bluuebunny/crossref_metadata_2025 huggingface dataset:
African American and Asian American Elders: An Ethnogeriatric Perspective
Authors: MCBRIDE MELEN R. , LEWIS RENE D.
Published: September 2018

By 2030, ethnic minority elders are expected to increase by 12%. Research about this highly diverse population is gaining momentum. This chapter summarizes selected research articles published after 1996 on access and utilization of services and resources by African American and Asian American elders. Computerized searches were made using PubMed and CINAHL (Cumulative Index of Nursing and Allied Health Literature) with the following terms used individually or combined: health care, aging, older adults, ethnicity, access, disparities, chronic illness, community health care, health beliefs, health practices, and ethnogeriatrics. Citations for 456 articles on two ethnic groups were retrieved; 155 were reviewed, and 84 citations were used for this chapter. The publications focus on African Americans (45%), Asian Americans (41%), and both groups (14%). Descriptive, exploratory, cross-sectional studies dominate the research effort, identifying unmet needs, and a limited number are on culturally appropriate and acceptable interventions. Results are discussed in the context of ethnogeriatrics, and recommendations for future studies are proposed.
Mental Health and Disabilities: What We Know About Racial and Ethnic Minority Children
Authors: DE LEON SIANTZ MARY LOU , KELTNER BETTE R.
Published: September 2018

The recognition that children and adolescents suffer from mental health problems and disabilities is a recent phenomenon, not arising until the late 19th century. Because of the increasing numbers and importance of ethnic minority children and youth to the vitality of the United States, their mental health and disabilities can no longer be overlooked. Mental health is paramount for fostering social integration, unity, and inclusiveness within and between ethnic groups. Thus the significance of changing demographics and the disparity in mental health indicators make this a key issue for the future. Nursing research in this area has been limited, in spite of the fact that mental health problems and disabilities exert a disproportionate negative effect on racial and ethnic minority children (NIMH, 2001a). The purpose of this chapter is to critique the available nursing research on mental health and disabilities in racial and ethnic minority children, including how such research has been conceptualized, conducted, and interpreted.
Language Barriers and Access to Care
Authors: SEONAE YEO
Published: September 2018

The purpose of this chapter is to examine how language barriers contribute to health disparities among ethnic and racial minorities in the United States. A literature search was systematically conducted using selected computer databases (MEDLINE and CINAHL). Searches were limited to English-language-published research in the years from 1985 to 2003. A total of 47 published articles were included in this review. Overall these studies indicate that language barriers are associated with longer visit time per clinic visit, less frequent clinic visits, less understanding of physician’s explanation, more lab tests, more emergency room visits, less follow-up, and less satisfaction with health services. The results also indicate that people who are older, poorer, and female tend to have severe language barriers compared to those who are younger, wealthier, and male. Improvement of communication between patients and providers in relation to health disparity consists of cultural competency and communication skills. Implications of these studies for practice and further research are outlined.
Health Disparities Among Men from Racial and Ethnic Minority Populations
Authors: DALLAS CONSTANCE , BURTON LINDA
Published: September 2018

The purpose of this chapter is to review empirical nursing literature on the health care of racial and ethnic minority men, specifically African American/Black, Hispanic/Latino, American Indian/Alaskan Native, and Asian/Pacific Islander men. CINAHL and MEDLINE computer databases were searched from their earliest online date until 2003 using a combination of manual and computer-based methods to identify the nursing literature with samples that included minority men. Articles were selected according to their relevance to the four areas of adult health disparities targeted by the Department of Health and Human Services (DHHS): heart disease, malignant neoplasms (cancer), diabetes, and HIV/AIDS.

A total of 52 empirical articles were selected. Findings were categorized as addressing disease prevention, disease screening, or disease management of the targeted conditions. This review demonstrates that some important work has already been accomplished in nursing research to address the four adult health disparities targeted by DHHS. Future research should be based on gaps identified in existing literature and should be guided by culturally appropriate theories and constructs.
Alcohol Consumption During Pregnancy
Authors: Krulewitch Cara J.
Published: September 2018

Alcohol is a potent teratogen in humans, and prenatal alcohol exposure is a leading preventable cause of birth defects and developmental disabilities. The term fetal alcohol syndrome (FAS) refers to a pattern of birth defects found in children of mothers who drank during pregnancy. FAS has four criteria: maternal drinking during pregnancy, a characteristic pattern of facial abnormalities, growth retardation, and brain damage (often manifested by intellectual difficulties or behavioral problems). As surveillance and research have progressed, it has become clear that FAS is but a rare example of a wide array of defects that can occur from exposure to alcohol in utero. At least 1 in 10 women will continue to consume alcohol during pregnancy, putting their fetuses at risk for the effects of alcohol exposure.

