bluuebunny/crossref_metadata_2025 huggingface dataset:
Are We Implementing Community Health Promotion in Nursing?
Authors: Baldwin Joan H.
Published: May 2007

Abstract Promoting the health of communities has been the rallying cry (now renewed) from the nation's top public health officials. Public health nurses have always stressed community health promotion, not only in their work but also in the educating of future public health nurses. Facilitating the shift from focusing primarily upon secondary and tertiary prevention, individual, and disease‐oriented processes is a constant challenge, given the current health care and reimbursement systems. The objectives of this paper are: to give a brief historical review of the nation's health objectives, other recent pertinent documents, and early public health nursing's emphases regarding community health promotion; to give a selected overview of recent community health promotion programs implemented by community and public health nurses in nursing education and practice; and to focus on present challenges to nursing in implementing community health promotion.
A Study on Functioning for Independent Living among the Elderly in the Community
Authors: Yu Shu
Published: May 2007

Abstract The primary purposes of this study were to understand the level of functioning for independent living (FIL) as well as to analyze related factors among the elderly. A questionnaire was used to collect data in a face‐to‐face interview. A total of 247 subjects over 65 years of age completed the questionnaire. The subjects, who lived at home in Keelung City in Taiwan, Republic of China, were interviewed by trained interviewers. Data analysis was performed using a personal computer with SPSS/PC + 5.0. The results indicated the following: The most common diagnoses of the elderly were hypertension, visual impairment, stomach disease, and arthritis. The level of FIL for most subjects ranged from total independence to mild impairment. According to step‐wise multiple regression analysis, five significant variables (physical activity status, the number of chronic diseases, health care needs, age, and care provider) were the optimal predictors of physical FIL and total FIL. Three variables (physical activity status, number of chronic illnesses, and care provider factors) were the optimal predictors of mental FIL. Finally, recommendations are made regarding health policy, community nursing practice, and further study.
Prenatal Peer Counseling: An Answer to the Persistent Difficulties with Prenatal Care for Low‐Income Women
Authors: Lapierre Judith , Perreault Michel , Goulet Céline
Published: May 2007

Abstract Our intention in this article is to provide the reader with the theoretical framework of prenatal peer counseling. A second article describing a prenatal peer program that is functional in the province of Quebec will be presented subsequently with its outcomes and recommendations. However, before planning the implementation of such a program or even assessing its effectiveness, one must understand how peer counseling can be used as an assistive strategy and why it is perceived to be a community approach worth considering with pregnant women from poor socioeconomic backgrounds. This approach addresses most problems encountered when prenatal programs fail to meet the specific needs of these women. Principles of the therapeutic community and its derivatives are put forward to lay the theoretical foundation of prenatal peer counseling. The studies reviewed show that psychosocial variables associated with pregnancy outcome and poverty such as anxiety, social support, and self‐esteem can be positively influenced through a prenatal peer counseling program. We strongly recommend that nurses working with low‐income families consider prenatal peer counseling as an empowering strategy for mothers within a given community.
Barriers to Well Child Care for Homeless Children under Age 13
Authors: Riemer Judith G. , Cleve Lois Van , Galbraith Michael
Published: May 2007

Abstract Barriers perceived by homeless families to preventive health care for their children under age 13 have been underdocumented. This descriptive study was designed to identify perceived barriers to care and to determine if there was a relationship between perceived barriers and duration of the family's home‐lessness. Using an investigator‐modified version of Melnyk's Barriers Scale and a demographic measure, a convenience sample of homeless families (n= 53) from three transitional shelters was surveyed via questionnaire.

Four barriers were cited most frequently by the respondents as greatly affecting their children's care. These barriers involved provider‐selection difficulties, waiting for well child appointments, waiting during well child appointments, and the high cost of transportation and/or parking. No relationship was found between duration of homelessness and perceived barriers.

These findings confirm the reality of potential barriers to care suggested by earlier studies. Innovative forms of health care delivery that may reduce or eliminate these barriers include the use of shelter‐site clinics, mobile units, and the use of a nurse liaison between family shelters and hospital‐based clinics.
A Concept Analysis of Home Visiting
Authors: Byrd Mary E.
Published: May 2007

Abstract Throughout the history of community health nursing, home visiting has been and remains a central nursing intervention. Yet little conceptual clarification has dealt with this intuitively very valuable nursing intervention. Here, the concept of home visiting was investigated through a concept analysis. The nature of home visiting as it emerged over time was gleaned from historical and current literature. A working definition, capturing the essence of home visiting and implying new measurement possibilities, was formulated. Home visiting emerged as a specific nursing intervention, preceded by an antecedent event, unfolding as a process, with phases labeled as “contacting,”“going to see,”“gaining entry,”“seeing,”“terminating,” and “telling.” Nurse sub‐outcomes, nursing strategies, contextual factors influencing the process, and potential consequences of home visiting were uncovered.
The Contributions of Sleep to Perceived Health Status during Adolescence
Authors: Mahon Noreen E.
Published: May 2007

