bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vulnerability to health problems in female informal caregivers of persons with HIV/AIDS and age‐related dementias
Authors: Flaskerud Jacquelyn H. , Lee Patricia 
Published: March 2003

Vulnerability to health problems in female informal caregivers of persons with HIV/AIDS and age‐related dementias The health of informal caregivers is often studied from the perspective of caregivers’ and care receivers’ personal and interpersonal characteristics. This study offers an alternative explanation based on a vulnerable populations framework and considers the role of resource availability to the health status of informal caregivers (n=76). Caregivers in a convenience sample were females of diverse ethnicity and socioeconomic status, and care recipients were diagnosed with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) or age‐related dementias (ARD). Personal interviews using structured instruments were conducted with caregivers who were attending outpatient clinics at a public hospital and a VA hospital. Instruments included the Center for Epidemiologic Studies Depression‐Scale (CES‐D), the Global Health Assessment (GHA), the Activities of Daily Living Scale (ADL), the Memory and Behavior Problems Checklist (MBPC) and items from the Symptom Checklist‐90 (SCL‐90) measuring anger, anxiety and loneliness. Caregivers were experiencing both physical and mental health problems. Regression analyses were used to examine the relationships among resources available to caregivers, conditions that put caregivers at risk for poorer health, and health status itself. Analyses were conducted for each group of caregivers separately (HIV and ARD) and for the total group, using depressive symptoms and perception of physical health as dependent variables. In caregivers of people with HIV/AIDS (PWHIV), caregiver distress over care recipient symptoms, anxiety and education were related to depressive symptoms. Depressive symptoms, anger and functional status of the PWHIV were related to caregivers’ perception of poorer physical health. In caregivers of people with ARD, there were no significant predictors for depressive symptoms or perception of physical health. In the total group of caregivers, lower income and more anger were related to depressive symptom score. When perception of physical health was the dependent variable, minority ethnicity and depressive mood were related to worse perception of physical health. These findings support the relationship of a lack of resources to health status. A community‐based programme of resources and health care services for the caregiver–care receiver dyad is recommended.
Male appropriation and medicalization of childbirth: an historical analysis
Authors: Cahill Heather A. 
Published: March 2003

Male appropriation and medicalization of childbirth: an historical analysis Aims of the paper.  This paper aims to explore through historical analysis some of the means by which medicine successfully appropriated and medicalized pregnancy and childbirth and to consider the impact that this has had on women’s experiences within maternity care. Background and rationale.
The appropriation and medicalization of pregnancy and childbirth by men are rooted in a patriarchal model that has been centuries in the making. A model that perceives women as essentially abnormal, as victims of their reproductive systems and hormones, it is also one that defines pregnancy as inherently pathological – a clinical crisis worthy of active intervention. In both law and medicine men have used their power to define reproduction as a biological defect (LeMoncheck L. 1996Journal of Clinical Ethics7, 160–176), requiring both legal regulation and medical intervention, whilst feminist writers have long argued that women’s experiences within the health care system at least to some extent reflects their social position. Conclusions.
Male justifications of female inferiority have been developed and nurtured through professional discourses and socialization processes inherent within medical education and practice (Cahill H. 1999 MA Thesis, University of Keele). These assumptions are internalized and reproduced to shape quite profoundly, the nature of doctors’ interactions with women in their care. Perhaps more fundamentally, such discursive explanations of women’s bodies as inherently defective continue to shape women’s position in society. Maternity care is a key area in which women’s ability to exercise real choice and make informed decisions is limited and where doctor–patient interactions are themselves constructions of existing gender orders; women’s autonomy continues to be violated through both quite subtle and overt discourse and practice.
The relationship between menstrual attitudes and menstrual symptoms among Taiwanese women
Authors: Lu Zxy‐yann Jane 
Published: March 2003

The relationship between menstrual attitudes and menstrual symptoms among Taiwanese women Aim of the study. This study explored characteristics of the menstrual cycle including duration, prevalence and severity of symptoms and examined the relationship of these characteristics with attitudes toward menstruation. Background. Conceptualization of menstrual phenomena and attitudes toward menstruation may vary among cultures. While data about menstrual health among American women are widely available, there are little data concerning menstrual health in Taiwanese women. Design/Methods. A total of 30 healthy women with a mean age of 24·4 years participated in the study and made daily records of symptoms over a 90‐day period with the Woods Daily Health Diary (WDHD). They then retrospectively completed the Moos Menstrual Distress Questionnaire (MMDQ) and the Menstrual Attitudes Questionnaire (MAQ). Results. The mean age of menarche of these women was 13 years, their mean cycle duration was 5·8 days and the cycle length was 31·1 days. The mean scores of five subscales for MAQ ranged from 2·19 to 3·28. Forty‐six percent of the surveyed Taiwanese women agreed that the onset of menstruation can be predicted and anticipated, and 78% of these women agreed that menstruation was a natural event. Conclusions. Menstrual attitudes in Taiwanese women are multidimensional, and that significant cross‐cultural differences are present. Attitudes toward menstruation in Taiwanese women are related to their physical, cognitive, behavioural and psychological changes in the premenstrual and menstrual phases.
The evaluation of the effectiveness of health education interventions in clinical practice: a continuing methodological challenge
Authors: Twinn Sheila 
Published: March 2003