Nurses are in a key position to provide care and conduct research that will contribute to the prevention of the adverse effects of prenatal alcohol exposure during the preconception and perinatal periods, as well as deal with the negative outcomes of exposure in the developing infant. Many areas have yet to be evaluated. Screening tools and interventions have been developed and tested, mostly in majority cultures. Culturally sensitive instruments must be generated and validated for high-risk groups such as Native Americans. Fetal alcohol biomarkers and genetic research are new and need considerably more work. Effective “no drinking during pregnancy” campaigns for high-risk groups must be created and tested. Nurses are well placed to conduct research that will describe the effects at social, behavioral, and biological levels; develop middle-range theories targeted at preventing the drinking behavior and optimizing care of affected children after birth; and generate and test effective interventions that enhance prevention strategies in the 21st century.
Alcohol Misuse, Abuse, and Addiction in Young and Middle Adulthood
Authors: Handley Sandra M. , Ward-Smith Peggy
Published: September 2018

This chapter reviews research on alcohol misuse, abuse, and addiction in young and middle adulthood. Young adulthood is defined as ages 21 to 35 and middle adulthood as ages 36 to 65.

The authors searched the Cumulative Index of Nursing and Allied Health Literature (CINAHL) and other databases for the years 1992 through 2004 using the terms alcohol abuse, alcoholism, and alcohol dependence, then hand-searched for the inclusion of age as a variable. The search was limited to research and English-language publications. Unpublished dissertation studies were excluded, as were topics that were reviewed in other chapters of this volume. When possible, articles for review were limited to alcohol only, as compared with other drugs of abuse. Research articles were selected for review if they contained the variables alcohol misuse, abuse, or alcohol addiction or dependence and age. The review included both nurse- and non-nurse-investigators and was comprised of 50 studies.

The results are in four content areas across the global area of alcohol misuse, abuse, and dependence in young and middle adulthood: incidence and prevalence, developmental changes, the work setting, and the family setting. Few articles used a developmental framework, although in some studies, the framework was implicit. Nurse-investigators were more likely to produce qualitative studies, although the studies varied dramatically in size of sample, research design, and variables. Overall, there was greater breadth than depth.

The use of adult developmental theory was limited despite its potential explanatory potential in this field. There is a need for more nurse-researchers to explore adult developmental theory and pay increased attention to age and developmental stage as explanatory variables.
Alcohol and Risky Behaviors
Authors: Corte Colleen M. , Sommers Marilyn S.
Published: September 2018

The purpose of this chapter is to review and critique the literature on risky drinking, driving, and sexual behaviors. To complete this review, electronic searches using databases from the disciplines of nursing, medicine, and psychology were used with keywords alcohol and risky behavior, risky drinking, risky driving, risky sex, and sexual aggression, as well as other relevant terms.

The basic tenets of contemporary theoretical models of risky behaviors are used as a framework for reviewing the literature. Most relevant to the discussion are the relationships among the behaviors, risk and protective factors, and major unresolved theoretical and methodological issues. In the literature, sensation seeking was differentially associated with risky drinking, driving, and sex, but causal assertions are premature.

Important conceptual and physiological issues are clarified. First, unconventionality contributes to risky drinking, risky driving, and, among adolescents, risky sex. Second, the pharmacologic effects of alcohol on cognitive processing contribute to risky sex, but only among persons who feel conflicted about risky sex (e.g., condom use). This perception may be particularly true for men who have a belief that alcohol will enhance sex. Third, sexual aggression appears to stem from a variety of factors, including the pharmacologic effects of alcohol on aggression and stereotypes about drinking women.

Exploration of risk and protective factors adds breadth and depth to the discussion of risk taking. Risk factors include (1) high tolerance for deviance, (2) unconventional attitudes and behaviors such as early alcohol use and precocious sex, (3) peer norms for deviance, (4) high sensation seeking, and, to a lesser extent, (5) disturbed risk perception and positive beliefs about alcohol. Protective factors appear to mitigate risk and include (1) conventional attitudes and behaviors and (2) having peers that model conventional attitudes and behaviors. Although empirical evidence suggests that risky behaviors tend to covary, most intervention trials to date have focused on single behaviors, and often are based on clinical information rather than existing theoretical and empirical knowledge.
Moderate Drinking and Cardiovascular Disease
Authors: Masters Joan A.
Published: September 2018

The adverse consequences of heavy alcohol use are well known. However, recent media reports of a possible cardiovascular benefit associated with moderate drinking have revived public interest in the use of alcohol for “medicinal purposes.” Knowledge development regarding guidelines for moderate alcohol use has lagged behind public interest in the possible health benefits of moderate alcohol use. At this time, evidence-based primary health promotion interventions related to the risks and benefits of moderate alcohol use are lacking in the health care literature. This chapter reviews 22 reports describing the relationship between moderate drinking and cardiovascular disease. The reports are classified by the level of evidence and critiqued on seven aspects of method. Conclusions related to the strength of the evidence that moderate drinking is a useful primary health promotion intervention are presented.
Organizational Climate and Culture Factors
Authors: Clarke Sean P.
Published: September 2018