Abstract The purposes of this correlational study were to examine the relationships of three dimensions of sleep quality (sleep disturbance, sleep effectiveness, and sleep supplementation) and sleep quantity (the amount of sleep obtained per day) to perceived health status in early, middle, and late adolescents. The samples consisted of 106 early adolescents (aged 12 to 14), 111 middle adolescents (aged 15 to 17), and 113 late adolescents (aged 18 to 21). In classroom settings, all subjects completed the VSH Sleep Scale, which measures sleep disturbance, sleep effectiveness, and sleep supplementation (the amount of sleep per day was calculated from two items on the scale); the General Health Rating Index, which measures perceived health status; and a demographic data sheet. Pearson product moment correlation coefficients between the sleep variables and perceived health status were not statistically significant for early and late adolescents. For middle adolescents, however, the correlations between sleep disturbance and perceived health status, between sleep effectiveness and perceived health status, and between amount of sleep per day and perceived health status were statistically significant, but the correlation between sleep supplementation and perceived health status was not. A post hoc regression analysis indicated that the sleep variables explained a small, but statistically significant, amount of variance in perceived health status for middle adolescents. Findings are discussed in light of theories guiding the study, and implications for nursing practice are addressed.
Population Management in an HMO: New Roles for Nursing
Authors: Graff Wendy L. , Bensussen‐Walls Wendy , Cody Eileen , Williamson Joanne
Published: May 2007

Abstract A project to define and test population‐management roles in nursing was implemented in a large HMO. Three patient populations were selected: diabetics, patients with multiple sclerosis, and pregnant adolescents. Expert nurse clinicians in each of the three areas piloted the role for six months, including establishing a system of care coordination for the populations. In all three pilots, patient care outcomes were improved. Keys to success included aligning the work with the critical clinical work of the organization, practicing in multidisciplinary settings, and reporting objective outcome data to constituents.
Health Promotion and the “Ideology of Choice”
Authors: Lowenberg June S.
Published: May 2007

AbstractAssessment and intervention in public health nursing are intricately linked to health promotion. Health promotional strategies in turn focus attention on life‐style modifications. A broad base of research warns of the dangers of the “ideology of choice” that currently accompany such lifestyle‐change attempts. The “ideology of choice” is inherent in pervasive views that individuals are “responsible for” and “choose” their disease. The rhetoric of individual responsibility pervades the discourse around both health promotion and health care reform. Without continual awareness of both the complex and multifaceted nature of such life‐style “choices,” and the balancing of a compassionate stance toward human frailty, health promotion attempts easily degenerate into a victim‐blaming stance. Public health nurses need to be particularly aware of these dangers during this period when cost constraints are generating more pervasive “ideology of choice” rhetoric, targeting those with the scarcest resources and the most profound needs.
Development of the Home Care Client Satisfaction Instrument
Authors: Westra Bonnie L. , Cullen Laura , Brody Donna , Jump Patricia , Geanon Letitia , Milad Ellen
Published: May 2007

Abstract Client (patient) satisfaction has been studied extensively in the health care sector, yet those receiving home health care services have been the focus of few studies. The purpose of this study was to test the reliability and validity of the Home Care Client Satisfaction Instrument (HCCSI). A total of 400 clients, randomly selected from 20 randomly chosen home care agencies in one state, completed the HCCSI and demographic form. Most respondents were older adults with multiple health problems and their families or informal support systems. Since data were skewed, item analysis was used. The revised instrument (HCCSI‐R) is unidimensional and includes 12 items rated on a 5‐point Likert scale measuring specific aspects of care. In addition, there are three global measures of satisfaction rated on a 10‐point scale. All items except one had significant item‐total correlations greater than .59. The total score correlates with likeliness to recommend the agency to others (.37,p= .0001), showing some evidence for criterion‐related validity.
Using Critical Feminist Principles to Analyze Programs for Low‐Income Urban Women
Authors: Reutter Linda , Neufeld Anne , Harrison Margaret J.
Published: May 2007

