 1994 and continued through 1998.

Methods: CGs and CRs were interviewed in their homes with one researcher interviewing the CG regarding the care experience while another researcher interviewed the CR. Qualitative content analysis was used to analyze the data.

Findings: The theory of CG and CR dyadic identity development, formulated in this study, indicates that a mutually agreed‐upon care dyadic identity is developed when both parties negotiate a set of rules about their conduct together in the caregiving and care receiving relationship. Failure to agree on these dyadic rules may result in strain in the care process. Three archetypes of dyadic relationships were identified, based on the degree of immersion into a dyadic identity: (a) complete and mutually accepted immersion of an identity into the care process by both parties, (b) retention of personal identities while also accepting the caregiving or care‐receiving roles, and (c) rejection of the roles by one or both parties.

Conclusions: Negotiation was important in these dyadic care relationships, and thus attention to assisting CGs and CRs to develop negotiation skills is needed. More research is needed to substantiate and expand this theory of CG and CR dyadic identity development, and to examine linkages between negotiated processes and outcomes.
Sexually Abstinent African American Adolescent Females' Descriptions of Abstinence
Authors: Haglund Kristin
Published: April 2004

Purpose: To describe sexual abstinence from the perspective of abstinent African American female adolescents.

Design: Descriptive qualitative.

Methods: Data were collected from 14 sexually abstinent, African American adolescent girls during two semi‐structured interviews. Data were collected using the life history method and were analyzed in the style of narrative analysis.

Findings: This analysis indicated four themes in descriptions of abstinence: limited information, categorization of sexual behaviors, activities that lead to intercourse, and abstinence as a self‐determined choice. For most participants, “having sex” referred to heterosexual vaginal intercourse and being abstinent meant that one chose to refrain from intercourse.

Conclusions: The participants' limited definition of abstinence might lead them to unknowingly put themselves at risk by engaging in other forms of genital sexual activities. They may think that they are protected because they believe that they are practicing abstinence.
Nurses' Attitudes and Practice Related to Hospice Care
Authors: Cramer Laura D. , McCorkle Ruth , Cherlin Emily , Johnson‐Hurzeler Rosemary , Bradley Elizabeth H.
Published: April 2004

Purpose: To describe characteristics, attitudes, and communications of nurses regarding hospice and caring for terminally ill patients.

Design: A cross‐sectional study of randomly selected nurses (n=180) from six randomly selected Connecticut community hospitals was conducted in 1998 and 1999.

Methods: Hospice‐related training, knowledge and attitudes, demographic and practice characteristics, and personal experience with hospice were assessed with a self‐administered questionnaire (response rate=82%). Logistic regression was used to model the effects of hospice‐related training, knowledge, and attitudes on these outcomes, adjusting for personal experience and other characteristics of nurses.

Findings: Characteristics associated with discussion of hospice with both patients and families included greater religiousness, having a close family member or friend who had used hospice, and reporting satisfaction with hospice caregivers. Greater self‐rated knowledge was significantly associated with discussion of hospice with patients. Attitudinal scores indicating greater comfort with initiating discussion and greater perceived added benefit of hospice were significantly associated with discussion with patients' families.

Conclusions: Nurses' discussion of hospice with terminally ill patients and their families are related to the potentially modifiable factors of self‐rated knowledge and attitudes revealing comfort with discussion and perceived benefit of hospice care.
Views of Community‐Dwelling, Old‐Old People on Barriers and Aids to Nutritional Health
Authors: Callen Bonnie L. , Wells Thelma J.
Published: April 2004

Purpose: To examine barriers and aids to maintaining the nutritional health of community‐dwelling old‐old residents from their perspectives.

Design: Cross‐sectional exploratory study completed in March 2002 of old‐old people living independently in one county in the Midwestern United States (US).

Methods: Sixty‐eight in‐home interviews were conducted with community‐dwelling people aged 80 or older. Content analysis was done to examine answers to two open‐ended questions about barriers and helps to nutritional health.

Findings: These old‐old people believed they were doing well nutritionally despite reduced independence and physical limitations. They were positive about their lives and creative in problem solving to remain independent. Social connectedness was the major factor for maintaining independence into old age. The leading barrier to maintaining nutritional health was health problems. Those with more barriers were more likely to be depressed.