Nurses and others have expressed a great deal of interest in the potential for incorporating notions about organizational culture and climate in research and practice aiming to improve health care safety. In this review, definitions and measures of these terms are explored, the state of the research literature connecting culture and climate with safety is reviewed, and directions for future research and leadership practice are outlined.
HIV Symptoms
Authors: Portillo Carmen J. , Holzemer William L. , Fang-Yu Chou
Published: September 2018

People with HIV/AIDS are a vulnerable group whose symptoms can seriously affect their quality of life. HIV/AIDS symptoms can result from the disease itself, from secondary complications of the disease, or from side-effects of highly active antiretroviral therapy (HAART) and other medications related to comorbidities. HIV symptoms are the single most important indicators for patients and practitioners. Symptoms prompt patients to seek medical attention and provide health care providers with essential clues about changes in health status and quality of life. Despite increased recognition of the importance of addressing symptoms among people with HIV/AIDS, few studies have examined the management of HIV symptoms. This chapter introduces HIV symptoms, reports on the methods of review, provides an overview of contextual issues including the literature on symptoms, issues related to symptom measures, theoretical foundations on symptom management, HIV-specific measures, non-HIV-specific measures, translation of findings into practice, and implications for future research and policy.
Promoting Culturally Appropriate Interventions Among Vulnerable Populations
Authors: Newman Giger Joyce , Davidhizar Ruth
Published: September 2018

Evidence-based practice is critical for the improvement of interventions for culturally diverse and disadvantaged groups in the community. Nurses are strategically located in the line of patient care and must be grounded in knowledge related to the delivery of culturally appropriate intervention strategies. Although many of the health care disciplines have failed to conduct or disseminate culturally competent interventions among vulnerable populations, it is important to note that nursing has long been engaged in such activities. Clearly, all health care professionals must be provided with the tools that they need to give appropriate and effective care to patients and to conduct and disseminate relevant research about vulnerable populations. This chapter focuses on culturally competent interventions for ethnic and racial minority groups, women, and the mentally ill.
Development of Nursing Theory and Science in Vulnerable Populations Research
Authors: Nyamathi Adeline , Koniak-Griffin Deborah , Ann Greengold Barbara
Published: September 2018

Inequalities with respect to the distribution of societal resources can predispose people to vulnerability, which has led to a growing concern across America. The Federal Government has taken a leadership role and has launched several initiatives to combat health inequalities experienced by vulnerable populations. The National Institute of Health and all of its institutes, including the National Institute of Nursing Research, have written strategic plans to reduce, and ultimately, eliminate such health disparities. Nursing research has been conducted in the setting of vulnerable populations; several theoretical models for studying vulnerability have been created; and interventional studies designed to reduce health disparities have been implemented. This introduction includes the following: (a) a definition of the concept of vulnerability and health disparities; (b) a discussion of the conceptual models of vulnerability and health disparity and their applications; (c) a description of the impact of federal funding on vulnerable populations research; (d) a synopsis of the contributions made by nurse researchers in the field of vulnerable populations research; and (e) an overview of the volume.
Improving the Quality of Rural Nursing Care
Authors: Cox Kathleen , Mahone Irma , Merwin Elizabeth
Published: September 2018

The purpose of this chapter is to review the literature on quality of care in rural areas. Keywords related to rural quality of care were used to search CINAHL and MEDLINE databases for articles published between 2005 and 2007 (limited to studies occurring in the United States). The review consisted of a total of 46 articles. Limitations include inconsistent definitions of rural, the use of only articles available to the reviewers, an unclear understanding of the context of many of the studies, and lack of a clear operational definition of quality. The studies were grouped and discussed according to quality of workforce, practice, treatment, interventions, and technology in rural areas. Each study’s contribution to the understanding of quality health care in rural areas and to determining what was effective in improving staff, patient, or organizational outcomes in rural areas was considered. This chapter also offers a discussion of ethical issues and data quality in rural research. Issues for future research include a focus on patient safety, mental health issues, and the use of technology to improve quality of care in rural areas. Future research should also focus on demonstration studies of model applications. The nursing profession has a unique opportunity to conduct research that will contribute to the development of knowledge that will ultimately improve the quality of health and health care for individuals in rural communities.
Nursing Patient Safety Research in Rural Health Care Settings
Authors: Thornlow Deirdre K.
Published: September 2018

