bluuebunny/crossref_metadata_2025 huggingface dataset:
Being Strong: How Black West‐Indian Canadian Women Manage Depression and Its Stigma
Authors: Schreiber Rita , Stern Phyllis Noerager , Wilson Charmaine
Published: April 2004

Purpose: To discover how women from a nondominant cultural background (West Indian)experience and manage depression.

Design: Explanatory using grounded theory.

Methods: Semistructured interviews were conducted with 12 Black West‐Indian Canadian women who experienced depression. Between 1994 and 1996, the first author engaged in participant observation.

Findings: The women used the basic social process they called “being strong” to manage or ameliorate depression. Being strong included “dwelling on it,”“diverting myself,” and “regaining my composure.” For most of the women, the range of available life choices was limited to the three processes; however, a few engaged in “trying new approaches.” These women were less limited in their range of cultural and behavioral boundaries than were the others, and began tentatively to explore other options for themselves.

Conclusions: Black West‐Indian Canadian women in this study managed their depression in culturally defined ways by being strong and not showing vulnerability. Because being strong was also evident in a previous study of dominant‐culture women as a prelude to depression, the process may be widespread in women prone to depression. The findings provide helpful information for intervening in an unfamiliar culture.
An Historical Analysis of Disclosure of Terminal Status
Authors: Krisman‐Scott Mary Ann
Published: April 2004

Purpose: To examine the concept of disclosure of terminal status and trace its development and implementation over time. An individual's ability to make appropriate end‐of‐life decisions, exert some control over the place and manner of death, and prepare self and significant others for this loss depends on knowing that life is drawing to a close.

Organizing Framework: An analysis of disclosure of terminal status was performed within the context of American social, political, and cultural history from 1930 to 1990.

Methods: A combination of manual and computerized search mechanisms was performed utilizing popular, nursing, medical, sociological, psychological, and thanatological literature from 1930 to 1990. The articles and books obtained through these searches were scanned and those articles and books that dealt with health care disclosure issues were selected. Works included in the review were 149 articles and 22 books.

Findings: A long‐standing tradition of nondisclosure exists in the medical profession. Societal events in the 1950s and 1960s influenced individuals' perceptions of death, individual rights, and physician responsibility, and culminated in some change in this tradition in the 1970s. The magnitude of this change is unknown. Current practice has not been investigated. This topic is rarely addressed in nursing literature even though nursing care is influenced by physicians' practice.

Conclusions: A tradition of nondisclosure prohibits patients from managing the end of their lives and making choices about their manner of death. Nursing care of terminally ill patients is compromised when patients are uninformed.
Trends in Nursing Education in China
Authors: Wong Frances Kam Yuet , Chan Sally , Yeung Sue
Published: April 2004

Purpose: To explore the current trends and development of nursing education in China. Nursing education in China has developed rapidly in alignment with economic growth of this country.

Design: Descriptive, using 345 manuscript abstracts from various regions of China, submitted for the 1996 Sino‐Hong Kong Educational Conference.

Methods: Content analysis of manuscript abstracts was done to describe the trends. Codes were determined after several rounds of independent analysis.

Findings: Development of nursing education in China appears in line with global trends. preparation of a pragmatic nurse was emphasized by nurse educators who also advocate total patient care and the integration of traditional Chinese medicine in nursing education. Areas seldom mentioned, however, were student‐centered approaches to learning, advanced practice, and the evaluation of educational processes and outcomes.

Conclusions: Nurse educators in mainland China appear aware of the dynamics and challenges in health care, and the need for preparing a new generation of nurses to face these challenges. Educators in China need to adopt new approaches in teaching and learning to prepare nurses to function in a wide range of health care settings, and to monitor and evaluate educational outcomes.
Qualitative Outcome Analysis: Evaluating Nursing Interventions for Complex Clinical Phenomena
Authors: Morse Janice M. , Penrod Janice , Hupcey Judith E.
Published: April 2004

Purpose: To describe a method that allows evaluating nursing interventions derived from a qualitative research project, and that shows appropriate interventions.

Organizing Framework: Qualitative research has expanded over the last decade and has contributed significantly to Inderstanding patients' experiences of health, illness, and injury. Yet the value of qualitative research in determining clinical interventions and subsequently evaluating the effects of these interventions on patients' outcomes has been limited. This method is used to confirm the efficacy of nursing interventions when experience changes over time, to extend the repertoire of intervention strategies, and to further clinicians' understanding of possible outcomes.

Design: From a completed study, Qualitative Outcome Analysis (QOA) enhances the identification of meaningful intervention strategies and plans for utilization. The researcher identifies the type of qualitative data that will enable the interpretation and evaluation of interventions, devises a means of data ecording and analysis, and finally, disseminates the findings.

