bluuebunny/crossref_metadata_2025 huggingface dataset:
Sensoristasis and Imbalance in Persons with Dementia
Authors: Kovach Christine R.
Published: April 2004

Purpose:To present a model of sensoristasis and imbalance for use by health care professionals to deliver care to older adults with irreversible dementing illness.

Organizing Constructs:The Sensoristasis Model shows the need of people with dementia to experience a balance between sensory‐stimulating and sensory‐calming activity. This model builds on Lawton's environmental docility hypothesis and on Hall and Buckwalter's Progressively Lowered Stress Threshold Model.

Methods:The model was derived from empirical evidence, theory, and clinical experience. Levels of agitation of three acute care patients experiencing sensoristasis and imbalances in sensoristasis indicate tenets of the model.

Findings:Older adults with dementia experience intrapsychic discomfort because of imbalances in the pacing of sensory‐stimulating or sensory‐calming activity. Consequences of intrapsychic discomfort include agitated behaviors and episodic or premature decline in instrumental and social function.

Conclusions:Pacing of activity must be guided by interventions that facilitate optimum sensoristasis and often need to be adjusted during stress, environmental change, and progression of the illness. Interventions can ameliorate some of the negative consequences of imbalances in sensoristasis when optimal pacing is not attained.
Quiet Pride: The Experience of Chronic Illness by Rural Older Adults
Authors: Davis ReNel , Magilvy Joan K.
Published: April 2004

Purposes: To explore how chronic illness is experienced and managed by rural Hispanic and non‐Hispanic older adults and their families, and to identify how the health care system and community facilitate or inhibit the ability to manage chronic illness in a changing health care environment.

Design: Descriptive ethnography with purposive sampling.

Methods: Data‐generation methods included audiotaped interviews from 42 Hispanic and White, non‐Hispanic participants, participant observations, examination of documents and artifacts, and photography in rural Colorado. Interpretive ethnographic methods were used to identify an overarching cultural theme.

Findings: Living with chronic illness was a proactive, reciprocal learning process shaped by interrelationships in the context of multiple, diverse communities. Participants expressed living with chronic illness as a quiet pride on the journey toward living a meaningful life.

Conclusions: Findings provide an understanding of the webs of relationships that constitute the experience of elders living with chronic illness in rural communities. Viewing life as meaningful in the context of a broader understanding of health and well‐being is important for nursing practice and future models of care.
The Pros and Cons of Data Analysis Software for Qualitative Research
Authors: John Winsome St , Johnson Patricia
Published: April 2004

Purpose: To explore the use of computer‐based qualitative data analysis software packages.

Scope: The advantages and capabilities of qualitative data analysis software are described and concerns about their effects on methods are discussed.

Findings: Advantages of using qualitative data analysis software include being freed from manual and clerical tasks, saving time, being able to deal with large amounts of qualitative data, having increased flexibility, and having improved validity and auditability of qualitative research. Concerns include increasingly deterministic and rigid processes, privileging of coding, and retrieval methods; reification of data, increased pressure on researchers to focus on volume and breadth rather than on depth and meaning, time and energy spent learning to use computer packages, increased commercialism, and distraction from the real work of analysis.

Conclusions: We recommend that researchers consider the capabilities of the package, their own computer literacy and knowledge of the package, or the time required to gain these skills, and the suitability of the package for their research. The intelligence and integrity that a researcher brings to the research process must also be brought to the choice and use of tools and analytical processes. Researchers should be as critical of the methodological approaches to using qualitative data analysis software as they are about the fit between research question, methods, and research design.
A Gender Perspective on Conflict Management Strategies of Nurses
Authors: Valentine Patricia E.B.
Published: April 2004

Purpose: To apply a gender perspective to synthesis of research findings on conflict management.

Organizing Construct: The Thomas‐Kilmann Mode Instrument (TKI), for measuring five conflict‐handling strategies: avoiding, compromising, collaborating, accommodating, and competing.

Method: Nursing research studies with the TKI and other studies are synthesized from perspectives in three gender theories.

Conclusions: Findings were that two conflict management strategies, avoiding and compromising, were used predominantly by all categories of nurses. Possible reasons for over‐ and underuse of the remaining three strategies (collaborating, accommodating, competing) are described. Implications of these findings for nurses and nursing organizations are discussed.
Ethical Issues in HIV Research in Poor Countries
Authors: Mabunda Gladys
Published: April 2004

Purpose: To increase awareness of the potential for conducting unethical research in poor nations in the name of scientific inquiry, and to enumerate ethical questions in HIV/AIDS research.

Organizing construct: Principles of ethics and ethical analysis in clinical research.

Sources and methods: Review of literature on ethical principles of research in developing nations.

Findings: People who participate in clinical trials in poor countries often do so because that may be the only way to gain access to health care. However, access to tested drugs beyond clinical trials is not guaranteed. Participants often do not understand the consequences of being research subjects.