Adverse events occur in virtually all health care arenas, and while rural health care settings are no exception, these facilities often face unique financial burdens and personnel shortages. That may hamper patient safety efforts. Many of the interventions recommended to improve patient safety have largely been based on research conducted in urban hospitals. This chapter demonstrates the extent and type of nursing research being conducted to advance rural-specific patient safety research. The studies were conducted in various settings, with topics ranging from error reporting in hospitals to safety screening in the community. Limitations of these works are discussed, and the chapter offers guidance for a future nursing research agenda to include the need for interdisciplinary research; cross-national and international collaboration; and, at a minimum, the necessity for nurse researchers to sample rural hospitals in larger studies of patient safety.
Conducting Culturally Competent Rural Nursing Research
Authors: Bushy Angeline
Published: September 2018

The face of America is changing. In efforts to provide services to and meet the needs of consumers of different ethnicities and cultures, cultural competence has become a driving force not only in health care but also in business, education, and research. Lack of cultural competence among caregivers has been linked to health disparities, decreased client satisfaction, and decreased client adherence to recommended medical regimens. The depth of rural research in general, and by nurse researchers focusing on rural cultural groups in particular, is limited. This chapter focuses on conducting rural nursing research with rural cultural groups, highlights methodological issues that are commonly encountered with rural populations, and proposes strategies to address them. Addressing methodological challenges will contribute to the limited knowledge base related to culture and ethnicity in rural nursing research.
Diabetes Care Among Rural Americans
Authors: Williams Utz Sharon
Published: September 2018

The prevalence of diabetes in the United States is higher among those living in rural/nonmetropolitan statistical areas than in urban centers. Managing this complex chronic illness is complicated by factors such as limited access to care, low socioeconomic status, aging, and membership in a racial or ethnic minority group. A review of the literature was conducted focusing on research about rural Americans with diabetes by searching databases of CINAHL, PubMed, and MEDLINE, and selecting articles in English that were published between 2000 and 2007. Search terms included: nursing, research, rural, rural nursing, rural health services/programs, and diabetes care. Additional search strategies included journal hand searching and networking. Twenty-six research reports were found and included qualitative and quantitative methods and program evaluations. All regions of the United States were represented except the Northwest. The vast majority of research reports were of descriptive studies (n = 16), with program evaluation reports (n = 7) and studies testing an intervention (n = 3) also represented. The quality of each study is examined and summarized.
Coping Skills Treatment of Situational Vomiting: A Case Study
Authors: Friedberg Fred
Published: September 2018

The rarely reported problem of involuntary psychogenic vomiting was successfully treated with self-controlled relaxation, cognitive restructuring, and behavioral prescription. Specifically, the client learned to relax tense abdominal and eye muscles and to reevaluate cognitively the anger- and anxiety-evoking irrational beliefs preceding episodes of vomiting. Finally, the behavioral antecedents of vomiting were modified. At the termination of treatment and during the 3-year follow-up, no vomiting was reported. In addition, the client discontinued an antinausea medication without a resurgence of nausea.
The Effectiveness of Cognitive Therapy in Morbid Jealousy: A Case Report
Authors: Dolan Mairead , Bishay Nagy R.
Published: September 2018

This report illustrates the progress through treatment of a single case of nonpsychotic morbid jealousy using assessment measures specifically designed to evaluate changes in the cognitive behavioral and emotional aspects of jealousy as described earlier.
Morbid Jealousy: A Cognitive Outlook
Authors: Bishay Nagy R. , Tarrier Nicholas , Dolan Mairead , Beckett Richard , Harwood Sue
Published: September 2018

Jealousy as a clinical problem has received little attention in the psychiatric and psychological literature. Recently the literature on morbid jealousy has been reviewed and the concept placed within a cognitive-behavioral framework (Tarrier, Beckett, Harwood, & Bishay, 1990). The term morbid jealousy is used to signify an excessive irrational preoccupation with the partner’s fidelity for which there is no objective foundation. Normal jealousy can therefore be defined as a jealousy reaction occurring when the partner is unfaithful. Cognitive therapy is a therapeutic approach based on a model of psychopathology that identifies distortions of thought processes as important in emotional disorders (Beck, Rush, Shaw, & Emery, 1979; Beck & Emery, 1985). This paper describes a cognitive approach to treating the problem of morbid jealousy.
Computerized Cognitive Therapy: The Interface Between Man and Machine
Authors: Stuart Scott , LaRue Stephanie
Published: September 2018

Computer programs designed to collect clinical information from patients have been extant for a number of years. Recent efforts, however, have focused on the development of computerized forms of psychotherapy. Cognitive therapy has been modified for use in such computerized psychotherapy programs, primarily because of its structured format, logical approach to therapy, and its empirically demonstrated efficacy. We present a case study in which a computerized form of cognitive psychotherapy was used to treat a depressed, hospitalized patient. The interactions between the patient, the computer, and the personnel involved in assisting the patient with the computerized psychotherapy suggest that the interpersonal context in which the computerized therapy takes place is essential to the treatment process. Moreover, the case suggests that the interpersonal processes which occur during the delivery of CT in any form are essential to its effective delivery.
Cognitive Therapy with an HIV-Positive Depressed Gay Man
Authors: Gluhoski Vicki L.
Published: September 2018