The evaluation of the effectiveness of health education interventions in clinical practice: a continuing methodological challenge Aim. This paper examines the methodological issues arising from an evaluation of the effectiveness of a health education project undertaken to increase Hong Kong Chinese women's knowledge of the prevention of cervical cancer and the uptake of screening. Background. The significance of health promotion to the prevention of diseases currently affecting contemporary society has become increasingly recognized. Within the context of health promotion health education continues to provide an important preventive strategy. Indeed the leading causes of mortality such as coronary heart disease and cancer lend themselves well to health education interventions. However the evaluation of the effectiveness of health education remains complex and raises some important methodological issues. Design. The project used a health education intervention as the major preventive strategy and employed multiple methods of evaluation to assess its effectiveness. Outcome evaluation consisted of a confidential questionnaire administered at two points in time to measure changes in health‐related behaviour and knowledge. It also included the collection of data from service providers to assess changes in the uptake of cervical cancer screening. Process evaluation involved the use of focus groups with randomly selected groups of women who had participated in the health education intervention and a diary kept by the project nurse. Findings. Methodological issues identified in the evaluation of the project included the extent to which changes in health‐related knowledge and behaviour could be attributed to the intervention, the sensitivity of outcome measures and challenges in developing methods of process evaluation appropriate to the target population. Conclusions. The findings highlight the complexity of designing effective evaluation strategies for health education and the need to consider these issues in the development of both process and outcome evaluation.
A measure of critical care nurses’ post‐code stress
Authors: Cole Frank L. , Slocumb Elaine M. , Mastey Jean Muldoon 
Published: March 2003

A measure of critical care nurses’ post‐code stress Aim.  The purpose of this research was to develop an instrument to measure critical care nurses’ post‐code stress and then to examine the psychometric properties. Background.  Critical care nurses experience stress from multiple sources. One source of stress may arise from participation in resuscitation attempts and this has been labelled post‐code stress; however, no means exist for measuring this source of stress. Design/Method.  In phase 1, 47 items were developed and submitted to a panel of experts for content validity. Based on content experts’ ratings, 20 items were retained for phase 2 instrument testing. To test the instrument, a convenience sample of critical care nurses was obtained from four institutions in north‐eastern United States. Each nurse received the Post‐Code Stress Scale and completed it anonymously. A subsample completed the Post‐Code Stress Scale a second time to assess stability reliability. The Nursing Stress Scale was also administered to assess construct validity. Results/Findings.  An exploratory principal components factor analysis with varimax rotation suggested five dimensions to post‐code stress. These five dimensions accounted for 66% of the variance and indicated that stress arose from feeling discomposed, oppressed, uncertain, burdened and morally conflicted. The Pearson product moment correlation between the Post‐Code Stress Scale and the Nursing Stress Scale was 0·46, providing preliminary evidence of construct validity. Internal consistency reliability estimates for the five‐factor subscales ranged from 0·57 to 0·77 with only one factor being <0·70. The internal consistency reliability estimate for the final 14 items on the scale was 0·79. Conclusions.  The instrument shows promise as a measure of post‐code stress based on the evidence obtained in this study; however, further psychometric testing is warranted.
Nurses’ attitudes to terminally ill patients
Authors: Román Eva M. , Sorribes Eva , Ezquerro Olga 
Published: March 2003

Nurses’ attitudes to terminally ill patients Background. The care of terminally ill patients is a challenge for nurses that has raised special interest in recent years. Several studies have shown a stereotyped negative attitude in nurses towards terminally ill patients. However, all have used methods with several limitations. Aim. The aim of the study presented in this paper was to identify the nurses’ attitude to the terminally ill patient in Catalonia, Spain, and the relationship of this attitude to different socio‐demographic data (type of centre, shift, years of experience, age and sex) by means of a new quantitative method based on the free word‐association test. Methods. One hundred and seventy‐five nurses working in 18 hospitals and hospices in Catalonia, Spain were included in the study. Data were analysed by the Associative Semantic Field Differential method by means of the computer programme CONTEXT and a quantitative evaluation of the degree of attitudes positivity was obtained. Results. The study revealed a general slight negative trend in attitudes towards the terminally ill patient. A more positive attitude was observed in older caregivers and in women. The positivity in attitude decreased from morning to night shift. No differences were observed between nurses working in hospitals and those working in hospices. Conclusions. We conclude that nursing attitudes can be analysed by methods such as that used in this study. Attempts can be made to modify this attitude in caregivers by means of training programmes and stimulating awareness of an adequate professional approach.
Changes in health visitors’ work
Authors: Ellefsen Bodil 
Published: March 2003