Conclusions: Conducting research in poor nations requires recognition of ethical issues and maintenance of ethical standards, regardless of material wealth of the countries. Ethical standards also indicate including people from the target population in decisions relating to designing and conducting clinical trials.
Misconceptions Among Nurses About Evidence‐Based Practice
Authors: Jennings Bonnie Mowinski , Loan Lori A.
Published: April 2004

Purpose: To delineate the origins and fundamental tenets of evidence‐based practice (EBP) and to enhance understanding of this important term.

Methods: A critical review of the literature pertaining to evidence‐based practice from the fields of medicine and nursing, including international reports.

Findings: The roots of EBP indicate this term is not a synonym for research utilization but rather is the rubric for a set of epistemologic assumptions. Key components of EBP include evidence hierarchies and systematic reviews. Differences were found between the views of EBP presented in papers published by nurses within the US compared to those published by nurses outside the US.

Conclusions: The literature shows incongruity in the interpretation of the basic tenets of the evidence‐based paradigm. Additionally, nurses may underestimate implications of the evidence‐based movement. These two problems impede nurses' participation as full partners in the advancement of evidence‐based practice. They also represent a call to action to achieve a more standardized framework for advancing EBP in nursing.
Transcultural Adaptation of Champion's Health Belief Model Scales
Authors: Mikhail Blanche I. , Petro‐Nustas Wasileh I.
Published: April 2004

Purpose: To translate to the Arabic language, adapt, and test Champion's revised Health Belief Model Scales to measure Jordanian women's beliefs about breast cancer and breast self‐examination (BSE). In Jordan, the primary site of cancer in women is the breast. Nopublished studies have been found which describe women's beliefs or practices about breast cancer and BSE in Jordan.

Design: Descriptive correlational, using a cross‐sectional survey with a random sample of 519 female university students and employees in Jordan, 1999 to 2000.

Methods: Champion's revised Health Belief Model Scales were translated to Arabic, validated by professional judges, back‐translated to English, and pretested. Analyses included descriptive statistics of all the study variables, internal consistency, reliability estimates, construct validity using factor analysis, and predictive validity using multiple regression analyses. The dependent variables were the frequency of practice of BSE and the intention to practice BSE.

Findings: Factor analysis yielded nine factors: confidence 1, confidence 2, benefits, susceptibility, barriers, seriousness 1, seriousness 2, motivation 1, and motivation 2. All items on each factor were from the same construct. Significant correlations were found between the two confidence factors, the two motivation factors, and the two seriousness factors. Alpha coefficients ranged from 0.65 to 0.89. All the health belief variables accounted for 21% of the variance in the frequency of practice of BSE, and 7% of the variance in the intended frequency of practice.

Conclusions: The translated version of Champion's scales was found to be a valid and reliable tool for use with Jordanian women. It can be used in planning and testing interventions to improve BSE beliefs and practice.
Children's Exposure to Community Violence
Authors: Veenema Tener Goodwin
Published: April 2004

Purpose: To analyze the effects of exposure to chronic community violence on children and adolescents.

Design: An integrative review of the literature was conducted on reports of studies about children's exposure to community violence.

Sources: Studies for analysis were identified through a literature search of relevant topics in Medline, CINAHL, and PsycINFO.

Conclusions: Exposure to community violence is related to significant stress and depression in children. Evidence on how exposure to violence affects children's growth patterns, intellectual growth, school performance, decision‐making ability, or their hope for a future is needed.
A Response to California's Mandated Nursing Ratios
Authors: Bolton Linda Burnes , Jones Deloras , Aydin Carolyn E. , Donaldson Nancy , Brown Diane Storer , Lowe Marian , McFarland Patricia Lenihan , Harms Dorel
Published: April 2004

Purpose: To explore the need for evidence‐based health policy, as illustrated by the mandatory staffing bill passed by the California state legislature in 1999.

Design: Prospective data were collected from a voluntary sample of California acute care representatives to describe selected patient safety and clinical outcomes and nurse staffing variables at the patient‐care unit level.

Methods: Data for descriptive analysis were collected on hospital nurse staffing, patient falls, and pressure ulcers from 257 medical, surgical, medical‐surgical combined, step‐down, 24‐hour observation units, and critical care patient care units in 38 California acute care hospitals from June 1998 to June 1999.

Findings: Nursing staffing ratios varied among the 257 units. RNs provided 91% of the nursing care in critical care units. Patients in medical‐surgical units received 59% of their care from RNs, 11% from licensed vocational nurses, and 30% from other caregivers. Preliminary data showed no relationships between reported staffing ratios in these hospitals and the incidence of patient falls or hospital‐acquired pressure ulcers.