Clinicians may be increasingly called upon to work with HIV-positive clients. Although cognitive therapy has proven efficacious with a broad range of populations, limited information is available on the application of cognitive therapy to HIV-positive clients. This article will describe the case of an HIV-positive gay man seen for cognitive therapy, as part of a research protocol. This case was chosen for several reasons: (1) to demonstrate how to address specific HIV-related issues in cognitive therapy (e.g., disclosing to family, coping with illness progression), (2) to illustrate how to work with multiple levels of cognitions in a short time period, and (3) to show how to work with long-held beliefs within the context of HIV.
Enhancing Creativity in Cognitive Therapy
Authors: Kuehlwein Kevin T.
Published: September 2018

This article explores the nature of creativity in psychotherapy and offers several methods and frameworks with which to enhance creativity as a cognitive therapist. It reviews the methodologically permissive parameters of Beck’s model, while providing a framework for enfolding methods from other models so as to retain the cognitive character of these interventions when used within the cognitive therapy session. It also extrapolates from Edward deBono’s model of how to improve the quality of thinking to suggest specific interventions as well as general principles that can be used or adapted in cognitive therapy treatment. Numerous case examples are given and further resources for nurturing and generating creativity are provided.
An Examination of the Symptom Component of the Hopelessness Theory of Depression in a Sample of Schoolchildren
Authors: Abela John R. Z. , D’Alessandro David U.
Published: September 2018

The hopelessness theory of depression hypothesizes the existence of a distinct subtype of depression, hopelessness depression, that may be identified by its unique symptom profile as well as by its specific etiology, course, and response to treatment. The goal of the current study was to examine the symptom component of the hopelessness theory in a sample of schoolchildren between the ages of 7 and 13. Three-hundred-and-seventy-three participants completed measures of hopelessness and depressive symptomatology. Hopelessness was significantly associated with all six hypothesized symptoms of hopelessness depression (100%) but with only two of the four non-hopelessness depression symptoms (50%). Further, when symptoms were evaluated in combination, hopelessness depression symptoms exhibited a significantly greater association with hopelessness than did non-hopelessness depression symptoms. An exploratory factor analysis revealed that symptoms that were associated with hopelessness formed independent factors when compared to symptoms not associated with hopelessness. Overall, the results provide strong support for the symptom component of the hopelessness theory in children.
Cognitive Therapy for Depression: A Review of Its Efficacy
Authors: Strunk Daniel R. , DeRubeis Robert J.
Published: September 2018

The empirical status of cognitive therapy for depression, based on Aaron T. Beck’s model, is reviewed. Available evidence suggests that cognitive therapy is at least as effective in the short run as other psychotherapies, as well as pharmacotherapy. Patients in cognitive therapy experience a large reduction in depressive symptoms and a substantial portion meet recovery criteria at the end of a 12- or 16-week acute treatment period. Moreover, there is evidence that cognitive therapy produces a prophylactic effect. Thus, we conclude that cognitive therapy works well and should be strongly considered as a first-line treatment for depressed people.
Components of Cognitive Behavioral Therapy: The Factor Structure of the Cognitive Coding Scale for Bulimia Nervosa
Authors: Spangler Diane L. , Beckstead D. Joel , Hatch Arlin , Radpour-Wiley Marzi , Agras W. Stewart
Published: September 2018

Existing rating scales measuring therapist execution of the components of cognitive behavior therapy (CBT) have been criticized as too narrow to assess the theorized multidimensional structure of CBT. The current study sought to evaluate the factor structure of the combination of existing CBT therapist rating scales. A second goal of the study was to test a newly developed patient rating scale for use in CBT for bulimia nervosa. Therapy sessions from patients receiving a standardized CBT protocol for bulimia nervosa were coded and analyzed using both confirmatory (CFA) and exploratory factor analysis (EFA). The factor structures obtained were consistent across the CFA and EFA and were also consistent across raters and sessions. The therapist factors obtained were: therapist interpersonal effectiveness, cognitive interventions, structure, behavioral interventions and assumptions. These five factors corresponded well with theory about the major components of CBT. The obtained patient factors were also highly consistent with CBT treatment principles. Uses of the comprehensive rating scale for CBT for clinical and research purposes are discussed.
Cognitive Psychotherapy and Milieutherapeutic Processes in Psychiatric Inpatient Units
Authors: Perris Carlo
Published: September 2018

In this article it is argued that the implementation of a cognitive psychotherapeutic approach is both feasible and particularly conducive to therapeutic processes, even in acute-care wards to which unselected, severely ill patients are admitted. The author’s experience so far suggests that the flexible use of cognitive psychotherapy principles and techniques allows for the overcoming of some of the obstacles met with in other approaches.
What is Therapeutic Change?
Authors: Strupp Hans H.
Published: September 2018