Abstract Public health nurses are committed to promoting the health of vulnerable populations, including the economically disadvantaged. One of the perspectives that can be used to work with low‐income women is feminist theory. In this paper, we analyze program descriptions from 45 community agencies whose services are accessed by urban low‐income women. The purpose of the analysis is to identify congruence between agency programs and selected feminist principles. As a result of the content analysis, empirical referents and examples were identified for each principle. Public health nursing programs can incorporate feminist principles by responding to the perspectives of the vulnerable and facilitating their efforts to change the conditions that led to their vulnerability. Questions are presented that could guide public health nurses in stimulating reflection and in facilitating dialogue in the process of developing programs for low‐income women.
Use of Community Resources by Prenatal Case Managers
Authors: Issel L. Michele
Published: May 2007

AbstractComprehensive, community‐based case management has been inadequately studied with regard to case managers' use of community resources. The purpose of the study was to identify what federal, state, and local health and social services are used by case managers in coordinating services for prenatal case management of high‐risk, Medicaid‐eligible women. Thirty‐three case managers in two local health departments and one managed care organization provided three types of data about the community resources to which they refer clients. Categories of types of services were developed using content analysis. The results indicate that case managers refer their clients to 10 types of services. Federal assistance programs of Medicaid and the Women, Infant, and Children (WIC) nutrition program were used most. Hospitals, private physicians, family planning services, and transportation and housing services were frequently used. Implications for practice and research are discussed.
An Instructional Model for Primary Health Care Education
Authors: Davis Janet Haggerty , Pearson Merry Ann
Published: May 2007

Abstract Primary health care (PHC) offers nurses a framework for community‐based practice in a restructured health care system. This study examined a Nursing in Primary Health Care course model. Self‐directed learning readiness among baccalaureate nursing students enrolled in the course was examined in relation to evaluation of course content and instructional methods. The majority of students responded positively to the course methods and significant differences in course evaluations were found to be relative to self‐directed learning readiness. The results suggest the Nursing in Primary health care course model effectively introduces students to PHC.
Community Collaboration: Prevention and Control of Tuberculosis in a Homeless Shelter
Authors: Mayo Kelly , White Sue , Oates Sharon K. , Franklin Faith
Published: May 2007

Abstract An urban shelter in Charleston, South Carolina developed and began a tuberculosis (TB) prevention and control plan that addressed the priorities recommended by the Centers for Disease Control and Prevention. After an increase in TB in the shelter in 1992, the local health department, the homeless clinic nurse practitioners, and Medical University of South Carolina College of Nursing faculty and students collaborated with the shelter staff to provide initial mass screenings for contact investigation. They also developed and implemented new policies and procedures for an ongoing TB prevention and control program. The new policies required that guests obtain screening for TB within 7 days of arrival at the shelter and every 6 months thereafter. Also, a public health nurse began providing directly observed therapy twice weekly at the shelter. Of the initial 22 persons who started TB preventive therapy in 1993, 17 (77%) completed therapy. The clinic nurse practitioners, nursing students, and public health nurses had important and defined roles in the mass‐screening process, case identification and treatment, policy development and implementation, health education, and establishing methods of communication between the shelter, clinic, and health department. An ongoing health care community collaborative effort may successfully reduce tuberculosis disease in a homeless shelter population.
Survey Data Collection: Operationalizing the Research Design
Authors: Hildebrandt Eugenie
Published: May 2007

AbstractThis article describes how indigenous interviewers were used to collect data about the health needs and resources in a black South African township. The survey was done during the dismantling of the apartheid political system of South Africa. The political unrest, distrust, and tension were barriers to carrying out a survey and threatened the quality of the data collection. A vulnerability of survey research is the difficulty in controlling the variables of the community and the interviewer during the process of data collection. How this survey was carried out, in this unstable setting, influenced the quality of the data and the validity and reliability of the research. The data‐collection requirements were carried out in a way that was functional in the real‐world setting while maintaining research standards. The criteria used for hiring interviewers and the content and delivery of training were effective in this tense, educationally disadvantaged community setting. Methods that were used to motivate and supervise interviewers were successful and are recommended for use in similar survey research.
Focus Groups
Authors: Stevens Patricia E.
Published: May 2007

Abstract Focus‐group method is an apt strategy for studying community health phenomena at the aggregate level. Not only can its use facilitate the inclusion of segments of the population who have been underserved by previous research, but it can generate a depth of understanding about public health problems, community strengths, and potential interventions that have local meaning and utility. Advantages and potential uses of focus groups are explored, as well as purposes and processes of focus‐group interviewing, strategies for analysis, methodological limitations, and implications for practice and policy. The author presents investigatory examples to illustrate how focus‐group method expands on the possibilities of individual interviewing to explore community interpretations and understand the health needs and experiences of an aggregate.
Field‐Workers' Sense of Coherence and Perception of Risk When Making Home Visits
Authors: George Valerie D.
Published: May 2007