Conclusions: California Nursing Outcomes Coalition (CalNOC) data showed wide variations in staffing ratios, patient falls, and hospital‐acquired pressure ulcers among nursing units and hospitals. These early findings indicate the need for additional research before determining minimal RN staffing requirements. Analysis of multiple sources of data may be necessary to determine safe staffing ratios and to provide evidence‐based data for public policy.
Benchmarking Patient Outcomes
Authors: Rudy Ellen B. , Lucke Joseph F. , Whitman Gayle R. , Davidson Lynda J.
Published: April 2004

Purpose: To examine the usefulness of three types of benchmarking for interpreting patient outcome data.

Design: This study was part of a multiyear, multihospital longitudinal survey of 10 patient outcomes. The patient outcome used for this methodologic presentation was central line infections (CLI). The sample included eight hospitals in an integrated healthcare system, with a range in size from 144 to 861 beds. The unit of analysis for CLI was the number of line days, with the CLI rate defined as the number of infections per 1,000 patient‐line days per month.

Methods: Data on each outcome were collected at the unit level according to standardized protocols. Results were submitted via standardized electronic forms to a central data management center. Data for this presentation were analyzed using a Bayesian hierarchical Poisson model. Results are presented for each hospital and the system as a whole.

Findings: In comparison to published benchmarks, hospital performances were mixed with regard to CLI. Five of the 8 hospitals exceeded 2.2 infections per 1,000 patient‐line days. When benchmarks were established for each hospital using 95% credible intervals, hospitals did reasonably well with only isolated months reaching or going beyond the benchmark limits. When the entire system was used to establish benchmarks with the 95% credible intervals, the hospitals that reached or exceeded the benchmark limits remained the same, but some hospitals had CLI rates more frequently in the upper 50% of the benchmarking limits.

Conclusions: Benchmarking of quality indicators can be accomplished in a variety of ways as a means to quantify patient care and identify areas needing attention and improvement. Hospital‐specific and system‐wide benchmarks provide relevant feedback for improving performance at individual hospitals.
Preparing for the Future Through Genetics Nursing Education
Authors: Jenkins Jean F. , Dimond Eileen , Steinberg Seth
Published: April 2004

Purpose: To determine recommendations for curriculum change that are indicated by innovations in genetics.

Methods: Both quantitative and qualitative. The sample (n = 356) consisted of nurses identified as experts in genetics (n = 228) and nurses identified as potential users of genetics education (n = 128). Nurses' opinions of core components of a genetics curriculum were elicited via a mailed survey questionnaire. Participants also provided demographic information and completed the Jones Innovativeness Scale (1997).

Findings: Recommended content in genetics education for practicing nurses was identified by both groups of nurses. Innovativeness characterized 3% of the respondents. Ninety‐eight percent of respondents said that adopting genetics education is important. In total, 398 items were identified as potential consequences of education that incorporates genetic information.

Conclusions: Identified content provides a template for genetics education programs for nurses. Genetics nursing education was perceived to have positive outcomes for both nurses and clients.
Discourses of Worry, Stress, and High Blood Pressure in Rural South Louisiana
Authors: Boutain Doris M.
Published: April 2004

Purpose: To explore how a sample of rural Louisiana residents constructed accounts about worry and stress in relationship to their high blood pressure.

Design: Qualitative study combining critical social theories, African American studies, and critical discourse concepts. Study participants consisted of a convenience sample (N=30) of African American women (n=15) and men (n=15) with high blood pressure.

Methods: Over a 4‐month period in 1999 a community‐based population sample was interviewed twice. Field experiences in the community and the assistance of community consultants were critical to data analysis. Based on 60 interviews, 191 passages about worry and 58 passages about stress were analyzed using discourse analysis.

Findings: Participants not only distinguished between worry and stress in their everyday lives, but they also highlighted how those concepts were interrelated. Participants' concerns about themselves as well as their children, kin, and community were emphasized in passages about worry. Stress was primarily associated with doing multiple tasks and confronting multiple prejudices in the workplace and surrounding community.

Conclusions: Participants perceived worry and stress as important health‐related concepts that affected their high blood pressure. Nursing strategies designed to address these concerns may better facilitate holistic health.
Affiliative Preferences, Self‐Change, and Adolescent Condom Use
Authors: Tigges Beth Baldwin
Published: April 2004

Purpose: To describe the social comparisons, as measured by affiliative preferences, of Hispanic and non‐Hispanic White adolescents who are either contemplating, initiating, or maintaining effective condom use, and to examine whether these preferences vary with stage of change for condom use and behavioral self‐esteem.

Design: School‐based survey of 180 sexually‐active, 12th grade students at two public high schools in northern New Mexico.

Methods: Participants anonymously completed structured questionnaires in the classroom.

Findings: With few exceptions, respondents preferred to affiliate with others who were similar demographically. Stage of change had a significant main effect on adolescents' affiliative preferences related to condom use. Contemplators wanted to be with peers who used condoms more than they did (upward affiliations), while those in the preparation and maintenance stages wanted to affiliate with those who used condoms essentially the same amount as they did (lateral affiliations). Stage of change also had a significant interaction with behavioral self‐esteem in predicting preferred affiliations related to condom use. Among participants in the preparation stage, those with low self‐esteem wanted to affiliate with peers who used condoms less than they did (downward affiliations), while those with moderate self‐esteem preferred affiliations that were slightly upward.