Conclusions: QOA is a systematic means to confirm the applicability of clinical strategies developed from a single qualitative project, to extend the repertoire of clinical interventions, and to evaluate clinical outcomes.
Children's Rights in Clinical Research
Authors: Bragadóttir Helga
Published: April 2004

Purpose: To address the use of children and children's genetic information in research, analyze Icelandic laws as an example, review existing literature on children in clinical research, and describe nurses' actions as children's advocates.

Method: An integrated literature review was conducted using theoretical and empirical literature on children as human subjects in clinical research. Five Icelandic laws were analyzed.

Findings: Legal protection of children as human subjects is an international issue and is lacking in Icelandic legislation. In spite of an identified need to protect children as human subjects, research on children's rights in clinical research is scarce. Nurses have not taken an active stance in protecting children as human subjects.

Conclusions: The recently passed Bill on Health Sector Database in Iceland raises questions about protection of human subjects regardless of age and stature. The effects of this Icelandic case could have international implications regarding centralized health care databases, ownership of data, and related ethical and legal decisions.
Use of Certificates of Confidentiality in Nursing Research
Authors: Lutz Kristin F. , Shelton Kathleen C. , Robrecht Linda C. , Hatton Diane C. , Beckett Ann K.
Published: April 2004

Purpose: To discuss the use of Certificates of Confidentiality in nursing research.

Organizing Construct: In situations that are particularly complex, sensitive, and in which the participants are extremely vulnerable, a Certificate of Confidentiality issued by the U.S. Department of Health and Human Services (DHHS) may be useful to help ensure the privacy of research participants.

Sources: Theoretical and research literature, DHHS documents, and research experience.

Findings and Conclusions: Not all research with vulnerable populations requires the additional protection provided by Certificates of Confidentiality. However, certificates may be indicated in studies in which participants and researchers may be exposed to compelled legal disclosure of research data.
Nursing Research and HIV Infection: State‐of‐the‐Science
Authors: Goldrick Barbara A. , Baigis Judith A. , Larsen Jeanne , Lemert Jennifer L.
Published: April 2004

Purpose: To provide an update of the nursing research literature on HIV infection and to develop an HIV/AIDS database using arcs© computer software.

Methods: Nursing research literature from 1986 through 1997 on human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) was reviewed. With an emphasis on client‐focused research, 246 studies were entered into the arcs© HIV/AIDS database.

Findings: Analysis of over 1,000 citations in the HIV/AIDS nursing research literature over the past decade indicated that 22% (n = 219) of the nursing studies were client‐ or patient‐focused; 29% (n = 292) were risk‐group focused; and 49% (n = 492) were provider‐focused. Of the 246 studies entered into the arcs© HIV/AIDS database, 88 (35.7%) were classified in the psychologic domain, 65 (26.4%) in the physiologic domain, 24 (9.7%) in the behavioral domain, and 25 (10%) in the social domain. In addition, 17 (6.9%) of the studies were classified in the quality of life domain, and 27 (10.9%) in the stage of HIV disease domain. The majority (53%) of the 246 studies (n = 131) were correlational, 86 (35%) were descriptive, and 29 (12%) had experimental or quasi‐experimental designs.

Conclusions: Although nursing studies have described some of the problems that affect HIV‐infected people, further research is needed, particularly related to clinical interventions.
A Taxonomy of Passive Behaviors in People with Alzheimer's Disease
Authors: Colling Kathleen Byrne
Published: April 2004

Purpose: To construct a taxonomy of passive behaviors for understanding people with Alzheimer's disease. Passive behaviors are those associated with decreased motor movements, decreasing interactions with the environment, and feelings of apathy and listlessness. Little is known about behaviors associated with passivity, and these behaviors have not been categorized.

Organizing Construct: Taxonomy construction. Passive behaviors in people with Alzheimer's disease were conceptualized as disturbing behaviors, patterns of personality change, and negative symptoms.

Methods: The taxonomy was developed using critical reviews of 15 empirical studies published 1985 through 1998. Procedures included listing behaviors; clustering behaviors into inductively derived groupings; conducting an expert panel‐review, making revisions, and conduting a second review; establishing global and category‐by‐category reliability using Cohen's Kappa.

Findings: The nonhierarchic, natural taxonomy indicated five categories of behaviors associated with passivity in Alzheimer's disease: diminutions of cognition, psychomotor activity, emotions, interactions with people, and interactions with the environment. Analysis indicated substantial agreement beyond chance and showed statistically significant agreement among the six nurse‐expert raters. Areas of synchrony between the taxonomy and the Need‐Driven Dementia Compromised Behavior Model were identified.

Conclusions: This taxonomy of passive behaviors in patients with Alzheimer's disease showed empirical rigor and compatibility with a middle‐range theory and can be viewed as a sensitizing analytic scheme to guide future practice, research, and theory development.
The Experience of Acupuncture for treatment of Substance Dependence
Authors: Bernstein Kunsook Song
Published: April 2004

Purpose: To explore the meaning of substance abusers' experience while receiving acupuncture as a part of the treatment for substance dependence.