Abstract This study explored the relationship between the strength of the sense of coherence (SOC) and perceptions of different aspects of risks perceived by field‐workers making home visits for Medicare‐certified home care agencies. SOC is the disposition that individuals have toward stimuli. Field‐workers with a strong SOC identified fewer risk encounters, attributed a lower level of risk to characteristics of home visits that have the potential for injury, and evaluated fewer situations as having the potential to be threatening than their weak SOC counterparts. Strong SOC field‐workers were prepared to use behaviors similar to those of their weak SOC counterparts to protect themselves from harm should a situation become threatening. Knowledge of the strength of the SOC of field‐workers can be helpful in the screening, selection, and orientation of potential field‐workers as well as in designing programs to enhance the safety of home health care agency staff.
Social Support and Knowledge Level of the Older Adult Homebound Person with Diabetes
Authors: Zink Margo R.
Published: May 2007

Abstract The purpose of this study was to continue research related to the identification of social support systems for an older adult homebound population of people who have diabetes compared to a control group of elder home care clients without diabetes, their knowledge level, and the significance of home health care intervention in these support networks. A sample of 11 older adult homebound people with diabetes and 11 older adult home care controls without diabetes from two home care agencies in Connecticut were used for this pilot study. A large sample was projected, but home‐visiting scheduling difficulties arose. Eighty‐two percent of both groups had adequate support systems. There was some difficulty with interpretation of the Homebound Diabetes Knowledge Level Questionnaire and further refinement is needed, especially in relationship to non‐insulin‐dependent diabetes mellitus client responses. Results from chart review, utilizing the Diabetes Clinical Indicator Tool, yielded a 59%‐66% rate of the criteria met in the four categories outlined. It is evident that social support makes a significant contribution to the physical and psychological well‐being of the home care elder, but further study is needed to examine the relationship between an individual's personal and professional network of support in this setting.
Nurses' Diagnostic Work on Possible Physical Child Abuse
Authors: O'Toole Anita W. , O'Toole Richard , Webster Stephen W. , Lucal Betsy
Published: May 2007

Abstract The concept of diagnostic work (A. Strauss, S. Fager‐haugh, B. Suczek, & C. Wiener, 1985) is used to explore nurses' responses to potential child abuse. A total of 1,036 nurses (response rate of 67%) completed a mailed questionnaire that included open‐ended qualitative‐type questions about a hypothetical situation involving possible child abuse. We report their judgments regarding information presented in the hypothetical situation and additional information they requested to make the diagnosis. Nurses focused primarily on the child's injuries and behavior and wanted more information about the abuse event. Diagnostic work was then analyzed by specialty group: community health, school health, emergency, and pediatric nursing. Nurses' specialization influenced the choice of information that was determined to be decisive and the additional information desired to make a diagnosis.
A Description of an Occupational Reproductive Health Nurse Consultant Practice and Women's Occupational Exposures during Pregnancy
Authors: Hewitt Jeanne Beauchamp , Tellier Laurie
Published: May 2007

Abstract It is estimated that each year 20 million workers in the United States are potentially exposed to a variety of reproductive hazards. In 1986, Wisconsin implemented an advanced practice public health nurse role to serve as the occupational reproductive health consultant to employees, employers, health care professionals, unions, and others. This article describes this advanced practice role in public health nursing and the women who sought reproductive health consultation. Data on the types of workplace exposures that these consultees had during pregnancy are used to illustrate the occupational history and its importance for preconceptional and early‐pregnancy counseling. The sample for analysis was limited to the 118 women, aged 19‐43 years, who received consultation services between 1990 and 1993 and whose pregnancies resulted in live births. Data were abstracted from the consultant's records of telephone and written consultations and linked to birth certificate records to provide information on smoking and alcohol use during pregnancy. The findings are summarized using descriptive statistics. Implications of the findings for public health nursing are discussed.
Clarification of the Constructs of Satisfaction and Dissatisfaction with Home Care
Authors: Forbes Dorothy Anne
Published: May 2007

Abstract This study examined what elderly clients perceived as being important in contributing to their satisfaction and dissatisfaction with home care. Nineteen guided interactive interviews were conducted with 10 home care clients using storytelling, scenarios, and a rating of the importance of the dimensions of client satisfaction and dissatisfaction. A hierarchical thematic analysis revealed that satisfaction with home care was influenced by client characteristics and was composed of clients' expectations, program characteristics, home care workers' attributes, relationships with the workers, and clients' involvement with planning their care. Dissatisfaction was reported if positive aspects of these dimensions were lacking. This suggests that satisfaction and dissatisfaction are at opposite ends of multiple continua of dimensions.
A Public Health Nursing Model
Authors: Kuss Trang , Proulx‐Girouard Lori , Lovitt Shana , Katz Cindy B. , Kennelly Patty
Published: May 2007