Conclusions: Social comparison theory was a useful theoretical framework for examining preventive health behaviors. Adolescents' preferences for affiliation with peers varied according to stage of change and behavioral self‐esteem. Implications regarding the use of targeted interventions for each stage of change are discussed.
Women's Voices Reflecting Changed Expectations for Pregnancy after Perinatal Loss
Authors: Côté‐Arsenault Denise , Morrison‐Beedy Dianne
Published: April 2004

Purpose: To describe women's experiences of pregnancy after loss and their long‐term effects of perinatal loss.

Design: Phenomenology.

Methods: Three focus groups were conducted in fall 1996 with a total of 21 women. These women varied in their obstetrical and loss histories. The time since their losses ranged from 34 years ago to the previous year. Data analysis was guided by Colaizzi's procedural steps.

Findings: Women's stories portrayed perinatal loss as a life‐altering event. Women did not feel emotionally safe in their pregnancies after loss and were afraid that those babies too would die. Despite the differences in their obstetrical and loss histories and time since loss, similarities in their responses to pregnancy far outweighed their differences. These commonalities contained in six themes: (a) dealing with uncertainty, (b) wondering if the baby is healthy, (c) waiting to lose the baby, (d) holding back their emotions, (e) acknowledging that loss happened and that it can happen again, and (f) changing self.

Conclusions: This study indicated many common concerns and experiences among women in response to perinatal loss and subsequent pregnancies. Variations were not linked to the number or gestational age of the losses. Care providers should acknowledge women's past losses, address their concerns during a current pregnancy, and recognize the potentially life‐long effect perinatal loss may have on these women.
The Point of Triangulation
Authors: Thurmond Veronica A.
Published: April 2004

Purpose: To explore various types of triangulation strategies and to indicate when different types of triangulation should be used in research.

Methods: Reviews included literature on triangulation and multimethod strategies published since 1960 and research books specifically focusing on triangulation.

Findings: Triangulation is the combination of at least two or more theoretical perspectives, methodological approaches, data sources, investigators, or data analysis methods. The intent of using triangulation is to decrease, negate, or counterbalance the deficiency of a single strategy, thereby increasing the ability to interpret the findings.

Conclusions: The use of triangulation strategies does not strengthen a flawed study. Researchers should use triangulation if it can contribute to understanding the phenomenon; however, they must be able to articulate why the strategy is being used and how it might enhance the study.
Health and Social Service Utilization Among Elderly Immigrants from the Former Soviet Union
Authors: Aroian Karen J. , Khatutsky Galina , Tran Thanh V. , Balsam Alan L.
Published: April 2004

Purpose: To explore factors that affect health and social service use among elderly Russian immigrants from the perspectives of the elders, their adult caregiving children, and the health and social service professionals who serve them.

Methods: A qualitative, case‐oriented study design was used and 17 elderly Russian immigrants, 8 adult caregiving children, and 15 health professionals were interviewed in the Boston area in 1998. Perceptions about the patterns of and reasons for Russian elders' health and social service use were summarized through content analysis of the interview data.

Findings: Participants across groups perceived extensive service use by elderly Russian immigrants. Life circumstances associated with immigration, cultural norms and beliefs, and structural characteristics of the local Russian immigrant community accounted for service use.

Conclusions: Findings indicate that providing support for depression and loneliness associated with immigration, educating immigrants about the role of primary care providers in the US as well as realistic expectations for American medicine, and managing care to decrease the use of unnecessary services would facilitate appropriate service use among elderly Russian immigrants.
Professional Development of Nursing in Saudi Arabia
Authors: Tumulty Gail
Published: April 2004

Purpose: To describe the development of nursing in Saudi Arabia and to recommend further directions for development of professional nursing in that country.

Organizing Construct: A comprehensive needs assessment was performed in 1996 by an onsite consultant to: (a) evaluate the existing nursing system at the ministry, regional, and hospital levels, (b) describe the functional interrelationships of a nursing division within the Ministry of Health, and (c) prepare a work plan outlining the program elements that a nursing division could address to foster high‐quality health care in the public sector.

Methods: The needs assessment was conducted through direct observation, interviews, and review of existing documents in the Ministry of Health and representative hospitals, health centers, and health institutes. Data were collected about six factors as they pertained to the Ministry of Health Nursing Services: (a) key organizational and managerial activities, (b) the external environment, (c) the social system, (d) employees, (e) nursing services and research, and (f) formal organizational arrangements.