Changes in health visitors’ work Aims.  The Spurpose of this investigation is to describe Scottish health visitors (HVs) experience of changes in their work and compare these with their Norwegian counterparts. Background.  The renewed emphasis on community health care, health promotion and illness prevention is a strong reason to focus on health visiting work. Knowledge about changes in practice are of special interest for nursing science as such knowledge could contribute to the development and advancement of the health visiting service. Design.  The study used a comparative descriptive design. The data are based upon in‐depth interviews with nine HVs from Scotland and 12 HVs from Norway. Results.  The results showed similarities as well as differences. HVs in Scotland and Norway experienced changes in work load with decreases in some areas and increases in others, changes in work practice, approaches and techniques with more emphasis on clients’ empowerment, and also fewer management positions held by nurses. The differences mainly related to the ways that the health visiting service had specialized and expanded. The aim of Scottish health visiting from ‘cradle to grave’ service was not adopted by the Norwegian HVs to the same extent. Scottish HVs specialized individually in some areas and used each other’s competence to a much greater degree than the Norwegian HVs. Conclusions.  It appeared that the Scottish HVs had found a path where health visiting work aimed at illness prevention and health promotion for everyone was on the way to becoming a comprehensive service and a stronger and more integrated part of the health visiting service. This is a pathway that Norwegian HVs still have to pursue. The qualitative approach and the slightly different samples limited the possibility for generalizations. Further research should address the question of changes and patterns in health visiting work, of how the development came about, and what are the bases for the differences in specialization and expansion of the service. Secondly it should be asked to what degree the development influences the quality of health visiting and consequences for clients, community and health visiting service.
Chronic illness – a disruption in life: identity‐transformation among women with chronic fatigue syndrome and fibromyalgia
Authors: Asbring Pia 
Published: March 2003

Chronic illness – a disruption in life: identity‐transformation among women with chronic fatigue syndrome and fibromyalgia Background. People with chronic illnesses often suffer from identity‐loss. Empirical research concerning patients with chronic fatigue syndrome (CFS) or fibromyalgia has not, however, adequately addressed the consequences of these illnesses for identity. Aim. The aim of this article is to describe how women with CFS and fibromyalgia create new concepts of identity after the onset of illness, and how they come to terms with their newly arisen identities. I aim to illuminate the biographical work done by these individuals, which includes a re‐evaluation of their former identity and life. This process is illustrated by the following themes: An earlier identity partly lost and Coming to terms with a new identity. Method. The study is based on interviews with 25 women in Sweden, 12 with the diagnosis of CFS and 13 diagnosed with fibromyalgia. A grounded theory orientated approach was used when collecting and analysing the data. Findings. The main findings are that: (1) the illnesses can involve a radical disruption in the women’s biography that has profound consequences for their identity, particularly in relation to work and social life, (2) biographical disruptions are partial rather than total, calling for different degrees of identity transformation, (3)␣many of the women also experience illness gains in relation to the new identity. Conclusions. Thus, the biographical disruption and illness experience comprised both losses and illness gains that had consequences for identity.
Experiences of well spouses after lung transplantation
Authors: Kurz Jane McCausland 
Published: March 2003

Experiences of well spouses after lung transplantation Aim of the study. To explore what life is like for well spouses after their partners’ lung transplantation? Background. The numbers of people having a lung transplant in the United States of America (USA), as well as surviving beyond 1 and 5 years, has increased steadily over the last decade. This trend is expected to continue. Few have examined the transplant experience from the view of well spouses who are the most typical patient‐support person. Researchers have shown that spousal adjustment is closely associated with patient adjustment and recovery. Design/methods. Using written surveys and taped telephone interviews in 1998, a convenience sample of 12 well spouses shared details of their lives after their partners’ lung transplant. Spouses from eight states in the USA responded to an invitation to participate which was posted on an internet listserv. Ages ranged from 40 to 66 years and the posttransplant time ranged from 4 to 60 months. Spouses completed a demographic form, the Family Inventory of Life Events (FILE), and the Center for Epidemiologic Studies Depression Scale (CES‐D) prior to interview. Triangulation of methods augmented and corroborated data. Interviews stopped when saturation was reached. Data collection and analyses were carried out simultaneously using a constant comparative method. Results. The core theme was the ‘roller coaster ride’ characterized by a series of ups and downs. Other major themes were coping, giving medications, knowing the donor, making comparisons, togetherness, and caring for the well spouse. Five identified stages were: the transplant event, cocooning, normalizing, branching‐out and settling down. Conclusions. This study supports nurses using a family centred focus. Nurses in all practice areas can apply information gained from this study to help spouses anticipate chaos at each stage and develop effective coping strategies.
The effectiveness of parenting programmes facilitated by health visitors
Authors: Long Ann , McCarney Shane , Smyth Gladys , Magorrian Noreen , Dillon Audrey 
Published: March 2003