This article describes a model for experiential learning that provides a cognitive reorganization. The experience of a good therapeutic relationship will in and of itself lead to cognitive changes. Ultimately, these new therapeutic experiences provide a new perspective on the client’s difficulties. This experiential learning becomes especially meaningful when painful affect is aroused that is related to the earlier faulty learning.
Alcohol Consumption and Looking for Alternatives to Drinking in College Students
Authors: Corcoran Kevin J. , Carney Michelle D.
Published: September 2018

Rotter (1978) has suggested that, within social learning theory, a generalized expectancy related to internal versus external control of reinforcement (“locus of control”) is that of “looking for alternatives.” Rotter suggests that psychotherapy clients may be taught to look for alternatives to their problematic behavior. Within this framework college students were surveyed to examine the relationship between alcohol consumption and expectancy of finding satisfying alternative behaviors to drinking. After assessing the frequency and quantity of alcohol consumption, subjects were presented with a description of a situation in which a same sex friend asked them to go out for a “couple of drinks.” They were then asked to rate on a scale of 1 to 100 how likely it was that there were satisfying alternatives to following the friend’s suggestion. Results supported the hypothesis that heavier drinkers had a significantly lower expectancy that satisfactory alternatives to drinking were available. Results are discussed in terms of research and intervention with heavy-drinking college students.
The Elaboration Likelihood Model and Psychotherapeutic Persuasion
Authors: Stoltenberg Cal D. , Leach Mark M. , Bratt Avery
Published: September 2018

The psychotherapeutic process has long been considered a context for persuasion. The Elaboration Likelihood Model of Persuasion provides an integrative framework from which to examine the process of persuasion in psychotherapy. Various source, message, recipient, and context factors interact in a complex manner to produce attitude change. Two routes to persuasion are presented and their relevance for psychotherapy are discussed. The central route requires more effort and more active cognitive processing on the part of the client, resulting in relatively permanent attitudes that are predictive of subsequent behavior. The peripheral route requires minimal cognitive effort, relying on cues in the situation or rather simple decision rules. Attitudes resulting from this route are relatively temporary and are not predictive of subsequent behavior. Both routes to persuasion are characteristic of the psychotherapeutic process. The role of affect in information processing and methods for encouraging central route processing are discussed.
Rational Thinking as a Goal of Therapy
Authors: Baron Jonathan , Baron Judith H. , Barber Jacques P. , Nolen-Hoekseman Susan
Published: September 2018

To provide a positive goal for cognitive therapies, we define a conception of rational thinking. We describe thinking as a search for possibilities, evidence, and goals, and a process of inference by which the possibilities are evaluated. The possibilities may be choice options, beliefs, or goals. Rational thinking is actively open minded. That is, search is sufficiently thorough, and inference is unbiased in bringing forward the possibility that is best in terms of all the thinker’s goals. The most common departures from rational thinking are insufficient search and bias in favor of possibilities that are already strong. This perspective is applied to the analysis of coping. Cognitive therapies are discussed as training in rational thinking, including instruction in useful heuristics. Suggestions for research are made.
Cognitive Therapy for Panic Attacks
Authors: Salkovskis Paul M. , Clark David M.
Published: September 2018

Although cognitive therapy for panic attacks is a relatively recent development, it has attracted considerable interest; partly because of early reports of good long-term outcome. Cognitive treatment of panic focuses on the identification and modification of misinterpretations of bodily sensations. Outcome studies suggest that the treatment is highly effective and the theory upon which treatment is based is supported by a growing body of experimental evidence. The present article provides a brief outline of the details of treatment. As the treatment contains several elements, the extent to which re-appraisal of bodily symptoms is an active element is discussed and possible alternative explanations of treatment effectiveness are considered. The available evidence is consistent with the view that cognitive factors are at least partly responsible for the effectiveness of treatment. Ways in which clinicians might maximize treatment effectiveness are also discussed.
Cognitive Therapy: The Repair of Memory
Authors: Fleming Karen , Heikkinen Rebecca , Dowd E. Thomas
Published: September 2018

This article outlines current cognitive constructs of explicit and implicit memory and argues that the subjective experience of memory is a significant object of change in cognitive therapy. The integrative process view of memory constrains memory through the variables of context, attention, and the number of times an event is recalled. The article discusses implications for the practice of cognitive psychotherapy which are drawn from theory and research on memory. These ideas are then elaborated in the discussion of an actual therapy case.
Cognitive Therapy on Wall Street: Schemas and Scripts of Invulnerability
Authors: Leahy Robert L.
Published: September 2018