Findings and Conclusions: The data showed a young country and an equally young nursing profession struggling to meet the needs of a growing population. The highest priority for the advancement of nursing in Saudi Arabia is the creation of a kingdom‐wide system of nurse regulation. Pressing needs include regulation of professional standards, licensure of all nurses practicing in the Kingdom, accreditation of educational programs, and formation of a national nurses association.
Promoting Responsiveness between Mothers with Depressive Symptoms and Their Infants
Authors: Horowitz June Andrews , Bell Margaret , Trybulski JoAnn , Munro Barbara Hazard , Moser Deborah , Hartz Shelley A. , McCordic Lisa , Sokol Elyse Shirley
Published: April 2004

Purpose: To test the efficacy of an interactive coaching intervention to promote responsiveness between mothers experiencing postpartum depressive symptoms (PPDS) and their infants.

Design: An experimental design with 117 postpartum women in the Northeastern United States.

Methods: Participants were randomly assigned either to the treatment or control group. Both groups had home visits at 4–8 weeks, 10–14 weeks, and 14–18 weeks postpartum and mother‐infant interaction was videotaped and coded for responsiveness. The treatment group also received a coached behavioral intervention designed to promote maternal‐infant responsiveness. Measures included the Edinburgh Postnatal Depression Scale, the Beck Depression Inventory‐II, and the Dyadic Mutuality Code.

Findings: The hypothesis, that the treatment group would show significantly higher maternal infant responsiveness after the intervention, was supported. No effect of the intervention on depression scores was found. A significant increase in responsiveness and a significant decrease in depression scores occurred over time for both treatment and control groups. No interaction between group and time was detected.

Conclusions: The study showed that a coaching strategy had a positive effect on maternal infant interaction in this sample. Future research is needed to test coaching interventions in conjunction with other strategies targeted to promote maternal‐infant responsiveness and to reduce PPDS.
The Theory of Planned Behavior and Postpartum Smoking Relapse
Authors: Gantt Cynthia J.
Published: April 2004

Purpose: To explore the applicability of Ajzen's theory of planned behavior to postpartum smoking relapse.

Organizing Framework: The theory of planned behavior is proposed as an appropriate framework for the study of postpartum smoking relapse.

Methods: The literature on smoking cessation, postnatal smoking, and the theory of planned behavior were reviewed. References included electronic database and manual search results.

Conclusions: The theory of planned behavior provides a framework for explaining, predicting, and influencing human behaviors based on modifiable factors of attitude, subjective norm, and perceived behavioral control. The inclusion of instrument development guidelines significantly strengthens the usefulness of the framework. A theoretically based understanding of postpartum smoking relapses can guide and strengthen appropriate interventions directed toward significantly reducing postpartum smoking, thereby increasing the number of women who are able to remain smoke‐free for life.
Development of the Arabic Language Readiness to Stop Smoking Questionnaire A‐RSSQ
Authors: Haddad Linda G. , Hoeman Shirley P.
Published: April 2004

Purpose: To develop and evaluate the psychometric properties of an Arabic language version of the ‘Smoking and Women Questionnaire’ (SWQ) for men and women.

Design: The core elements of the SWQ were translated into Arabic, back‐translated, and pilot tested to ascertain cultural sensitivity and appropriateness for both men and women in the Eastern Mediterranean Region (EMR). A convenience sample (N=260) of smoking and nonsmoking adults completed a demographic sheet and the Arabic Readiness to Stop Smoking Questionnaire (A‐RSSQ). Pre‐ and post tests were conducted on a smaller sample.

Methods: Researchers used methods to assure accuracy of content and understanding of concepts across cultures. Cronbach's alpha and Pearson's correlation coefficients were calculated to evaluate instrument development.

Findings: The scale showed internal consistency. Pre‐ and post test stability was supportive of respondents' consistent attitudes over 2 weeks at both the item and scale level. Construct validity was shown for both men and women in that scores for smokers were significantly lower than for nonsmokers. The alpha reliability coefficient was 0.78 for the total scale.

Conclusions: The A‐RSSQ showed initial reliability and validity for men and women. It is useful as a cost‐effective means for identifying people in the EMR who are ready to stop smoking.
Correlates of Recent Suicide Attempts in a Triethnic Group of Adolescents
Authors: Rew Lynn , Thomas Nancy , Horner Sharon D. , Resnick Michael D. , Beuhring Trisha
Published: April 2004

Purpose: To describe recent self‐reported suicide attempts in a triethnic group of adolescents, to analyze differences in the correlates of attempts by ethnicity and gender, and to explore theoretical correlates of recent suicide attempts using a resilience framework.

Methods: Quantitative data were collected from 10,059 students in 7th, 9th, and 11th grades in Connecticut in 1996. Secondary analysis was done to compare respondents of African American, Hispanic Latino, and Caucasian ethnicities. Data were analyzed using bivariate and multivariate procedures. Logistic regression was used to identify the best set of explanatory variables for recent suicide attempts.

