ISSN:0029-6562    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundHuman immunodeficiency virus (HIV) infection has become a serious health problem for low-income African American women in their childbearing years. Interventions that help them cope with feelings about having HIV and increase their understanding of HIV as a chronic disease in which self-care practices, regular health visits, and medications can improve the quality of life can lead to better health outcomes.ObjectiveThis study aimed to determine the efficacy of an HIV self-care symptom management intervention for emotional distress and perceptions of health among low-income African American mothers with HIV.MethodWomen caregivers of young children were randomly assigned to self-care symptom management intervention or usual care. The intervention, based on a conceptual model related to HIV in African American women, involved six home visits by registered nurses. A baseline pretest and two posttests were conducted with the mothers in both groups. Emotional distress was assessed as depressive symptoms, affective state, stigma, and worry about HIV. Health, self-reported by the mothers, included the number of infections and aspects of health-related quality of life (i.e., perception of health, physical function, energy, health distress, and role function).ResultsRegarding emotional distress, the mothers in the experimental group reported fewer feelings of stigma than the mothers in the control group. Outcome assessments of health indicated that the mothers in the experimental group reported higher physical function scores than the control mothers. Within group analysis over time showed a reduction in negative affective state (depression/dejection and tension/anxiety) and stigma as well as infections in the intervention group mothers, whereas a decline in physical and role function was found in the control group.ConclusionsThe HIV symptom management intervention has potential as a case management or clinical intervention model for use by public health nurses visiting the home or by advanced practice nurses who see HIV-infected women in primary care or specialty clinics.

ISSN:0029-6562    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundIn light of health disparities and the growing prevalence of chronic disease, there is a need for community-based interventions that improve health behaviors and health status. These interventions should be based on existing theory.ObjectiveThis study aimed to evaluate the health and utilization outcomes of a 6-week community-based program for Spanish speakers with heart disease, lung disease, or type 2 diabetes.MethodThe treatment participants in this study (n= 327) took a 6-week peer-led program. At 4 months, they were compared with randomized wait-list control subjects (n= 224) using analyses of covariance. The outcomes for all the treatment participants were assessed at 1 year, as compared with baseline scores (n= 271) usingt-tests.ResultsAt 4 months, the participants, as compared with usual-care control subjects, demonstrated improved health status, health behavior, and self-efficacy, as well as fewer emergency room visits (p< .05). At 1 year, the improvements were maintained and remained significantly different from baseline condition.ConclusionsThis community-based program has the potential to improve the lives of Hispanics with chronic illness while reducing emergency room use.

ISSN:0029-6562    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectivesThis study aimed to determine the accuracy of using self-reported signs and symptoms to identify the presence of lymphedema as well as the usefulness of identifying clinically measurable lymphedema on the basis of certain symptoms elicited by the Lymphedema Breast Cancer Questionnaire (LBCQ).MethodsThis analysis used logistic regression to identify symptoms predictive of differences between symptom experiences of participants belonging to two distinct groups (study A): those with known post-breast cancer lymphedema (n= 40) and those in a control group of women with no history of breast cancer or lymphedema (n= 40). Symptoms in this model of best fit were used to examine their relation to limb circumferences of breast cancer survivors in a second independent data set (study B;n= 103) in which a diagnosis of known lymphedema was not previously determined using symptom experiences.ResultsThe presence of lymphedema was predicted by three symptoms comprising a model of best fit for study A (c = .952): “heaviness in past year,” “swelling now,” and “numbness in past year.” Using this model, prediction of absolute maximal circumferential limb difference (i.e., ≥2 cm) in study B showed that “heaviness in the past year” (p= .0279) and “swelling now” (p= .0007) were predictive. “Numbness in the past year” was not predictive. However, those with lesser limb differences reported this symptom more often.ConclusionsThe findings suggest that changes in sensations may be indicators of early lymphedema or other treatment-related sequelae that must be assessed carefully at each follow-up visit and over time. A combination of symptom assessment and limb volume measurement may provide the best clinical assessment data for identifying changes associated with post-breast cancer lymphedema.

ISSN:0029-6562    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundImprovement of healthcare in the United States is a national priority. Nursing intervention science can contribute substantially to addressing this priority.ObjectivesThe aim of this study was to describe strategies needed to maximize the base of nursing intervention science.MethodsThe study involved a review of reports on the state of quality in healthcare and an examination of nurse-led intervention studies funded by the National Institute of Nursing Research aimed at improving healthcare processes and outcomes.ResultsNursing has contributed valuable data regarding the meaning of quality from the perspectives of individuals, families, and communities. Increased efforts are needed to ensure that this science informs ongoing initiatives to define, assess, and improve the quality of healthcare.ConclusionsNurse-led intervention research is making significant contributions to the advancement of the science underpinning quality healthcare. However, the message regarding the substantive and unique contributions of this body of work needs to be disseminated more broadly. Future nursing intervention research aimed at improving healthcare quality should consider individual behavior in a broader context, extend the traditional foci of interventions, and be grounded in the sciences of multiple disciplines.

