摘要:

BackgroundAlthough fall prevention studies for the elderly have been reported, there is a paucity of work summarizing the effectiveness of these interventions.ObjectivesThe research question that guided this study was: “What are the effects of fall prevention programs on the proportion of falls in the elderly?”MethodMeta-analysis was employed to summarize findings of intervention studies of fall prevention in the elderly involving a comparison group and a quantifiable outcome. Studies were reviewed by two of the authors with the eligibility criteria in mind. Studies were then coded and an inter-rater reliability check was performed.ResultsThe overall mean weighted effect size for the 12 studies included in the meta-analysis was .0779 (Z= 5.03,p< .001). For fall prevention intervention types, exercise alone had a mean weighted effect size of .0220 (Z= .5303,p> .5), exercise and risk modification had a mean weighted effect size of .0687 (Z= 3.41,p< .001), and comprehensive risk assessment intervention studies had an effect size of .1231 (Z= 3.97,p< .001). The mean weighted effect size size for community-based studies was .0972 (Z= 5.37,p< .001) and for institution-based studies was .0237 (Z= .7822,p= .22). Time to outcome measure analyses revealed that the mean weighted effect size for studies measuring proportion of falls at 12 months was .0905 (Z= 5.43,p< .001), and those measuring at four months or less was −.0972 (Z= −.005,p> .50).ConclusionsThe results of this meta-analysis indicate that there was a 4% decrease in the rate of falls for individuals who were in the treatment groups receiving various fall prevention interventions. Additional intervention studies need to be conducted in the elderly population with a goal of preventing falls.

ISSN:0029-6562    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0029-6562    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundThe survival benefit of adjuvant chemotherapy for breast cancer is established but the experience of organ system toxicity for women, specifically ovarian toxicity, is not fully known.ObjectivesThe purpose of the study was to develop a substantive theory that would describe and explain women’s responses to chemotherapy-induced premature menopause within the context of breast cancer.MethodsQualitative inquiry with Grounded Theory methodology was used to collect, code, and analyze the data. The purposive sample consisted of 27 women with early stage breast cancer who received adjuvant chemotherapy. The majority of women were married, well educated, and employed with a mean age of 41 years. Amenorrhea was reported by 24 women, a peri-menopausal pattern of bleeding was described by two women, and one woman had return of normal menses. Women participated in interviews ranging from 45 minutes to 2 hours and other data sources, such as informal discussions with oncology care providers, and lay women’s writings about menopause and midlife women’s health were used to increase interpretation of the data.ResultsVulnerability was identified as the basic social psychological problem for women. Carrying On is the basic process that explains how women respond to vulnerability as they attempt to assimilate drug-induced premature menopause into their breast cancer experience. The stages of Carrying On (Being Focused, Facing Uncertainty, Becoming Menopausal, and Balancing) progressed from minimizing the early menopause experience to developing an awareness to balancing the dynamic relationship of menopause and cancer in their lives.ConclusionsThis study described the complexity of the experience of chemotherapy-induced premature menopause in women with early stage breast cancer and identified gaps in knowledge about menopausal symptom distress and factors influencing symptom management and outcomes in this population. Future research is needed to evaluate interventions during and after adjuvant therapy to improve the quality of survival of women who experience ovarian toxicity related to early stage breast cancer treatment.

ISSN:0029-6562    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundIntegration is an emerging concept in the study of self-management and chronic illness, yet this process and how it occurs is not well understood.ObjectivesThis investigation, part of a triangulated study, focused on the experience of integrating type 2 diabetes treatment recommendations into an existing lifestyle while participating in a nurse-coaching intervention.MethodAn interpretive method elicited data from nurse-coaching sessions (4), field notes, and an interview in 9 women with type 2 diabetes. The process of data reduction and analysis (Miles & Huberman, 1994) was used to interpret data.ResultsThe core process of integrating lifestyle change in type 2 diabetes was multifaceted and complex. Challenges to the process of integrating lifestyle change included reconciling emotions, composing a structure, striving for satisfaction, exploring self and conflicts, discovering balance, and developing a new cadence to life. These challenges required acknowledgment in order for participants to progress toward integration.DiscussionBalance was an integral component to the experience of integration, between structure and flexibility, fear and hope, conflict and acceptance, diabetes and life. Conceptualizations identified with this investigation extend understanding of theories of integration and lifestyle change and invite the development and testing of nursing interventions.

ISSN:0029-6562    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundA growing body of literature has demonstrated that demographic factors and acculturative stress contribute to depression in recent immigrants from many countries. Few studies examine potentially protective personality factors, such as resilience, for dealing with the challenges related to the early postmigration transition period.ObjectivesThe purpose of this analysis is to examine relationships among demographic characteristics, acculturation, psychological resilience, and symptoms of depression in midlife women from the former Soviet Union who recently immigrated to the United States.MethodData for this analysis are from a larger cross-sectional study that explored the impact of immigration during midlife on women’s health. The volunteer sample included 200 women from the former Soviet Union, 45–65 years old, who had lived in the U.S. fewer than 6 years. This analysis involves measures of acculturation, demands of immigration, resilience, and depressed mood.ResultsFindings include very high scores on the depression scale compared to U.S. norms. Older women, and those reporting greater demands of immigration, had higher scores on the depression scale. However, lower depression scores were found for women reporting greater English usage and resilience.DiscussionThe results corroborate previous studies that suggest high levels of depression in immigrant women, but additional validation is suggested to differentiate symptoms of depressed mood from clinical depression in this culture. Findings also suggest that interventions that encourage use of English language and enhance resilience may help decrease symptoms of depression in midlife women who are recent immigrants from the former Soviet Union.