Design: Phenomenology. Eight participants with diagnosis of substance dependence were selected for the study. The participants were in an inpatient setting with detoxification and rehabilitation programs provided to substance abusers.

Methods: In 1997, eight substance abusers who had accepted acupuncture as a part of their treatment for substance dependence were interviewed about their experiences with acupuncture treatment. Data collection included interviews with each of the subjects, the researcher's field notes, and demographic data obtained from the participants' medical records. The verbatim transcripts of each of the interviews were analyzed using Giorgi's modification of phenomenological method.

Findings: Analysis of the data after one treatment with acupuncture indicated seven major themes: anticipation of pain, apprehension concerning a new experience, mood elevation, inability to describe the experience, physical sensation, relaxation, and improved sleep.

Conclusions: The substance abusers' experiences with acupuncture revealed an acceptance of a new treatment method, and demonstrated potential for healing through integration and balance. Further research is indicated to assess the effects of repeated treatments
Biobehavioral Effects of Therapeutic Touch
Authors: Engle Veronica F. , Graney Marshall J.
Published: April 2004

Purpose: To document immediate and short‐term biobehavioral effects of therapeutic touch (TT), estimate the magnitude of TT effects, and compare TT effects to placebo responses.

Design: A repeated measures, pretest‐posttest quasi‐experimental design. TT and mimic TT were administered using standardized protocols to 11 adults in a controlled setting.

Methods: Four physiological (total pulse amplitude, blood pressure, pulse, temperature) and three subjective (stress, self‐assessment of health, time perception) variables were evaluated over 24 hours.

Findings: Total pulse amplitude and time perception decreased significantly immediately after TT intervention, indicating vasoconstriction and time passing “faster,” with large and medium effect sizes significantly greater than were placebo responses. Vasodilation, a relaxation response, was expected instead of vasoconstriction.

Conclusions: TT may have adverse and positive outcomes.
Fatigue and Relatedness Experiences of Inordinately Tired Women
Authors: Dzurec Laura Cox
Published: April 2004

Purpose: To examine the association of fatigue and interpersonal relatedness of fatigued women.

Design: Hermeneutics.

Methods: Seventeen fatigued American women, recruited through purposive sampling, were interviewed. Questions were based on data from previous research of women's fatigue and on characteristics of the theory of relatedness.

Findings: Relatedness was significantly linked to fatigue. Participants moved toward disconnectedness, parallelism, comfortable noninvolvement, or through enmeshment and then toward parallelism. A spiral of intrapersonal and interpersonal changes, sense of emotional absence, lack of energy and motivation, and depression‐like symptoms were reported by fatigued participants, particularly those whose state of relatedness shifted toward disconnectedness. Depression‐like symptoms were associated with fatigue, but were differentiated from diagnosed depression. Participants noted that physical movement was helpful to them in mediating their fatigue.

Conclusions: Findings from this study indicate the need for a database to describe the interplay among biological, psychosocial, and behavioral components of fatigue and to clarify its association with medical diagnoses, particularly depression.
Effects of Group Therapy on Chemically Dependent Women's Self‐efficacy
Authors: Washington Olivia G.M.
Published: April 2004

Purpose: To determine effects of experiential and cognitive group therapy on self‐efficacy of chemically dependent women.

Methods: This quasi‐experimental study indicated differences in the effects of cognitive and experiential group therapy on perceptions of general and social self‐efficacy in 52 recovering chemically dependent women living in a Midwestern urban area of the United States. Two additional groups of women were recruited for control groups. One control group (n%34) consisted of chemically dependent women from the same sites who did not participate in the treatment programs. The second control group consisted of working women (n%35) who were matched to the chemically dependent women on age, race, and gender, and who self‐reported not being chemically dependent and never having used illegal drugs. All participants completed the Self‐Efficacy Scale, and both experimental groups (cognitive and experiential) participated in six 90‐minute group therapy sessions.

Results: A statistically significant difference was found for general self‐efficacy among the four groups. The chemically dependent control group women had significantly lower scores on general self‐efficacy than did the other three groups. The chemically dependent treatment groups had significantly higher levels of general self‐efficacy than did the chemically dependent control group. Social self‐efficacy did not differ among treatment and control groups.

Conclusions: Strengthening chemically dependent women's self‐efficacy beliefs to deal effectively with a variety of situations and tasks can increase their confidence that they can be productive and accomplish their goals.
Intuition and Analysis in Decision Making and Choice
Authors: Lamond Dawn , Thompson Carl
Published: April 2004

Purpose: To discuss the need for a shift in focus from intuitive to more analytic ways of examining both the process and outcomes of professional decisions based on “best evidence.”

Scope: Different assumptions inherent in intuitive and analytic explanations of nurses' decision making are outlined, and the two approaches are compared. The benefits and limitations of such approaches to decision making in nursing and health care are discussed, using available research evidence to show that in most instances the analytical approaches are more effective.