ISSN:0029-6562    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundMen and women differ in anxiety, which is one of the most stressful outcomes of an acute myocardial infarction (AMI). This anxiety may be moderated by coping styles of preference for information and control.ObjectiveThis study aimed to examine the relation of gender and preference for information and control to anxiety during the critical care period after AMI.MethodsAs part of a larger study on complications after AMI, a descriptive cross-sectional multicenter one-group investigation designed with a convenience sample of AMI patients admitted to acute care units was conducted. Within the first 48 hours after the patients were admitted to the hospital, anxiety was assessed using the State Anxiety Inventory, and preference for information and control was measured using the Krantz Health Opinion Survey.ResultsThe sample of AMI patients (N= 410) was 68% male, 87% White, 68% married. The women were significantly older than the men (p< .05) and significantly more anxious (p< .05). Multiple stepwise regression analysis with a control for age demonstrated that neither preference for information nor preference for control moderated the relation of gender and anxiety.ConclusionsThe women expressed greater anxiety than the men. However, the men and women were similar at all levels of anxiety in their preference for information and control. The search for other factors related to the stress of AMI will help healthcare providers design effective interventions to reduce anxiety among men and women.

ISSN:0029-6562    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundPatients with lung cancer present late in the disease and have multiple symptoms. Previous research has shown the symptom cluster of fatigue, weakness, weight loss, appetite loss, nausea, vomiting, and altered taste to be present at time of lung cancer diagnosis.ObjectivesThe study determined whether the symptom cluster identified at the time of diagnosis remained 3 and 6 months later, and whether there was a difference in the mean number of symptoms and the mean level of symptom severity over time. The relation of the severity rating for individual symptoms at the time of diagnosis and at 3 and 6 months after diagnosis was examined. Predictors for the number of symptoms and whether the symptom cluster was predictive of death were determined.MethodsSecondary analysis of an existing data set for 112 patients with newly diagnosed lung cancer assessed at diagnosis and at 3 and 6 months was performed and determined whether they were alive or dead 19 months after diagnosis.ResultsThe cluster of seven symptoms had internal consistency that remained at 3 and 6 months. The mean symptom severity and the number of symptoms at diagnosis were correlated with later ratings, but decreased in severity over time. A similar decrease in severity rating was seen for the individual symptoms in the cluster. The stage of cancer at diagnosis was the most predictive of the number of cluster symptoms reported. Death 6 to 19 months after diagnosis was predicted by age, stage of cancer at diagnosis, and symptom severity at 6 months.ConclusionsThe symptom cluster remains over the course of lung cancer and is an independent predictor of the patient’s death. Symptom severity, the number of symptoms reported, and the severity of the individual symptoms decreased over time. The stage of cancer at diagnosis is the best predictor of symptoms later in the disease.

ISSN:0029-6562    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundPatients and family caregivers repeatedly experience reactive depression that leads to medication errors, mismanagement of chronic disease, and poor self-care. These problems place them at high-risk for malnutrition, infection, heart diseases, and psychiatric sequelae.ObjectivesA secondary data analysis compared findings across a series of studies to evaluate the acceptability, effectiveness, and cost of a therapeutic writing intervention to reduce reactive depression, a common and frequently recurring adverse symptom.MethodsSecondary analysis of data from the series of studies was conducted. Data came from patients requiring lifelong, daily central intravenous catheter infusion of home total parenteral nutrition necessitated by nonmalignant bowel disease and their family caregivers who assist with this complex home care. Variables combined across the studies were pre- and postintervention scores from the Center for Epidemiological Studies-Depression Scale (CES-D), the number of weeks patients wrote in their diaries (adherence), and the written content in the diaries. Content analysis was used to analyze written data. The intervention materials and nurses’ time spent were averaged across studies to determine costs.ResultsThe weighted average baseline CES-D scores across studies for patients (17.94) and caregivers (15.75) showed the presence of depression. After journal writing had been used for an average of 10.4 weeks across studies, the effect sizes of the between (d= .27) and within (d= .65) patient group scores indicated moderate to large improvement in depression. Themes from written diaries showed that missing out on activities, financial worries, strain related to the severe illness, and the complexity of home care were related to depression across the studies.ConclusionsThe intervention was acceptable to participants, effective for managing reactive depression, and low in cost. The next steps will address testing for the longitudinal effects of the intervention.

ISSN:0029-6562    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundThe experience of unpleasant sensations associated with the presence of symptoms prompts self-care or help seeking to obtain explanations for the symptoms, manage emotional responses, or obtain treatment for symptom alleviation and elimination.ObjectiveThe purpose of this article is to summarize and comment on three existing symptom theories, with special attention to temporal factors.MethodsExisting theories are synthesized as the time dimensions of symptom experiences and symptom management processes are elucidated. Clinical examples and findings from empirical studies illustrate critical points.DiscussionExisting theories describing the symptom experience and the process of symptom management refer implicitly to the role of time or use limited dimensions of time. Symptom experiences in time (SET) theory is proposed as a synthesis and extension of existing theories. The SET theory conceives the symptom experience as a flow process that explicitly incorporates temporal dimensions. Four dimensions of time are recognized: clock-calendar, biologic-social, perceived, and transcendent time. The four temporal dimensions are placed against a backdrop of “meaning-in-time” that brings forth the potential for transformation in a symptom experience. Increasing sophistication in design, measurement, and data analysis is required to test and evaluate SET theory-based propositions.ConclusionsThe SET theory extends previous work by incorporating multiple temporal dimensions that reflect the human experience of health and illness manifested in the expression and management of symptoms.

ISSN:0029-6562    

出版商:OVID    

年代:2003

数据来源: OVID