Results: The percentage of suicide attempts was significantly higher among Hispanic Latina girls (19.3%) than in any other ethnic‐gender group. Significant relationships were found between recent suicide attempts and (a) family history of suicide attempt, (b) friend's history of suicide attempt, (c) history of sexual abuse, (d) history of physical abuse, and (e) environmental stress. The significant set of explanatory variables for recent suicide attempts for the three ethnic groups combined were stress, internalizing and externalizing behaviors, physical and sexual abuse, family and friend attempted suicide, social connectedness, and religious influence.

Conclusions: Findings support use of a resilience model for suicide attempts among three ethnic groups. The finding of a significantly higher percentage of recent suicide attempts by Hispanic girls compared to girls in other ethnic‐gender groups warrants further investigation along with development and testing of culturally sensitive preventive interventions.
Immigrant Nurses' Experience of Racism
Authors: Hagey Rebecca , Choudhry Ushi , Guruge Sepali , Turrittin Jane , Collins Enid , Lee Ruth
Published: April 2004

Purpose: To document and describe the experiences of immigrant nurses of colour who have filed grievances concerning their employers' discriminatory practices; and to solicit their views of existing policies and recommendations for equity in professional life.

Design and Methods: In this descriptive, exploratory study nine immigrant nurses of colour in Ontario, Canada, were interviewed between 1997 and 1998. Data were collected through face‐to‐face interviews and in focus groups. The discourse theory and methods of van Dijk and Essed were used to analyse the qualitative data.

Findings: Recurring themes were: (a) being marginalized and acknowledging and naming the racist experiences; (b) experiencing physical stress and emotional pain; (c) strategizing to cope and survive; (d) recommending policy changes.

Conclusions: All nurses interviewed had experienced reprisals as a result of complaining or filing grievances and unfairness was encountered in the redress process itself. Participants recommended policy initiatives to ensure equity and fair practices in the nursing profession.
Methodological Issues In Web‐based Research
Authors: Duffy Mary E.
Published: April 2004

Purpose: To examine methodological issues associated with using the Internet and World Wide Web for scientific research, namely, issues related to the nature of the sample, the testing environment and environmental factors, privacy, and confidentiality, and response rates.

Methods: Reviews of literature and personal observation and experience.

Findings: Web‐based research provides many advantages such as access to specific, sometimes difficult‐to‐find populations, speed of data access, and decreased costs for data collection and data entry. Such benefits are likely to increase as more nurse scientists use the Web for research purposes.

Conclusions: Nurse researchers who use this technology must consider the methodological problems associated with Web‐based methods. The research potential exists, but the methodological issues discussed in this paper are real and, if not addressed, they can seriously affect the validity of study findings.
A Concept Analysis of Uncertainty in Illness
Authors: McCormick Kim M.
Published: April 2004

Purpose:To examine the concept of uncertainty in illness and to propose an alternate model of uncertainty in the illness experience.

Organizing construct and methods:Following a review of the literature, Morse's description of concept analysis by critically appraising the literature was used as a guideline in examining the concept of uncertainty.

Findings:Characteristics of the illness situation‐ambiguity, vagueness, unpredictability, unfamiliarity, inconsistency, and lack of information‐underlie the process of uncertainty. Three attributes of the concept of uncertainty were identified as probability, temporality, and perception. Loss of personal control is often erroneously equated with uncertainty.

Conclusions:Uncertainty is a multidimensional concept that in its purest form is a neutral cognitive state and should not be mistaken for its emotional outcomes. To clarify the concept of uncertainty, further research is needed to determine the relationship of uncertainty to loss of control and psychosocial outcomes.
Leadership Research in Business and Health Care
Authors: Vance Connie , Larson Elaine
Published: April 2004

Purpose: To summarize research on leadership in the health care and business literature and to identify the outcomes of leadership on individuals, groups, and organizations.

Methods: A computerized search and review of research studies was conducted in the health care and business literature from 1970–1999. Studies were categorized and analyzed according to participants, design, primary topic area, and effects or outcomes of leadership.

Findings: Most of the health care and business literature on leadership consisted of anecdotal or theoretical discussion. Only 4.4% (n=290) of 6,628 articles reviewed were data‐based. Further, the largest proportion of the research (120/290, 41.4%) was purely descriptive of the demographic characteristics or personality traits of leaders. Other studies showed the influence of leadership on subordinates (27.9%). Only 15 (5.2%) of 290 research articles include correlations of qualities or styles of leadership with measurable outcomes on the recipients of services or positive changes in organizations.

Conclusions: Research on leadership in the health care and business literature to date has been primarily descriptive. Although work in the social sciences indicates that leadership styles can have a major influence on performance and outcomes, minimal transfer of this work to the health care system is evident. Limited research on leadership and health care outcomes exists, such as changes in patient care or improvements in organizational outputs. In this era of evidence‐based practice, such research, although difficult to conduct, is urgently needed.
An Ecological Perspective of Breastfeeding in an Indigenous Community
Authors: Dodgson Joan E. , Duckett Laura , Garwick Ann , Graham Barbara L.
Published: April 2004

Purpose: To describe the sociocultural patterns that promote breastfeeding or weaning in the Ojibwe community, which has very low breastfeeding rates compared to the general population.