Conclusions: A systematic approach to decision making in health care is needed, so that both health professionals and patients have a means for knowing the basis of decisions about treatment.
Correlates of Resilience in Homeless Adolescents
Authors: Rew Lynn , Taylor‐Seehafer Margaret , Thomas Nancy Y. , Yockey Ronald D.
Published: April 2004

Purposes: To (a) describe reasons adolescents give for their homelessness, (b) explore relationships among resilience and selected risk and protective factors, (c) identify differences in risk and protective factors by gender and sexual orientation, and (d) determine best predictors of resilience.

Design: A descriptive and exploratory correlational design was used to collect and analyze data from a convenience sample of 59 homeless adolescents who sought health and social services from a community street‐outreach project in central Texas in 1998.

Methods: A paper and pencil survey consisting of valid measures (Resilience Scale, UCLA‐Revised Loneliness Scale, Beck Hopelessness Scale, Social Connectedness Scale, and Death‐Related Attitude Schedule) was administered in a street‐outreach setting.

Findings: Nearly half the sample (47%) reported a history of sexual abuse and 36% self‐identified as gay, lesbian, or bisexual in orientation. Over half (51%) were thrown out of their homes by their parents, 37% left home because their parents disapproved of their alcohol or drug use, and nearly one‐third left home because parents sexually abused them. Lack of resilience was ignificantly related to hopelessness, loneliness, life‐threatening behaviors, and connectedness, but not to gender or sexual orientation. Hopelessness and connectedness explained 50% of the variance in resilience.

Conclusions: Participants who perceived themselves as resilient, although disconnected from other people, were less lonely, less hopeless, and engaged in fewer life‐threatening behaviors than were those who perceived themselves as not being resilient. They survived by adapting to street life and by becoming overly self‐reliant. Findings may be useful in planning interventions to promote health and well‐being in this vulnerable population.
Nurses' Experiences of Restructuring in Three Ontario Hospitals
Authors: Blythe Jennifer , Baumann Andrea , Giovannetti Phyllis
Published: April 2004

Purpose: To describe the effects of restructuring, particularly redeployment, on nurses' personal and work lives, and to compare the utility of “survivor syndrome” and empowerment as alternative concepts for understanding these effects and planning change.

Methods: Twenty‐six focus groups or interviews were held with 59 nurses working in three hospitals in Ontario, Canada.

Findings: Participants described how restructuring strategies had affected them as individuals, as members of nursing teams, and as employees. In each of these aspects of their work lives, relationships became less integrated, their work activities became less controllable, and the changes compromised their ability to deliver effective care.

Conclusions: Restructuring intensifies structural weaknesses in professions, such as nursing, whose members are primarily employed by bureaucracies. Nurses may not find survivor syndrome a useful model to explain their low morale following restructuring because it identifies nurses as “patients” in need of therapy. An empowerment model that takes into account nurses' concerns about uncertainty and integration may be more fruitful for devising strategies to enhance their ability to practice effectively in hospital settings.
Turnings and Adaptations in Resilient Daughters of Battered Women
Authors: Humphreys Janice C.
Published: April 2004

Purpose: To examine the major life‐turning points and adaptations of adult daughters of battered women, as a means of describing the dynamic of resilience in daughters of battered women.

Design: A convenience sample of 10 community‐based adult daughters of battered women in 1995.

Methods: Two unstructured, tape‐recorded life history interviews lasting 3–5 hours each and an investigator‐developed self‐report of significant life events.

Results: Seven major turnings and six adaptations were identified and described.

Conclusions: The findings indicate that these resilient adult daughters of battered women were able to experience formidable life events and to overcome them, but not without suffering. The women's adaptations resulted from a confluence of individual and environmental characteristics that are amenable to nursing interventions.
College Students' Perceptions and Practices of Sexual Activities in Sexual Encounters
Authors: von Sadovszky Victoria , Keller Mary L. , McKinney Kristan
Published: April 2004

Purpose: To examine college students' understanding of safer sexual encounters, including expectation for sexual activities, planning for sexual encounters, and ideas about what constitutes “safe” sex.

Design: Exploratory design of college students' perceptions of and actual sexual activities that occurred in their last or most memorable sexual encounter.

Methods: Participants in one U.S. university completed three open‐ and closed‐ended questions about their activities, as part of a larger questionnaire concerning contextual factors in their sexual encounters. A content analysis was conducted on data from open‐ended questions. Encounters were categorized by risk for further analysis.

Findings: No significant differences were found in expectations regarding sexual activities between participants who had risky and safer encounters, except that participants who had safer encounters expected touching through clothing significantly less than did those who had risky encounters. Frequencies of sexual activities varied greatly between the two risk groups. No differences were found between the two groups concerning whether the encounter was planned or in expectation of sexual activities by planning of the encounter. The majority erroneously thought they had “safer” sex. The most reported reasons for believing a risky encounter was safer included the use of a hormone‐based birth control method, use of a condom during vaginal sex only, and believing no sex had occurred in the case of oral sex.