Abstract Public health nurses are in a strategic position to maintain, promote, and protect the health of populations both now and in the future. In the changing health care environment of the 1990s, defining the expanding and evolving role of public health nursing assists in the effective utilization of public health nurses. During a time when the health care environment is emphasizing the protection and promotion of health, access to health services, and prevention of illness, it is necessary for public health nurses to be in the forefront in the changing focus to primary prevention. Therefore, a model for public health nursing is proposed to provide a framework for defining public health nursing roles and practice. A flowering tree is one symbol of public health nursing. The tree consists of seven parts symbolizing nine public health nursing concepts. This model is proposed to articulate clearly the capacity of public health nursing within today's ever‐changing environment and to provide a framework for public health nursing theory, public health nursing practice, policy development, and public health research.
Staff Evaluation of a High‐Risk Pregnancy Program
Authors: Mackey Marlene C. , Sobral Martha
Published: May 2007

Abstract A southeastern state implemented a multidisciplinary health care program for Medicaid eligible, medically high‐risk pregnant women and their infants as part of a statewide effort to reduce perinatal morbidity and mortality. The purpose of this study was to obtain the staff's evaluation of this high‐risk‐pregnancy program. Clinical, supervisory, and clerical staff (N= 182) completed a questionnaire about the operation of the program and its perceived benefits. Staff identified program strengths: nurse case management, interdisciplinary structure, quality care, and positive health outcomes. Staff also identified program limitations including limited staff and time, inflexible protocols, administrative tasks, and narrow enrollment criteria. The majority of staff reported that the following barriers interfered with the effective operation of the program: paperwork, limited support, time, difficulty locating patients, and mandated time frames for patient contact. The majority of staff also reported that transportation most interfered with patient access to the program. The findings of this study support the need for ongoing staff evaluation of all perinatal health care programs.
Health Behaviors of an Elderly Filipino Group
Authors: DiPasquale‐Davis Joan , Hopkins Sheila J.
Published: May 2007

Abstract More than 69 million elderly people are expected to be living in the United States by the year 2050 (American Association of Retired Persons, 1991). For public health nurses, this rapidly growing, diverse population poses a challenge. P. Ebersol and P. Hess (1994) suggest that health care professionals must become skilled in understanding the health needs and practices of the diverse, heterogeneous aged if they are to help the elderly achieve more healthful, satisfying existences. According to two studies, M. Nemcek (1990) and J. Flaskerud and C. Rush (1989), health behaviors of the elderly vary among and within cultural groups. The purpose of this descriptive survey study was to examine how culture affects the health behaviors of 52 elderly Filipino women and men. The Health Behavior Survey was designed and used by the researchers in this study. Unhealthy behaviors identified were inclusion of fried foods in diet, weight gain, and little or no exercise. Because of the value placed on personal health by the participants, it appears the group would be receptive to a health promotion program which would increase their probability for a healthy life.
Enhancing Client Competence: Melding Professional and Client Knowledge in Public Health Nursing Practice
Authors: Reutter Linda , Ford Joan S.
Published: May 2007

Abstract Providing health information is an important aspect of public health nursing. This article describes how public health nurses (PHNs) give information to enhance client competence. The findings are part of a larger study that explored PHNs' perspectives and experiences of their practice. The study employed an exploratory descriptive qualitative research design. Data were gathered through in‐depth individual and focus group interviews with 28 PHNs in Alberta, Canada. Content analysis revealed that nurses work to enhance client competence by sharing professional knowledge and by building on the client's experiential knowledge. Nurses provide information to assist clients with immediate concerns and for future use. PHNs use three main strategies to deal with immediate concerns: being direct, providing options, and presenting a different view. Information for future use focused on enhancing development and forestalling future problems. Nurses build on clients' experiential knowledge by acknowledging their present situation, giving positive feedback, being there, and gently persuading. The authors suggest that the melding of professional and client knowledge is foundational to health promotion approaches that enhance client competence. There is a need for further research that explores the intricacies of developing partnerships between professionals and clients that embrace a sharing of professional and experiential knowledge.
Giving Voice to Elderly People: Community‐Based Long‐Term Care
Authors: Krothe Joyce Splann
Published: May 2007