The content and development of schemas and scripts of narcissistic investors are described. These patients view themselves as highly visible, with special talents and destiny, excessive obligation to others, and avoidant of satisfaction. Their investment styles focus on regret, immediate outcomes and the use of recent, salient and irrelevant information. Envy is interpreted as reflecting a market value of the self, reflecting a belief in scarcity of respect and lack of intrinsic value. Developmental analysis indicates threats of abandonment, compensation for earlier inferiority, and family myths of uniqueness. Techniques for challenging narcissistic assumptions and a developmental cognitive treatment of a patient’s schemas and scripts are described.
A Cognitive Problem-Solving Employment Readiness Intervention for Methadone Clients
Authors: Platt Jerome J. , Husband Stephen D. , Hermalin Jared , Cater Jacqueline , Metzger David
Published: September 2018

Employment has been identified as a major goal of drug abuse treatment yet few rigorous tests of employment-related interventions have been conducted. A10-session, manual-guided vocational cognitive problem-solving intervention was evaluated at five methadone treatment sites in an effort to reduce the high unemployment rate among methadone clients. The group intervention focused on helping participants explore the value they place on work, identifying social and psychological barriers to work, developing action strategies to overcome those barriers, setting realistic expectations of work, and taking action. At six months post-intervention, the experimental group (N = 67) demonstrated a significant increase in employment rate (13.4% to 26.9%); no significant change occurred for controls (N = 63). At 12 months post-intervention, however, overall employment gains declined in the experimental group, suggesting the need for additional intervention in order to maintain employment gains.
Use of Treatment Manuals in Comparative Outcome Research: A Schema-Based Model
Authors: Hoffart Asle
Published: September 2018

The use of treatment manuals in clinical practice is purported to increase internal validity by ensuring specific, identifiable, and replicable treatments. In the present article, four factors in treatment manuals that should contribute to treatment integrity are singled out and addressed: (1) specification of model, (2) specification of relation between model and therapeutic practice, (3) circularity between model and actual practice, and (4) adoption of a natural attitude during therapy performance. Further, it is argued that theoretical contrast analyses and the accentuation of contrasting aspects in practice contribute to the differentiation of two or more treatments. A schema view of treatment manuals is developed and the implications for central issues in the field are inferred.
Multidimensional Schematic Restructuring Treatment for Obsessions: Theory and Practice
Authors: Sookman Debbie , Pinard Gilbert , Beauchemin Nathalie
Published: September 2018

This paper describes a multidimensional schematic restructuring treatment approach for obsessions, developed to provide more substantial and enduring clinical improvement as compared with existing treatment approaches. The aim of treatment is to ameliorate symptoms by restructuring dysfunctional, core cognitive and affective schemas relevant to the etiology and/or maintenance of O.C.D. (Obsessive Compulsive Disorder) symptoms. Aspects of cognitive theory and developmental psychology not previously reported to be applied to O.C.D. are integrated theoretically and technically. Treatment targets preexisting dimensions as well as those in response to the obsession. Explicit as well as tacit structural levels are addressed. These include automatic thoughts and core beliefs, emotional responses and schemas, and behavioral coping deficits. Significant attachment and developmental experiences are identified and utilized. Strategies to identify, access, and restructure core obsession-related schemas; to reframe and decenter the obsession; and to address respondent automatic thoughts and dysphoric mood are described and illustrated. Restructuring strategies are combined with existing skills acquisition and exposure-based techniques. A multifaceted schematic constellation is proposed to underlie O.C.D. symptoms. Eleven O.C.D. specific schematic dimensions are under investigation in a new 160-item scale (Obsessive Compulsive Cognitive Schematic Scale, Sookman & Pinard, 1991). Indications for research are discussed.
Guest Editorial: The Power of Story
Authors: Drake Emily E.
Published: September 2018

In this guest editorial, the author introduces the reader to the value of stories as a source of vision and inspiration for caregiving.
Letter from the Editor: Dancing with the One Who “Brung” You into Perinatal Education
Authors: Humenick Sharron S.
Published: September 2018

The childbirth education movement began with creating a cultural shift to foster understanding that women should have choice in their birth. It has moved to the perinatal education movement with recognition that there are many teachable perinatal moments.
A Web-Based Breastfeeding Education Program
Authors: Cheng Wei-Chen (Phoebe) , Thompson Cheryl B. , Smith Jackie A. , Pugh Leigh , Stanley Claire
Published: September 2018

Two Web-based breastfeeding programs were developed to provide new parents with necessary information on proper breastfeeding techniques. One version was plain text and the other version combined text with graphics. The computer was viewed as a valuable learning tool. The breastfeeding program that contained graphics was preferred over the text-only program. Educators are encouraged to use Web-based graphic programs to provide breastfeeding education to new parents.
Improving Nutrition in Pregnant Adolescents: Recommendations for Clinical Practitioners
Authors: Montgomery Kristen S.
Published: September 2018