Design: A focused ethnographic approach with an ecological framework provided community level data. Semi‐structured interviews (N=52) were conducted in an urban Ojibwe community and with three groups of women: health or social service providers, women currently breastfeeding, or people who acted as resources.

Methods: Data were analyzed using an ethnographic approach. Group summaries were compiled and community‐level patterns were identified.

Findings: Four patterns were identified that encompassed the influences of (a) Ojibwe and mainstream cultures (traditions), (b) communication‐related barriers from a variety of sources (mixed messages), (c) socioeconomic issues (life circumstances) and (d) social support (nurturing and supporting).

Conclusions: The values and practices of the studied group were not always congruent with those of the larger mainstream culture. Successful breastfeeding promotion and intervention programs based on culturally relevant perspectives are needed.
A New Foundation for Methodological Triangulation
Authors: Risjord Mark W. , Dunbar Sandra B. , Moloney Margaret F.
Published: April 2004

Purpose: To show how triangulation with qualitative and quantitative methods can help confirm a theory to a greater degree than can either method alone.

Construct: Coherence view of theory structure and confirmation. Evidence helps confirm a theory if the theory is the most coherent way of accounting for the evidence, and one theory is more coherent than another insofar as it leaves fewer unanswered questions (and fewer unquestioned answers).

Methods: The method of this theoretical essay is analytic. Analysis of the debate over methodological triangulation reveals presuppositions about theory structure and confirmation. Well‐known arguments in the philosophy of science are presented to show that the presuppositions are false. The arguments provide evidence for the construction of an alternative, coherence model of theory structure and confirmation.

Findings: Three consequences of the analysis are: (a) qualitative and quantitative methods do not produce theories with different structures; (b) qualitative and quantitative methods help to confirm theory in the same ways; and (c) used together, qualitative and quantitative methods can confirm a theory to a greater degree than the use of either method alone.

Conclusions and implications: A coherence of model of theory structure and confirmation supports a version of the blending view of methodological triangulation. Triangulation can provide completeness, abductive inspiration, and confirmation. This version of blending provides principles for resolving issues of methodological dominance and order, and it indicates how different methods can disconfirm theory.
The Experience of Italians Caring for Family Members with Alzheimer's Disease
Authors: Vellone Ercole , Sansoni Julita , Cohen Marlene Zichi
Published: April 2004

Purpose: To obtain a more complete understanding of the experience of Italian caregivers of people with Alzheimer's Disease (AD).

Design and Methods: In this phenomenological study of AD Italian caregivers, the participants were 26 family caregivers (6 men and 20 women, of whom 19 were spouses and 7 were children).

Findings: Six themes were identified in this analysis: changes in relationships, changes in lifestyle, difficulties in caring, hopes and fears for the future, family duty, and respectful treatment. Caregivers experienced profound changes in their lives, including changes in their relationships with patients, in their lifestyles, and in their relationships with other family members. Caregivers experienced difficulties in caring because of their lack of knowledge about the illness and the lack of support from the National Health System. Participants hoped to not see their loved ones' conditions worsen and hoped to see positive results from prescription medications. Moreover, they hoped that God would help them go on. Some caregivers feared that the illness was hereditary and that they would not be able to cope with it. The Italian caregivers' respectful treatment of the patients demonstrated their profound sense of family duty, which included encouraging the patients to do self‐care and occupational activities.

Conclusions: Similarities and differences among Italian caregivers and those in other countries are discussed, and implications for Italian health professionals and directions for future research are addressed.
The Efficacy of Tailored Interventions
Authors: Ryan Polly , Lauver Diane Ruth
Published: April 2004

Purpose: To evaluate the efficacy of Tailored Informational Interventions (TIs) compared to Standard Informational Interventions (SIs) and to determine whether efficacy varies by type of behavior, use of feedback, type of delivery channel, dose of the intervention, or time.

Methods: Cooper's method of literature integration (Cooper, 1989; Cooper & Hedges, 1994) was used. Eighty‐five articles were located that contained the word tailoring in the title or abstract; 20 met criteria for inclusion.

Findings: Participants preferred TIs to SIs, perceived that the TIs were personal, and read and remembered more of the TI information. TIs were more effective than were SIs in 50% of studies. The effects of tailored and standard interventions were equivocal in the remaining 50% of studies. TIs had small increases in effect sizes compared to SIs. The efficacy of TIs differed by type of behavior. TIs had greater efficacy when ipsative feedback (comparing current to past behavior) was included as part of the intervention than when the intervention did not include such feedback. Repeated versus single administration of TIs did not affect health behaviors. The efficacy of TIs changed over time in some studies, but the pattern of change was not consistent.