Abstract Information gained from elderly people regarding their needs for community‐based long‐term care is necessary for informed and responsive policy development. Informed policy development is essential given demographic projections and the need to develop cost‐effective alternatives to institutionalization. The purpose of this study was to understand the context within which elderly people would be able to continue residing in their communities. Programs have been developed based on providers' perceptions of services that are necessary to maintain elderly people at home. There is a lack of information about elderly people's perceptions. Data were collected from 9 elderly people who represented the phenomenon of being at risk for institutionalization. Participants were interviewed serially and contingently in stages using naturalistic methodology. The interviews were tape‐recorded, transcribed verbatim, and analyzed by the inquirer. Findings of the study indicated that the desire of elderly people to stay at home is motivated by their need to maintain control over their daily lives and have their individualized needs addressed. Perceptions related to nursing homes, roles of family, essential services, and future needs for assisted living emerged as major themes. The findings suggest policy implications for professional nurses related to the long‐term care system, providers, and nursing homes.
Focus Groups Among Public, Military, and Private Sector Mothers: Insights to Improve the Immunization Process
Authors: Houseman Clare , Butterfoss Frances D. , Morrow Ardythe L. , Rosenthal Jorge
Published: May 2007

Abstract The underimmunization of children younger than 2 years old is a major health problem in U.S. cities. Innovative methods to increase immunization rates are being researched and implemented. In 1993, six focus groups were conducted with 41 mothers (25 African Americans and 16 Caucasians) to discuss their views regarding immunizations and the services they received from health care providers in the public health (n= 27), military (n= 4), and private (n= 10) sectors. Participants viewed immunizations positively, but perceived many barriers to immunization. They suggested the following ways to improve the immunization process: enhancing knowledge acquisition, improving reminder and appointment systems, providing transportation and child care, decreasing waiting times, improving the clinic environment, and making the immunizations less traumatic. According to mothers in this study, obtaining an immunization on time is a complex task that requires planning and resources. The fewer resources that are available to mothers, the more difficult it is to succeed. Health care providers must help mothers identify and remove barriers if immunization rates are to be increased.
Childhood Lead Poisoning on the US‐Mexico Border: A Case Study in Environmental Health Nursing Lead Poisoning
Authors: Amaya Maria Alvarez , Ackall Gail , Pingitore Nicholas , Quiroga Martha , Terrazas‐Ponce Belen
Published: May 2007

Abstract Human exposure to environmental hazards is a major public health problem along the US‐Mexico border due to socio‐economic, cultural and political factors. Childhood lead exposure is endemic in areas of extreme poverty and substandard housing. Hispanic children of indigent, poorly‐educated, disenfranchised families are at disproportionate risk. Risk management is contingent upon consideration of the interrelationships between socioeconomics, politics, and culture. This case study explains childhood lead poisoning in a colonia family living at subsistence level from such a perspective. The purpose of the study was to identify, explain, and ameliorate lead exposure pathways. Case study methodology was used to support or refute the proposition that these children were exposed to occupational lead. The children were the study sampling unit and the family a subunit. An embedded single case explanatory design was appropriate. Data were collected from exposure surveys, environmental and blood specimens, and review of medical records. Pattern‐matching and explanation‐building techniques were used to analyze data. The study illustrated how extreme poverty, lack of access to health services, social isolation, language and legal barriers, and hazardous occupations may be singularly common risk factors for Hispanic children on the US‐Maxico border. The study is pertinent to public health nurses who work with this population.
Demographic Factors: Interaction Effects on Health‐Promoting Behavior and Health Related Factors
Authors: Felton Gwen M. , Parsons Mary Ann , Bartoces Monina G.
Published: May 2007

Abstract The purpose of this study was to examine the main and interaction effects of race, gender, and education on health‐promoting behaviors, problem solving appraisal, health value, and health definition. Using a convenience sample of 331 employees, a series of three‐way ANOVAs were performed. Only gender exerted main effects on health‐promoting behaviors, including exercise, relaxation, and health promotion. No interaction effects were presented. Neither main nor interaction effects were found for approaching problems and having confidence in solving problems. However, interaction effects indicated that better educated women and better educated black employees perceived less personal control when solving problems. Women valued health more than men, even though there were no gender, race or education differences in the sample's definition of health. Community health nurses and workplace wellness planners are challenged to design programs sensitive to gender differences regarding health behaviors and the valuing of health. Developing training programs to enhance personal control over problem situations is also indicated.
Rural Dwellers' Cancer Fears and Perceptions of Cancer Treatment
Authors: Burman Mary E. , Weinert Clarann
Published: May 2007

AbstractThe purpose of this study was to explore differences in cancer fears and perceptions of cancer treatment among four rural groups: men with cancer, men caregivers, women with cancer, and women caregivers (N= 590). The four groups differed in their cancer fears. About half or less feared pain, nausea, body disfigurement, and sexual problems from cancer. Over two‐thirds were worried about finances and decreases in quality of life. More worried about separation from loved ones than worried about death. The four groups differed only slightly in perceptions of treatment. The majority thought chemotherapy, surgery, and radiation were important treatments. A larger percentage saw nutritional interventions and biologicals as unimportant in cancer prevention or treatment. Nurses need to address fears and perceptions of cancer treatment with persons experiencing cancer and their families. In addition, these persons and their families need support for decisions regarding cancer treatment.
A Typology of the Potential Outcomes of Maternal‐Child Home Visits: A Literature Analysis
Authors: Byrd Mary E.
Published: May 2007