Conclusions: Knowledge of aids and barriers to nutritional health, from a personal perspective, gives an understanding of the issues and concerns of old‐old people.
The Nurse‐Community Health Advocate Team for Urban Immigrant Primary Health Care
Authors: McElmurry Beverly J. , Park Chang Gi , Buseh Aaron G.
Published: April 2004

Purpose: To describe: (a) development and implementation of an urban outreach health program for Latino immigrants; (b) nurse‐community‐health advocate (CHA) partnership roles in primary health care delivery, and (c) lessons learned from these activities over 7 years in urban community settings.

Methods: Descriptive study of a community‐based health project in a large Midwestern American city. Information was gathered from participants and staff, from observing staff, and from a variety of sources to describe the program and its individual, family, and community effects.

Findings: Major findings pertain to the project team's ability to address the health promotion needs of Latino immigrant families and to successfully incorporate CHAs in planning and implementing the program. CHAs were a “bridge” between health programs and the community, promoting cultural sensitivity. CHAs and nurses provided a range of services including health education and promotion, outreach through home visits, assessment of family needs for referrals to appropriate resources, and follow‐up support.

Conclusions: The nurse‐CHA team was an effective strategy for promoting Latino immigrant families' access to needed health care. This framework allowed for flexibility in assisting clients of different cultural backgrounds to obtain appropriate health care.
Parental Consent and Adolescent Risk Behavior Research
Authors: Tigges Beth Baldwin
Published: April 2004

Purpose: To identify methodological issues related to the use of active or passive parental consent in school‐based research on adolescent risk behavior research and to propose recommendations consistent with current legal and ethical standards in the United States.

Methods: Review and synthesis of the professional literature related to adolescents and parental consent, federal regulations and guidelines in the United States, and the author's experience presenting these arguments and issues to institutional review boards and funding agencies for over 10 years.

Findings: The procedures used for parental consent affect a study's participation rates, costs, and selection bias. When active parental consent is required, parental permission is typically obtained for only 30%–60% of students, compared to 93%–100% when passive consent is used. Extensive follow‐up may result in 55%–100% of parents giving permission, but at significant cost (typically $20–$25 per student). Active consent results in the exclusion of minorities, students having problems in school, and students already engaged in or at risk for problem behaviors. Strong methodological reasons were identified for using passive parental consent procedures when possible. Current federal regulations include four areas for possible waiver or alterations in parental consent procedures, including the use of passive parental consent.

Conclusions: Health researchers must understand the methodological, legal, and ethical issues related to parental consent to produce high‐quality, valid research about adolescents and to provide evidence for laws, policies, and regulations.
An International Perspective on the Time to Treatment for Acute Myocardial Infarction
Authors: Dracup Kathleen , Moser Debra K. , McKinley Sharon , Ball Carol , Yamasaki Keiko , Kim Cho‐Ja , Doering Lynn V. , Caldwell Mary A.
Published: April 2004

Purpose: To compare delay and circumstances of decisions to seek care in patients with acute myocardial infarction (AMI) in the United States (US), England, Australia, South Korea, and Japan.

Design: Comparative prospective design.

Methods: Patients diagnosed with AMI (N=913) were interviewed within 72 hours of hospital admission for confirmed AMI using the Response to Symptoms Questionnaire. Delay times were calculated from review of emergency room records and patients' interviews. Analysis of variance was used to test differences in delay time among countries.

Findings: Median delay ranged from 2.5 hours in England to 6.4 hours in Australia, with the three Pacific Rim countries reporting median delay times > 4 hours. The majority of patients experienced initial symptoms at home (range: 56% in Japan to 73% in the US) with the most common witness being a family member (32% in South Korea to 48% in England). Ambulance use was widely divergent with the highest use in England (85%) and the lowest use in the US (42%).

Conclusions: In all countries, median delay was too long to obtain maximum benefit from AMI therapies, particularly thrombolysis. Education and counseling of patients and families to reduce prehospital delay in AMI episodes might be more effective if the various factors influencing patients' first responses to symptoms are considered, as well as differences in health care systems.
Birth Outcomes and Maternal Morbidity in Abused Pregnant Women With Public Versus Private Health Insurance
Authors: Kearney Margaret H. , Haggerty Lois A. , Munro Barbara H. , Hawkins Joellen W.
Published: April 2004

Purpose: To compare the effects of recent intimate partner abuse on maternal and infant health in publicly versus privately insured pregnant women.