Conclusions: For these participants, planning of the encounter was not related to safer sexual activities and safer sexual activities were generally misunderstood.
Differences in Evidence‐Based Care in Midwifery Practice and Education
Authors: Carr Catherine A. , Schott Alexandra
Published: April 2004

Purpose: To examine site‐specific differences in managing labor and to describe variations in intrapartum practice in the context of clinical midwifery education.

Design: Descriptive design based on secondary analysis of an existing data set collected to evaluate the intrapartum clinical experiences of nurse‐midwifery students. The data set included 498 records collected by midwifery students in 23 sites from 1995–1998. The unit of analysis was the intrapartum record.

Methods: Students used The American College of Nurse‐Midwives Clinical Data Set for Intrapartum Care to collect data during clinical experiences, including patient demographic data, risk factors, and specific care processes and interventions.

Findings: Significant variations were found among settings despite use of the same clinical guidelines. Discrepancies between theoretical preparation of students for clinical practice and the realities of clinical practice were noted.

Conclusions: Despite a stated commitment to evidence‐based practice, practice patterns varied significantly. Clinicians and educators need to find common ground for combining evidence‐ based theory with evidence‐based practice.
Institutional Research Responsibilities and Needed Infrastructure
Authors: Youngblut JoAnne M. , Brooten Dorothy
Published: April 2004

Purpose: To describe research grantee institutions' responsibilities to the funding agencies, research participants, and investigators, and the infrastructure and resources necessary for successful completion of funded research projects.

Organizing Framework: Grants management includes investigator access to institutional and school infrastructure and resources, oversight and monitoring of the implementation of the research, and strategies to maximize research yield while stretching research dollars.

Conclusions: Grantee institutions are responsible for overseeing the conduct of research, protecting rights of research participants, safety of study personnel, monitoring conflict of interest, fiscal management, access to data, and disseminating study findings. Central and school departments that provide needed services are important infrastructure supports. In addition to research space and investigator time, senior research mentors and research administrators are the most valuable resources for research success.
Testicular Self‐Examination in Young Adult Men
Authors: Wynd Christine A.
Published: April 2004

Purpose: To describe patterns of testicular self‐examination (TSE) in a sample of young adult men and to identify factors distinguishing between men who do and do not practice TSE.

Design: A comparative descriptive design with a convenience sample of 191 adult men aged 18–35 years, recruited from a large industrial complex in the U.S. Midwest. Data were collected during several occupational health fairs held from 1999–2001.

Methods: A self‐report, 75‐item health risk appraisal (HRA) was administered to identify health‐related lifestyle habits. Men who did and did not perform TSE regularly were compared using Mann‐Whitney U statistics for discrete variables and t tests for continuous data. Discriminant function analysis was used to identify factors allowing prediction of frequent or infrequent TSE performance.

Findings: Sixty‐four percent of 191 participants reported rarely or never performing TSE, and 36% practiced TSE monthly or every few months. Men who infrequently performed TSE were more often African American or Hispanic and had less than a college education. Other significant factors associated with infrequent TSE practice included less satisfaction with current job assignment; less satisfaction with life in general; greater worries interfering with daily life; more serious family problems in dealing with spouse, children, or parents; and reduced availability of people to turn to for support.

Conclusions: Demographic and socioeconomic variables were related to TSE knowledge and performance. Further investigation is required to determine why men, especially ethnic minority men, are not performing this important cancer‐screening activity.
Outcomes of Therapeutic Massage for Hospitalized Cancer Patients
Authors: Smith Marlaine C. , Kemp Janet , Hemphill Linnea , Vojir Carol P.
Published: April 2004

Purpose: To examine the effects of therapeutic massage on perception of pain, subjective sleep quality, symptom distress, and anxiety in patients hospitalized for treatment of cancer.

Organizing Construct: Rogers' Science of Unitary Human Beings and Watson's theory of human caring.

Methods: Quasiexperimental. The sample consisted of 41 patients admitted to the oncology unit at a large urban medical center in the United States for chemotherapy or radiation therapy. Twenty participants received therapeutic massage and 21 received the control therapy, nurse interaction. The outcome variables were measured on admission and at the end of 1 week via the following instruments: a Numerical Rating Scale for pain intensity and Likert‐type scale for distress from pain; The Verran Snyder‐Halpern Sleep Scale, McCorkle and Young's Symptom Distress Scale, and the Speilberger State Anxiety Inventory. ANOVA and t tests were used to analyze between and within group differences in mean scores and main effects on outcome variables.

Findings and Conclusions: Mean scores for pain, sleep quality, symptom distress, and anxiety improved from baseline for the subjects who received therapeutic massage; only anxiety improved from baseline for participants in the comparison group. Statistically significant interactions were found for pain, symptom distress, and sleep. Sleep improved only slightly for the participants receiving massage, but it deteriorated significantly for those in the control group. The findings support the potential for massage as a nursing therapeutic for cancer patients receiving chemotherapy or radiation therapy.
Children's Perceptions of TV and Health Behavior Effects
Authors: Kennedy Christine M. , Strzempko Fran , Danford Cynthia , Kools Susan
Published: April 2004

Purpose: To understand and document children's stated experiences and beliefs about television and to elicit their suggestions for alternative activities.