Conclusions: Tailored interventions could be improved by (a) identifying the most salient characteristics to be tailored, (b) further delineating essential components of TIs, (c) determining the efficacy of different delivery channels, (d) determining factors that moderate effects of TIs, and (e) clarifying whether the efficacy of TIs changes over time.
Emotional Distress and Prenatal Attachment in Pregnancy After Perinatal Loss
Authors: Armstrong Deborah Smith
Published: April 2004

Purpose: To evaluate the association of previous perinatal loss with parents' levels of depressive symptoms, pregnancy‐specific anxiety, and prenatal attachment in a subsequent pregnancy, and to determine whether higher levels of depressive symptoms and pregnancy‐specific anxiety were associated with prenatal attachment.

Design: A three‐group comparative design was used to collect cross‐sectional survey data. The sample consisted of 103 couples who were in the second trimester of pregnancy: 40 couples who had a perinatal loss in a previous pregnancy, 33 couples were pregnant for the first time, and 30 couples had a history of prior successful pregnancies.

Methods: Structured questionnaires via in‐person or telephone interviews were used to measure depressive symptoms, pregnancy‐specific anxiety, and prenatal attachment.

Findings: Couples with a history of perinatal loss had higher levels of depressive symptoms and pregnancy‐specific anxiety than did couples with past successful pregnancies and no losses; mothers had higher levels of symptoms than did fathers in all groups. Couples with and without a history of perinatal loss did not differ in their level of prenatal attachment in the current pregnancy.

Conclusions: These findings do not support the theory that depressive symptoms and pregnancy‐specific anxiety affect subsequent parent‐infant attachment in a pregnancy after perinatal loss. However, they do provide insight into the continuing influence of parents' previous loss experience on their depressive symptoms and pregnancy‐specific anxiety in subsequent pregnancies. Families should be assessed to examine the potential long‐term influence of emotional distress as a result of prior perinatal loss.
Hydrotherapy in Labor
Authors: Benfield Rebecca D.
Published: April 2004

Purpose: To review the literature on hydrotherapy in labor to direct prescription of the intervention and design studies to test its effectiveness.

Methods: Studies of hydrotherapy were identified via searching literature and electronic databases.

Findings: A primary effect of immersion is a central blood volume bolus, which occurs almost immediately after bathing begins. Subjective maternal responses to bathing in labor have been favorable. No maternal or infant infections have been attributed to bathing by parturients with either intact or ruptured membranes. Maternal bathing in labor does not appear to affect infant Apgar scores or stress hormones at birth. No clear evidence exists to indicate that hydrotherapy increases cervical dilation, increases fetal descent, reduces uterine dyskinesia, shortens labor, decreases use of epidurals or analgesia, or decreases rates of operative delivery or hemorrhage.

Conclusions: Study findings indicate support for using hydrotherapy for relief of rapid pain and anxiety in labor. A methodical approach must be taken to determine for whom and under what circumstances intervention with hydrotherapy in labor is efficacious. Studies of the maternal and fetal effects of hydrotherapy in labor, including mechanisms of action, as well as large, prospective, randomized clinical outcome trials with control for intervening variables, are needed to help practitioners decide whether to prescribe hydrotherapy.
Decision‐Making Process for Living Kidney Donors
Authors: Yi Myungsun
Published: April 2004

Purpose: To explore what people experienced when deciding to donate a kidney and to explore associated issues and concerns when they made their decisions.

Design: Grounded theory.

Methods: The data were collected in Korea through semi‐structured individual interviews in 1998–1999. A purposeful sample of 14 living kidney donors participated. All interviews were audiotaped and were transcribed verbatim. Constant comparative analysis was done using the NUD*IST4.0 software program.

Findings: “Wishing to give (a kidney)” was the core category integrating the six subcategories: motives, intervening conditions, inhibiting factors, facilitating factors, donor characteristics, and consequences. Two phases in the decision‐making were the deliberation phase and the execution phase. Three decision‐making types related to the intensity of “wishing to give” are: high intensity as voluntary type, medium as compromising type, and low as passive type.

Conclusions: The decision to donate a kidney was described as a highly complicated process involving not only the medical but also psychological, interpersonal, familial, and financial concerns.
A Call for Replication
Authors: Fahs Pamela Stewart , Morgan Lindsay Lake , Kalman Melanie
Published: April 2004

Purpose: To promote the use of replication as a means for strengthening knowledge for nursing practice.

Methods: Examination of two clinical examples of how replication could strengthen nursing practice.

Findings: The first example had no research evidence to support the practice and the other was based on the findings of a single medical study. Both led to nursing practices that were not effective or efficient, although not harmful. Replication can be used to overcome design limitations, increase validity of findings, and bring about correction of error. In addition, potential barriers and solutions to increase replication were identified.

Conclusions: Replication is a critical step in validating research to build evidence and to promote use of findings in practice.