Design: Exploratory descriptive analysis in 13 Massachusetts prenatal care sites from records of 2,052 women who had been screened during pregnancy for domestic violence.

Methods: Clinicians screened pregnant women for domestic violence using the Abuse Assessment Screen. After delivery, prenatal and birth outcome data and abuse screening results were extracted from medical records by project staff. Odds ratios were used to compare maternal and infant health indicators in abused and nonabused women. Data from women with public and private health insurance then were examined separately, using logistic regression to control for low education and single marital status while examining the odds of adverse maternal and infant outcomes in abused and nonabused women.

Findings: In the sample as a whole, recently abused women were more likely to be publicly insured and unmarried, to have less than 12 years of formal education, and to have medical and obstetrical complications. Parity, ethnic background, and infant birth outcomes did not differ in relation to abuse. In separate analyses for women with public and private health insurance, after controlling for marital status and education, abuse increased the odds of low infant Apgar scores, poor nutrition, hyperemesis, hypertension, and substance abuse in publicly insured women, and abuse increased the odds of poor nutrition and bleeding during pregnancy for privately insured women.

Conclusions: The different correlates of abuse in publicly and privately insured women might be important for clinicians caring for these different populations. Screening for abuse and providing abuse‐related services are indicated for pregnant women.
Geostatistical analysis of cone penetration test (CPT) sounding using the modified Bartlett test
Authors: Phoon Kok-Kwang , Quek Ser-Tong , An Ping
Published: April 2004

More in situ tests are typically carried out over the same volume of soil in comparison to laboratory tests on undisturbed borehole samples. Hence, geostatistical analysis of in situ test records should in principle provide a more accurate and representative overview of spatial variation. A natural probabilistic model for correlated spatial data is the random field. Although the random field provides a concise description of spatial variation, it poses considerable practical difficulties for statistical inference because of the underlying autocorrelation structure. This note presents an extended discussion of the modified Bartlett random field estimation procedure, which is capable of rejecting the null hypothesis of weak stationarity for spatially correlated data. In comparison with simple visual inspection and the standard run test, the modified Bartlett test is shown to provide three advantages: (i) it is a more consistent measure that is unaffected by the vagaries of subjective interpretation; (ii) it is sufficiently discriminative to decide if a section is stationary, even when visual clues are ambiguous; and (iii) it is capable of accommodating realistic constraints (e.g., short record length). The possibility of identifying secondary soil boundaries that may not be readily apparent from visual inspection of cone soundings, its robustness to alternate transformations of the cone data, and the sensitivity of the proposed procedure to different levels of significance are discussed.Key words: geostatistics, random field, stationarity, modified Bartlett test, level of significance, run test.
Results of an Ophthalmologic Screening Programme for Identification of Cases with Anderson-Fabry Disease
Authors: Hauser Anna-Christine , Lorenz Matthias , Voigtländer Till , Födinger Manuela , Sunder-Plassmann Gere
Published: April 2004

Purpose: Anderson-Fabry disease is an inherited lysosomal storage disease with a broad and unspecific range of symptoms, a painful course of disease and early death. The recent development of new enzyme therapy emphasises the need for early diagnosis and treatment of undiagnosed patients. One of the affected organs of Anderson-Fabry disease is the eye. Cornea verticillata – corneal opacities and corneal dystrophy – as well as tortuositas vasorum can occur in an early stage of the disease affecting almost all hemizygous men and more than 70% of heterozygous women. In order to identify unknown cases with Anderson-Fabry disease, we carried out a screening programme contacting Austrian ophthalmologists. Methods: All 658 Austrian ophthalmologists were asked to record patients with cornea verticillata as well as tortuositas vasorum – twice at an interval of 3 months. Results: 33% of the contacted ophthalmologists replied, identifying 5 patients suspected of having Anderson-Fabry disease. After additional examinations including tests for enzyme activities Anderson-Fabry disease was confirmed in 1 man. Conclusion: We have identified 1 case with Anderson-Fabry disease through our ophthalmology screening programme among a population of approximately of 8 million. Ophthalmologic screening programmes for ocular manifestations typical of Anderson-Fabry disease are limited because of the moderate visual affection in these patients. Nevertheless, considering the limited options to detect such cases otherwise, ophthalmologists have a major responsibility to identify patients with Anderson-Fabry disease on routine examinations.