Design and Methods: Eleven focus groups were conducted with 51 Anglo and Latino children, ages 7–10, in a large Northern California city. Philosophical underpinnings of developmental psychology were the basis for multiphase thematic analysis. Data were collected in 1998–1999.

Results: Themes were identified in five conceptual categories. Findings showed that children did not perceive many parental rules related to TV watching, rather daily routines are associated with TV viewing. Children revealed both covert and overt motivations for watching. Nearly all participants spoke of the deception of advertising, but they were unclear about the role of commercial sponsors in payment for TV shows. Children perceived both negative physical and behavioral health effects of TV and they had great difficulty imagining life without a TV.

Conclusions: Children perceived television as providing educational and relational needs. Although they preferred alternatives to TV, they had difficulty articulating and getting those needs met. Clinicians and researchers can utilize these findings to design health interventions that attenuate the health‐impairing effects of habitual sedentary activity in childhood.
Priorities for Nursing Research in Korea
Authors: Kim Mi Ja , Oh Eui‐Geum , Kim Cho‐Ja , Yoo Ji‐Soo , Ko Il‐Sun
Published: April 2004

Purpose: To identify priorities for nursing research in Korea.

Methods: A national sample of nurses in academic and clinical settings, representing varied clinical specialties, participated in two rounds of a Delphi survey. Participants listed five most important nursing research problems rated on three dimensions: the degree of nurses' lead role, contribution to nursing profession, and nurses' contribution to health and welfare of patients and clients. A total of 29 research areas were derived from 1,013 research problems identified from the Delphi surveys, and 26 expert panel members who participated in a 1‐day workshop to determine the priority of these areas. Key words of 706 research articles published in the major nursing research journals in Korea were analyzed to identify priorities.

Results: In the two rounds of Delphi surveys 347 of 1,047 nurses participated (31%–33% response rates respectively). Top three research areas common to both Delphi survey and literature analysis were: clinical nursing practice, nursing education, and nursing research. Cultural nursing was rated the lowest in the Delphi survey but was rated third by the expert panel members.

Conclusions: In the clinical practice area, research on the advanced practice nursing system was the first priority research problem followed by development of nursing interventions, clinical competency, quality and effectiveness of nursing care, and standardized nursing tasks. Research on home health care, nursing education, utilization of nursing research, and geriatric nursing were other areas of priority. Nurses around the world are encouraged to develop collaborative research projects based on common priority areas.
Examination of Primary Care Characteristics in a Community‐based Clinic
Authors: Hartley Lou Ann
Published: April 2004

Purpose: To (a) examine the reliability and validity of the Primary Care Assessment Survey (PCAS), (b) describe the primary care characteristics of a community‐based clinic in an underserved area in Appalachia, (c) examine the relationships between primary care characteristics and socioeconomic factors, (d) compare and contrast patients who have regular providers of care with those who did not have regular providers of care; and (e) examine provider primary care characteristics that predict comprehensive knowledge of patients.

Design: Data for this cross‐sectional survey (N=227) were collected over a 4‐month period using face‐to‐face interviews at a not‐for‐profit, community‐based clinic serving patients in three Appalachian states in the southeastern United States.

Methods: The PCAS was used to measure 11 domains of primary care provider performance and to identify and group patients who had regular providers of care (n=126) and patients who did not have regular providers of care (n=98) at the clinic.

Findings: Cronbach's coefficient alpha for the total scale was .74 after deleting one subscale. Factor analysis revealed one PCAS dimension, Communication, accounting for 44% of the total variance. Primary care providers' Interpersonal Treatment and Longitudinal Continuity were predictors of Comprehensive Knowledge of the patient and accounted for 26% and 6% of the variance, respectively.

Conclusions: The PCAS showed evidence of reliability and validity with underserved Appalachian patients receiving care in a community‐based clinic. The findings showed that patients receiving care from primary care providers had sustained relationships that affected communication aimed at improving primary care outcomes.
Parental Uncertainty and Posttraumatic Stress in Serious Childhood Illness
Authors: Santacroce Sheila Judge
Published: April 2004

Purpose: To explicate the link between parental uncertainty and posttraumatic stress as a way to stimulate advancement in the design and evaluation of nursing interventions for parents of children with serious illness.

Methods: The literature on Mishel's uncertainty in illness theory and its reconceptualization‐parental uncertainty in serious childhood illness‐and posttraumatic stress are reviewed and synthesized. Pertinent methodological and sociocultural issues are discussed.