The effectiveness of parenting programmes facilitated by health visitors Aim of the study. This study was designed to evaluate the effectiveness of parenting programmes that are facilitated by health visitors and offer practical and emotional support to parents in the Down Lisburn Trust, Northern Ireland. Methods. All parents (n=78) taking part were given a self‐administered questionnaire both before and after attending a ‘Positive Parenting’ programme. The questionnaire contained items gathering demographic information, standardized measures of clinical anxiety/depression, personality states and coping styles and participants’ experience of being a parent and what they wanted from the parenting group. Two items adapted from the Parent Stress Index looked at participants’ ratings of themselves as parents, and if they enjoyed this role. Statistical analysis. All statistics were computed using the SPSS for Windows (version 7) statistical package. The parametric paired‐samples t‐test was used with the ratio data generated by the Hospital Anxiety and Depression Scale (HADS) questionnaire. It is used to test the difference between the means of the pre and postsets of scores for significance. The nonparametric Wilcoxon test was used to find if there was a significant difference between the pre and postprogramme related samples by ranking the means. The Wilcoxon was chosen firstly because the data were ordinal in nature, hence it cannot be assumed that the findings follow the normal curve of distribution and secondly because it cannot be assumed that the data have homogeneity of variance. Findings. At the end of the 8‐week parenting programme, findings demonstrated significant statistically reduced levels of clinical anxiety and depression. Parents demonstrated an increase in more positive ratings of personality states such as not shouting at their children and being more calm and energetic at the end of the programme. Adaptive problem focused coping strategies were reported as being used more often subsequent to the programme, although some of the less adaptive emotion focused strategies had also increased in use. However, no change was evident in their ratings of how good a parent they were or if they enjoyed being a parent. Conclusions. Health visitors have the skills and are in the position to be preventative agents of inadequate parenting, and advocates of positive parenting. Factors relevant to the realm of positive parenting are highlighted as possible avenues for future research.
Risk factors associated with noncompliance with methadone substitution therapy (MST) and relapse among chronic opiate users in an Outer London community
Authors: Mutasa H. C. F. 
Published: March 2003

Risk factors associated with noncompliance with methadone substitution therapy (MST) and relapse among chronic opiate users in an Outer London community Aims. The purpose of this study was to identify the risk factors associated with noncompliance with methadone substitution therapy (MST) and hence relapse in chronic opiate‐dependent users, as this has major clinical implications especially in community‐based detoxification programmes. Background. Community mental health nurses (CMHNs) and other health/social care professionals need to be aware of the main risk factors associated with MST noncompliance among long‐term opiate users living within their catchment areas. The sex‐matched patterns of biopsychosocial risk factors can be useful predictors of the ability of clients to comply with MST and their likelihood to complete the detoxification programme. A knowledge of the patterns of these high‐risk factors also allows the care professionals to: (1) draw‐up or re‐draw care contracts that reflect their patients’ biopsychosocial circumstances; (2) initiate much broader, client‐centred, relapse prevention strategies; (3) select suitable patients for specialized detoxification contracts; and (4) modify the care approach from detoxification to maintenance contracting particularly for clients with low predicted scores for the former contract‐type. Methods. As successfully demonstrated in this semi‐quantitative descriptive investigation, identification of these sex‐typed biopsychosocial high‐risk factors can easily be undertaken during assessment and when the clients attend regular review. In this study, numerical information was gathered during personal face‐to‐face interviews, and was supplemented with that contained in past multidisciplinary case notes. Results. Overall, the medication noncompliant female clients were associated with personality trait, decreased educational expectations, everyday life stresses, ambivalent thoughts, social company availability, comorbidity, boredom, and family‐related conflicts; whereas the noncompliant male clients were associated with poor motivation, fashion and reputation, peer association, uncontrollable drug‐cravings, drug availability, major life events, too stringent prescribing/poor client‐centred care package, heavy intravenous users, young polydrug users, and triple users. Conclusions. These findings have important nursing practice connotations. This study is advocating the routine identification of biopsychosocial high‐risk factors associated with MST noncompliance by all CMHNs working with chronic opiate‐dependent users.