Pregnancy represents an ideal time for health promotion activities. Many women, including adolescents, are interested and willing to change health behaviors to improve the chance that they will deliver a healthy infant. This paper focuses on improving nutrition in pregnant adolescents. Seven recommendations are presented to help achieve this goal: 1) Focus on foods, not nutrients; 2) individualize and work within the pregnant adolescent’s current eating habits; 3) consider the context of family and peer groups; 4) reward efforts; 5) make it easy; 6) focus on weight gain patterns for optimal birth outcomes; and 7) refer to a dietician, as needed. Use of these recommendations comprehensively addresses adolescent developmental needs to improve nutrition during pregnancy. These recommendations are not meant to be all-inclusive; rather, they are meant to serve as a guide for clinical management of nutrition for pregnant adolescents.
My Memorial Garden
Authors: Kohls Karen
Published: September 2018

In this article, a doula describes one way in which she can honor infants who died prematurely.
“Reality” Birth: Marketing Fear to Childbearing Women
Authors: Lothian Judith A. , Grauer Ann
Published: September 2018

In this column, the authors examine the effect of “reality” television shows on expectant parents’ fears of childbirth.
Integrating Preparation for Early Parenting Into Childbirth Education: Part I—A Curriculum
Authors: Corwin Ann
Published: September 2018

This curriculum framework was developed based on the assumed ability of expectant parents to comprehend early parenting information. The Parenting in Pregnancy curriculum is designed to integrate parenting information into an existing traditional childbirth education program in a framework that strengthens both types of preparation because it assists parents to generalize the use of the coping skills they are learning. This curriculum encourages childbirth educators to “insert” efficiently and effectively parenting materials into their current curricula. This parenting information provides parents with the coping mechanisms they need to attach to their newborn children and raise them in a non-judgmental environment. In the same way, childbirth education provides the opportunity for parents to problem-solve before labor and delivery. The author theorizes that the captivated childbirth education parents learning labor and delivery techniques can reuse these same techniques for effective postpartum parenting. In part II (Journal of Perinatal Education, 8(1), a study on the use of this curriculum with parents will be reported.
Evaluation of the Sensitivity and Use of the Nursing Outcomes Classification
Authors: Johnson Marion , Moorhead Sue , Maas Meridean , Reed David
Published: September 2018

The two purposes of the study were evaluation of the sensitivity of Nursing Outcomes Classification (NOC) outcomes to change in patient condition and description of the outcomes and interventions nurses select for patients with a specific nursing diagnosis. Data were collected in 10 clinical sites representing the care continuum. Sensitivity was evaluated by comparing paired serial ratings of the means of NOC outcomes at baseline and subsequent intervals, including discharge. Descriptive statistics were used to illustrate linkages between the outcomes and interventions selected for each diagnosis. There were 4,233 paired serial ratings on 166 NOC outcomes of which 804 included at least two follow-up ratings. The average change ranged from 0.00 to 1.47 on a 5-point scale. The 10 most frequently selected diagnoses varied across sites, as did outcomes and interventions selected for each diagnosis. The findings provide evidence of the sensitivity of NOC in the aggregate and the value of standardized terminology for studying nursing practice.
Reliability of Aggregated Organizational Data: An Evaluation of Five Empirical Indices
Authors: Forbes Sarah , Taunton Roma L.
Published: September 2018

Nursing systems research has included many levels of measurement such as individuals, work groups, organizations, and systems of organizations. Variables important to organizational survival often are measured at the individual level, with inferences made to the work group or the organization. This study demonstrated a process for determining the reliability of individual level data aggregated to the work group and organization levels. Data were analyzed on four variables: job enjoyment; manager’s leadership style in terms of structuring expectations and consideration; and control over nursing practice. Job enjoyment was assessed over time. Registered staff nurses (n = 632), representing 54 nursing units from 4 large acute care hospitals, comprised the sample. The results indicated the assessment of reliability and validity is important at the level of inference and at each time interval. Aggregated data were deemed reliable when the following criteria were met: Cronbach’s alpha >.60; intraclass correlation (1, k) >.60; and a significant F ratio. The interpretation of ω2 as an indicator of effect size suggested that the validity of inference at the aggregated level is in question when effect size is negligible or small.
Issues Regarding Aggregation of Data in Nursing Systems Research
Authors: Hughes Linda C. , Anderson Ruth A.
Published: September 2018

The unit of analysis at which variables are conceptualized and measured is an important consideration when conducting patient outcomes research. Outcomes research ranges from study of individual responses to nursing intervention to investigation of group level outcomes associated with the contexts and processes through which nursing care is delivered. Because many variables salient to the investigation of group level patient outcomes are not amenable to direct measurement, aggregation procedures are used to generate proxy measurement of organizational context or process variables. In this article, key conceptual and methodologic issues encountered when using data aggregation procedures are reviewed. Following this, estimation of aggregated data reliability is illustrated using data from a study conducted to investigate skilled nursing unit structures.