Conclusions: The literature indicates support for the theoretical link between parental uncertainty and posttraumatic stress. This linkage provides direction for the design and evaluation of nursing interventions to support parents of children with serious childhood illness.
Decreasing Pain and Depression in a Health Promotion Program for People With Rheumatoid Arthritis
Authors: Oh HyunSoo , Seo WhaSook
Published: April 2004

Purpose: To examine whether a comprehensive health promotion program for rheumatoid arthritis (CHPPRA) could alleviate patients' pain, depression, and functional disability.

Design: A quasi‐experimental design, nonequivalent control group pretest‐posttest design and a preexperimental design, one‐group pretest‐posttest design were used. The study was conducted in Korea.

Methods: Outcome variables (pain, depression, and functional disability) and objectives (the practice of pain‐management behaviors, regular exercise, and psychosocial coping strategies) were measured in 36 Korean outpatients diagnosed with rheumatoid arthritis (RA). ANOVA/MANOVA and the Wilcoxon signed rank test were used to analyze data.

Findings: Participants in CHPPRA had reduced pain and depression, but did not show improvements in functional disability. In the intervention group, pain management and psychosocial coping skills were significantly improved, but exercise was not significantly altered after participating in CHPPRA.

Conclusions: Although this study was limited in design, the results can be reference data for designing, using, and evaluating programs for people with RA.
Reconceptualizing the Nurse‐Patient Relationship
Authors: Hagerty Bonnie M. , Patusky Kathleen L.
Published: April 2004

Purpose: To review assumptions inherent in the nurse‐patient relationship as historically described and practiced, and to propose an alternate framework for nurse‐patient interaction that is congruent with current health care environments.

Organizing Constructs: The theory of human relatedness and the nurse‐patient relationship.

Methods: Analysis of assumptions inherent in the current theoretical and empirical literature on nurse‐patient relationships and evidence from observation of nurses engaged in practice. Proposal and discussion of the theory of human relatedness as an alternative model for conceptualizing nurse‐patient relationships.

Conclusions: The theory of human relatedness framework provides new insights and opportunities for assessment, intervention, and research within the context of nurse‐patient relationships.
Effects of a Relationship‐Enhancing Program of Care on Outcomes
Authors: McGilton Katherine S. , O'Brien‐Pallas Linda L. , Darlington Gerarda , Evans Martin , Wynn Francine , Pringle Dorothy M.
Published: April 2004

Purpose: To examine the effects of a relationship‐enhancing program of care (REPC) on resident and care provider outcomes.

Design and Methods: A quasi‐experimental, repeated measures design, with intervention and comparison groups. Questionnaires were distributed to 50 residents, and observations were conducted of 40 residents and 34 nursing staff at baseline and 3 months after the intervention, on two Canadian nursing home units. An investigator‐designed educational program based on Winnicott's theory of relationships and the empirical literature, was provided to care providers and their supervisors on the intervention unit. Repeated measures analysis of variance (RM‐ANOVA) was used to compare the intervention and comparison groups in regard to changes in the outcomes over time.

Findings: The REPC had statistically significant effects on (a) residents' perceptions of care providers' relational care, (b) care providers' relational behaviors, and (c) continuity of care.

Conclusions: Evidence showed that these care providers were taught how to enhance their relational skills with residents living in long‐term care facilities without added staff. Recommendations for practice and research are discussed.
Measuring Nursing Power Within Organizations
Authors: Sieloff Christina L.
Published: April 2004

Purpose: To describe the Sieloff‐King Assessment of Departmental Power (SKADP) instrument and the psychometric evaluation of both the SKADP and its revision: the Sieloff‐King Assessment of Group Power within Organizations (SKAGPO) instrument.

Design: A survey of 357 chief nurse executives in the United States to psychometrically evaluate the SKAGPO.

Methods: Psychometric evaluation of the SKAGPO included: (a) internal consistency reliability using Cronbach's alpha coefficient, split‐half with the equal‐length Spearman Brown Correction Formula, and item analysis; (b) concurrent criterion‐related validity; and (c) factor analysis.

Findings: Cronbach's alpha coefficient for the SKAGPO was.92. Subscales' alphas ranged from.63 to.88. Item‐total correlations ranged from.24 to.68, with an average item‐total correlation of.48 (n = 334). Concurrent criterion‐related validity was supported.

Conclusions: The SKAGPO and the related subscales showed initial reliability and validity.
Effects of Coresidence and Caregiving on Health of Thai Parents of Adult Children with AIDS
Authors: Kespichayawattana Jiraporn , VanLandingham Mark
Published: April 2004

Purpose: To explore potential effects on the health of older parents living with and caring for people infected with HIV.

Design: Comparison of health outcomes between affected parents and matched nonaffected parents, and between principal caregivers and nonprincipal caregivers in Thailand.

Methods: Survey data from 394 affected households and 376 nonaffected households; qualitative data from 18 interviews of affected older parents.