AbstractHome visiting the maternal‐child population has been a major focus of public health nursing. The focus of a large portion of empirical studies of maternal‐child home visiting has been on the demonstration of outcomes. Despite a general consensus about its benefits, public health nursing has experienced difficulty conclusively demonstrating the effectiveness of maternal‐child home visitation. A systematization of potential client outcomes across studies has not been conceptualized. With the aim of tracing overall trends in past attempts to identify, measure, and validate the potential outcomes of maternal‐child home visits, an overview and analysis of these studies is presented chronologically. How specific outcomes were identified and measured are analyzed, and support and nonsupport for potential outcomes are summarized. A tentative typology of maternal‐child home visitation client outcomes is proposed. Four types of outcomes, reflecting an ecological conceptualization of the client, emerged from this analysis. Maternal‐child home visiting outcomes were concerned with the mother (maternal outcomes), the child (child outcomes), the relationship and interaction between the mother and child (maternal‐child interaction outcomes), and the relationship of the family with the extended family, neighborhood, and community (environmental outcomes).
Social Networks of Women Caregivers
Authors: Fudge Heather , Neufeld Anne , Harrison Margaret J.
Published: May 2007

Abstract Social networks and the support that network members provide are important resources for family caregivers in sustaining their caregiving role. Caregivers' perceptions of support from family and friends have been linked to their health status (R. Kahn & T. Antonucci, 1980; I. Sandler & M. Barrera, 1984). The purpose of this study was to explore the social networks and types of perceived support described by women who are caregivers of cognitively impaired older adults. Content analysis was used to examine interview data from a longitudinal qualitative study of 20 women caregivers of cognitively impaired older persons. An important finding of this study was the identification of a typology of social networks of the women caregivers. The caregivers' perceptions of satisfaction with support received and experience of conflict with network members varied according to the characteristics of their social network. Those caregivers who belonged to diverse social networks reported high satisfaction with the support that they received and little or no conflict. Those caregivers with kin‐dominated social networks reported little satisfaction with support received and a high degree of conflict.
Adherence to Tuberculosis Preventive Therapy Among Latino Immigrants
Authors: Ailinger Rita L. , Dear Margaret R.
Published: May 2007

Abstract Tuberculosis infects someone in the world every second. Although TB is preventable and curable, it has resurfaced as a significant health problem in the U.S., particularly among Latino immigrant groups. In this study of 65 Latino immigrants primarily from Central America, we examined adherence to appointments and medication taking during the six months of preventive therapy for latent TB infection. Findings indicated that the Latinos' adherence to appointment keeping ranged from 81% on the first visit to 59% by the sixth monthly visit. Similarly, medication adherence dropped from 89% in the first month to 64% at six months. Demographic factors, self‐assessment of health, other support and presence of side effects were examined in the analysis. Implications for public health nursing are discussed.
The Recruitment and Participation of Hispanic Women in Nursing Research: A Learning Process
Authors: Naranjo Lucia E. , Dirksen Shannon Ruff
Published: May 2007

Abstract Limited information is available regarding the selection of culturally appropriate methods for obtaining data from the Hispanic population, which is currently the largest and fastest growing ethnic minority in the United States. Due to this lack of knowledge which would guide the investigator in the recruitment and retention of Hispanics in research studies, the Hispanic population remains understudied and underserved. This article describes the numerous challenges that were encountered in the actual process of recruiting Hispanic women into a research study which examined adjustment among breast cancer survivors. The rate of refusal to participate was unexpectedly high, which necessitated additional recruitment strategies, including a renewed emphasis on the importance of the study and the option of meeting with other members of the community in a group. Women who refused to participate in the study stated concerns related to a loss of health benefits, the influence of family members, and a recurrence of emotional stress. Instrument issues are also addressed. This learning process of developing, refining, and testing effective methods for recruiting Hispanic women in research studies remains an ongoing endeavor; through these efforts it is hoped that culturally competent health care can become a reality.
Case Study: Shaken Baby Syndrome—One Disorder with Two Victims
Authors: D'Lugoff Marion Isaacs , Baker Deborah Jean
Published: May 2007