ISSN:0029-6562    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundMost farmers are exposed to potentially hazardous noise levels through many of their work activities, such as operating tractors, grain dryers, and chain saws. Rates of noise-induced hearing loss in this group are high. Although this condition is preventable through the use of hearing protection, rates of protective device use are low. Understanding factors influencing the use of hearing protection devices will provide direction for programs to increase their use and decrease risk of noise-induced hearing loss.ObjectivesA study was designed using the Pender Health Promotion Model to identify factors affecting farmers’ use of hearing protection devices.MethodModel testing was conducted with a convenience sample of 139 farmers. Prior to model testing, existing instruments designed to measure concepts from the Health Promotion Model were modified for use with farmers through interviews, validity testing with an expert panel, and reliability testing with first a small (n= 36) then a second larger (n= 139) convenience sample of farmers. Instruments measuring cognitive and affective factors related to hearing protection device use were administered to farmers at a regional farm show in the Midwest.ResultsA logistic regression analysis identified interpersonal support, barriers, and situational influences as statistically significant predictors of this health behavior, correctly predicting 78% of the cases. Results of model testing were consistent with results of previous studies of Health Promotion Model variables with other worker groups’ use of hearing protection.ConclusionsInformation from this study can be used to design and evaluate interventions to promote hearing protection device use among farmers and reduce the level of noise-induced hearing loss in this high-risk and underserved worker group.

ISSN:0029-6562    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundAs many as 50% of total hospital admissions are readmissions. Because the factors contributing to hospital readmission are multiple, and research findings are not conclusive, it is important for clinicians to gain an understanding of the key factors that contribute to readmission.ObjectivesThis study explores the factors contributing to hospital readmission and derives an explanatory model that can best identify characteristics of patients at high risk for hospital readmission.MethodsThis research was a case-controlled study with readmitted patients (n= 168) as the readmitted group and nonreadmitted patients (n= 98) as the control group. The variables included demographic data, health assessment data, medical diagnosis, frequency of admissions, severity of illness, intensity of service and improvement of condition. The study sample was also interviewed to explore the patients’ views on their repeated hospitalization.ResultsIn the bivariate analysis significant differences between the study and control groups were multiple and generally consistent with findings in other studies. Using multiple logistic regression, however, the final model shows that only three factors best predict readmissions: frequency (3–4 times) of readmissions (OR = 9.96,p< .0001) and frequency (more than 5 times) of readmissions (OR = 15.73,p< .0001), financial assistance (OR = 5.03,p< .001), and severity of illness (OR = 3.12,p< .01). Our interview data suggest that the readmitted patients required assistance to accomplish daily living activities upon discharge and often returned to the hospital for the same health reason.ConclusionThe study findings suggest that patients who are frequently readmitted to the hospital are severely ill; are on public assistance; and may need special attention when discharged in order to attenuate repeated hospital readmission.

ISSN:0029-6562    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundNursing literature seldom examines Catholic sisters as entrepreneurs competing in the hospital marketplace, even though they established hospitals throughout the United States in the late 19thand early 20thcenturies.ObjectivesThis study examines the tension between hospitals as businesses and charities by asking how nursing sisters, who took vows of poverty, could build impressive hospital networks. What links did they forge to make hospital building possible?MethodHistorical methodology is used which draws upon primary sources in archives of three women’s religious congregations. These include nuns’ constitutions and letters, hospital chronicles, journals, minutes of meetings, annual reports, and census records. Secondary sources include nursing, hospital, religious, and economic histories.ResultsCatholic sisters’ entrepreneurial activities were pragmatic adaptions that reflected their commitment to their nursing and hospital establishments. They raised money and formed alliances not to build personal fortunes but to build religious values. Their entrepreneurship and spirituality worked together.DiscussionSister-nurses’ viewed their actions as doing what was necessary to their mission. A finacially stable hospital, with it’s large patient population, enhanced the social and spiritual importance of nun’s work. Yet, the broad-based corporate culture of Catholic hospitals still needs further study.

ISSN:0029-6562    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundThere are limitations of inter-class correlation (usually, the Pearson’s product-moment correlation) in evaluating reliability of an instrument. An intra-class correlation approach would be appropriate to examine the test-retest reliability of an instrument.ObjectivesTo introduce an intra-class correlation approach to examine the test-retest reliability of an instrument.MethodThe method of constructing an intra-class correlation coefficient was presented.ResultsThe instrument with visual analog scales to measure the perceived competence to practice breast self-examination and perceived barriers to breast self-examination was tested. The intra-class correlation coefficient was 0.640.ConclusionThe intra-class correlation is an alternative to test the reliability of an instrument and it is more sensitive to the detection of systematic error.

ISSN:0029-6562    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundA commonly used research design in the social sciences involves the matching of observations over 2 time periods (i.e., Time 1 → Time 2) to assess group change. Because coupled observations are usually correlated, a paired-or dependent-samplesttest is generally recommended in such applications to determine if there has been a statistically significant change in mean scores across time. Consequently, it is typically believed that unless information for matching respondents’ observations is available, researchers have no choice but to treat the observations as if they were independent.ObjectivesTo demonstrate alternative statistical approaches for employing the paired samplesttest when information for matching respondents’ observations is unavailable and to illustrate the applicability of these alternatives to longitudinal designs in which respondents at Time 1 are partially replaced by new respondents at Time 2.MethodTheoretical arguments and examples are employed to achieve the specified objectives.Results/DiscussionPerforming an independent-samplesttest when a paired-samplesttest is more appropriate will lead to a loss of statistical power and, thus, increase the likelihood of a Type II statistical error. The statistical approaches that are demonstrated allow researchers to account for pair wise dependency across observations and, therefore, to obtain a fairer test of group change in means.

ISSN:0029-6562    

出版商:OVID    

年代:2002

数据来源: OVID