Results: A large proportion of older people with HIV‐infected children provided time‐consuming and strenuous caregiving services to them. Mothers shouldered most of this burden. Mothers who had a child die from AIDS reported lower levels of overall happiness than did others who had not. Mothers and fathers of PHAs (persons with HIV/AIDS) who died reported lower levels of overall happiness compared to 3 years previously (before the time of the death of their child) and compared to parents from households that did not experience an adult child's death. Many parents of children with AIDS experienced anxiety, insomnia, fatigue, muscle strain, and head and stomach aches during the time they cared for their ill children.

Conclusions: Many older people suffered adverse health outcomes related to living with and caring for their children with AIDS. Recommendations indicate a variety of programs that might help such older parents.
Measuring Continuity and Discontinuity Following Stroke
Authors: Secrest Janet S. , Zeller Richard
Published: April 2004

Purpose: To design and test a valid, reliable, and parsimonious instrument to measure continuity and discontinuity of self following stroke.

Design: A 45‐item scale with a 3‐point response set was developed. The conceptual basis, “continuity and discontinuity in the experience of self,’ was derived from an existentialphenomenological study of stroke survivors. Study instruments included the Barthel Index (measure of functional abilities) and the pre‐ and poststroke QoL Cantril Ladder.

Methods: The instruments were administered one time, in random order, to 55 stroke survivors in the United States in rehabilitation hospitals and in the community. Data were analyzed using a principal components factor analysis.

Results: A 2‐factor solution with 10 items per factor was derived. Cronbach's alpha for Factor 1 (discontinuity of self) was .874 and for Factor 2 (continuity of self) was .869. Continuity and discontinuity were inversely related; continuity was related to functional abilities, but discontinuity was not.

Conclusions: Use of this instrument validated findings from a qualitative study, which showed that life following stroke was a paradoxical sense of both continuity and discontinuity in the experience of self. This instrument can be used to measure the effectiveness of nursing interventions aimed at increasing stroke survivors' sense of continuity.
Barriers to Utilization of Prenatal Care Services in Turkey
Authors: Erci Behice
Published: April 2004

Purpose: To identify barriers to utilization of prenatal care services in Turkey, including pregnant women's attitudes toward pregnancy and prenatal care.

Design: Descriptive. The population was Turkish women who lived in Erzurum and had delivered their infants but were still hospitalised.

Methods: The sample of 446 women had or had not received prenatal care, had no complications during pregnancy, carried their pregnancies to term, and were considered to have normal deliveries. Attitudes toward pregnancy and prenatal care and barriers to prenatal care services were measured by use of a questionnaire.

Findings: Low education of pregnant women and unwanted pregnancy were barriers to use of prenatal care services. Additional barriers were negative attitudes toward pregnancy and attitudes toward prenatal care. These barriers decreased frequency of use and delayed early initiation of prenatal care. The most important barrier reported by the women was being too busy at home to seek care.

Conclusions: Although this sample was limited, the findings indicate barriers for attention by health care providers to ensure appropriate prenatal care and maternal and infant health.
American and Icelandic Parents' Perceptions of the Health Status of their Young Children with Chronic Asthma
Authors: Svavarsdóttir Erla Kolbrun , Rayens Mary Kay
Published: April 2004

Purpose: To identify factors that influence American and Icelandic parents' health perceptions among families of infants or young children with asthma.

Design: A cross‐sectional research design of 76 American families and 103 Icelandic families. Data were collected mainly in the Midwest of the United States (US) and in Iceland from August 1996 through January 2000.

Method: Parents in these two countries who had children aged 6 or younger with chronic asthma completed questionnaires regarding family demands, caregiving demands, family hardiness, sense of coherence, and health perceptions. Descriptive statistics, chi‐square tests and t tests were compiled. Multiple regression analysis was used to test path models and for mediation.

Findings: American parents differed from their Icelandic counterparts in family hardiness. In both countries, significant differences were found in caregiving demands and health perceptions between mothers and fathers. Illness severity and caregiving demands affected health perceptions of both mothers and fathers. Sense of coherence mediated the relationship between family demands and parents' perceptions for both parents. For mothers only, family hardiness mediated the relationship between family demands and health perceptions.

Conclusions: The Resiliency Model of Family Stress, Adjustment, and Adaptation was useful for building knowledge on parents' health perceptions in two Western cultures for families of young children with asthma. Interventions emphasizing family and individual resiliency and strengths have the potential to affect parents' views of their children's health.
Modeling rate effects in undrained loading of sands
Authors: Boukpeti N , Mróz Z , Drescher A
Published: April 2004

The present technical note extends the previous work by the authors concerned with formulation of a constitutive model of elastoplastic response of sands (Superior sand model) and its application to the analyses of static liquefaction and instability states in triaxial compression and extension occurring in the undrained deformation of saturated granular materials. To account for time-dependent behavior and strain rate effects, an elastic, viscoplastic extension of the model to triaxial compression is proposed. The constitutive equations derived are used to predict the model response in different loading histories. In particular, strain rate and stress rate effects and undrained creep deformation for specified stress components are discussed in detail. Comparison of model predictions with available experimental data also is provided.Key words: saturated sand, constitutive model, elasticviscoplastic behavior.