Abstract Shaken Baby Syndrome is a complex disorder with implications for family members (especially the victim's mother) that are felt long after the emergency diagnosis and treatment of the child are concluded. The authors conducted a Women's Support Group for parolees over a two year period. Included in its group membership were several women who had been jailed for child abuse related crimes. This article synthesizes the significant progress in the research from the medical, legal, social, nursing, and preventive health perspectives on Shaken Baby Syndrome. A case study is used to illustrate the phenomenon of victimization of the mother, typically the nonoffending parent in Shaken Baby Syndrome. The difficulties of diagnosing Shaken Baby Syndrome in a timely manner are presented with emphasis on the diagnostic ambiguities confronting the various medical and nursing providers and nonoffending perpetrators. The case study attempts to raise the consciousness of nurses, with whom the nonoffending parents come into contact in the vast array of health service settings, as well as provide specific recommendations for enhancing community health nursing practice.
Rural Residents' Use of Cardiac Rehabilitation Programs
Authors: Johnson Julie E. , Weinert Clarann , Richardson Jdee K.
Published: May 2007

Abstract The goal of this study was to identify the factors that influence the use of cardiac rehabilitation services by rural residents. The Andersen‐Newman framework, which consists of three determinants of health services utilization (predisposing, enabling, and need factors), was used to direct this research. The three data collection points were at time of discharge from the hospital, two weeks post discharge, and one week following the date that the cardiac rehabilitation program would have been completed. Packets for the three data collection points were unique and contained instruments to assess various factors influencing the use of health services. The sample (N= 254) were adults living in rural areas who had experienced a cardiac event and received treatment at one of four hospitals in two western states and who provided useable data on all three questionnaires. Findings indicated that 72 (28%) of the participants attended some portion of a rehabilitation program, and only 43 (17%) completed the full 36‐week program. Four predisposing factors, one enabling factor, and two need factors were significant in explaining the number of cardiac rehabilitation sessions attended. Further research is needed to validate these factors and to identify others which may influence the use of cardiac rehabilitation by rural residents. Likewise, it is essential to examine alternate ways to meet the rehabilitative needs of rural cardiac clients.
Family Ritual Facilitates Adaptation to Parenthood
Authors: Niska Kathleen , Snyder Mariah , Lia‐Hoagberg Betty
Published: May 2007

ABSTRACT An ethnographic study done in Hidalgo County. Texas, among 25 Mexican American first‐time mothers and fathers documented the presence of an intergenerational family ritual that facilitated adaptation to parenthood in 24 of the 25 families. La cuarentena is a family ritual of 40 days duration postbirth with cultural prescriptions for maternal food and clothing and for paternal role reversal. La cuarentena instills parental responsibility, incorporates individuals into the family, and integrates the family during this critical life‐event of first birth. A thorough understanding of la cuarentena will assist nurses to enhance adaptation to parenthood for Mexican American parents.
The Community Health Nursing Implications of the Self‐Reported Health Status of a Local Homeless Population
Authors: Reichenbach Ellen M. , McNamee Mary J. , Seibel Lori Vrtiska
Published: May 2007

ABSTRACT This study explored the personal characteristics and the health and health‐related concerns reported by members of the local homeless population in order to design population‐specific health programming. The study also examined whether there were significant differences between homeless who are shelter residents and those who are not. An exploratory descriptive design was used to analyze retrospective data collected by a local County Health Department in interviews of 132 homeless adults. The demographic characteristics found reflect many common patterns: marked over‐representation of males, mean age in the mid‐thirties, education levels comparable to similar socio‐economic groups, high unemployment rates, and low health insurance rates. One third of the sample reported self‐assessed health statuses of fair or poor. The most frequently identified physical health issue was joint problems, followed by cardiovascular disease. Depression was mentioned most frequently as a self‐identified mental health problem. Loneliness was the number one fear identified. Chi Square analysis showed that homeless who did not stay in shelters were significantly longer term residents (p < 0.0001) of the community and reported fear of loneliness significantly more frequently (p < 0.01). This study identifies health concerns that local homeless people themselves find important and provides direction for development of sound population‐specific health programming.
Acanthosis Nigricans as an Early Clinical Proxy Marker of Increased Risk of Type II Diabetes
Authors: Bent Katherine N. , Shuster George F. , Hurley Judith S. , Frye Don , Loflin Pat , Brubaker Cheryl
Published: May 2007

ABSTRACT Diabetes affects 6% of the national population, yet approximately 50% of persons with diabetes remain undiagnosed and receive no treatment. In specific populations, Acanthosis Nigricans (AN) may serve as an early clinical proxy marker of increased risk of type II diabetes. The results of this pilot project to screen selected school age students in New Mexico for AN indicate that a large number of these students may be at increased risk for developing type II diabetes as young adults. The future burden of diabetes on individuals, families, communities, and health care systems may be greater than previously recognized.