Factors Affecting Psychosocial Adjustment in Persons With a Recent Ostomy.

PURPOSE: The aim of this study was to examine the influence of personal and clinical factors on psychosocial adjustment in persons living with an ostomy for less than 1 year. DESIGN: A cross-sectional survey. SUBJECTS AND SETTING: The study sample comprised 183 adult individuals who had a colostomy, ileostomy, or urostomy for less than 1 year, residing in the Northeastern United States. METHODS: Data were collected from May through November 2018 using 2 instruments: a sociodemographic questionnaire and the Ostomy Adjustment Inventory-23 (OAI-23). The OAI-23 items measured 4 psychosocial subscales: acceptance, anxious preoccupation, social engagement, and anger. Data were analyzed using analysis of variance, multivariate analysis of variance, Cramer's V correlations, and multiple regression. RESULTS: Univariate analysis indicated that factors influencing psychosocial adjustment to an ostomy include age, assistance with care, educational background, stomal type, body mass index, ostomy height, preoperative education, and stoma siting. Multivariate analysis of variance identified that those who reported independence with ostomy care experienced higher levels of adjustment in all areas of the OAI-23. CONCLUSIONS: Findings from this study may assist nurses and other care providers to better understand the physical and emotional needs of those with ostomies and to identify interventions to promote optimal health in this population.

The Experience of Men Whose Partners Have Postpartum Depression [Formula: see text].

BACKGROUND: The correlation of paternal depressive symptomatology to maternal postpartum depression can approach 50%. Paternal depression during a female partner's postpartum time period can include feelings of fear, confusion, frustration, anger, helplessness, and lack of support. There are only a few published studies that address the interaction between paternal and maternal mental health during the postpartum period. AIMS: The purpose of this study was to gain insight into the experiences of men whose partners had postpartum depression as a foundation for intervention and program development. METHOD: This qualitative study used a descriptive phenomenological approach. A purposive sample of 10 men who lived with a partner diagnosed with postpartum depression was recruited via flier postings in mental health clinics, a perinatal mental health email listserv, and word-of-mouth. Single, audiotape-recorded interviews were completed. Qualitative data analysis was used to reduce initial coding to final themes that described participant experiences. RESULTS: The participants described efforts to provide support and care for their families; their efforts not to make things worse; their fears, anxieties, and physical responses; and the isolation associated with not knowing how to ask for help. The five themes included needing to support partners, maintaining stability, experiencing mutual symptoms, feeling isolated, and providing insight for others. CONCLUSIONS: Depression is known to have a negative effect on all members of a family. It is imperative that fathers' experiences are understood in order to fill this gap in caring for families.

Working Conditions and Mental Health of Nursing Staff in Nursing Homes.

Nursing staff in nursing homes suffer from poor mental health, probably associated with stressful working conditions. Working conditions may distribute differently among nursing assistants, licensed practical nurses, and registered nurses due to their different levels in the organizational hierarchy. The objectives of this study were to evaluate the association between working conditions and mental health among different nursing groups, and examine the potential moderating effect of job group on this association. Self-administered questionnaires were collected with 1,129 nursing staff in 15 for-profit non-unionized nursing homes. Working conditions included both physical and psychosocial domains. Multivariate linear regression modeling found that mental health was associated with different working conditions in different nursing groups: physical safety (ß = 2.37, p < 0.05) and work-family conflict (ß = -2.44, p < 0.01) in NAs; work-family conflict (ß = -4.17, p < 0.01) in LPNs; and physical demands (ß = 10.54, p < 0.05) in RNs. Job group did not moderate the association between working conditions and mental health. Future workplace interventions to improve mental health should reach to nursing staff at different levels and consider tailored working condition interventions in different nursing groups.

Lessons learned about primary weight maintenance and secondary weight maintenance: results from a qualitative study.

BACKGROUND: Obesity is now a worldwide problem and Ireland is no exception with approximately two thirds of the adult population now overweight or obese. A recent report has found that 53% of Irish adults aged 50 years and over are classified as centrally obese and at substantially increased risk of metabolic complications. While most studies investigating weight maintenance have been conducted on those who have managed to lose weight and/or achieved weight loss maintenance (secondary weight maintainers), few studies have been undertaken to understand the attitudes, behaviours, motivations and strategies of those who maintain their weight within normal weight ranges over their lifetime, so called primary weight maintainers. This study aims to explore this issue through qualitative exploration of primary weight maintainers in an Irish University. METHODS: Seven focus groups were conducted (including three single interviews) with 17 participants in total across three different groups, 1) primary weight maintainers, 2) secondary weight maintainers, and 3) those unable to sustain or achieve weight loss. The interviews were transcribed and thematic analysis was applied to interpret the findings. RESULTS: After analyzing the participant's interviews, planning and organization or lack of, emerged as themes across the three groups in varying degrees. Strategizing, perseverance and willpower were seen as integral to weight maintenance and weight loss in groups one and two, these were lacking in group three. Prioritizing exercise and perseverance in maintaining a high level of activity was evident in groups one and two and was lacking in group three. Motivational influences were equal across the groups however, group three found it difficult to turn this into action. Group one had behavioural control of calorie intake maintaining a balance between week and weekend eating. Group three found it difficult to control calorie intake and portion size. Self-image differed across the three groups with cognitive dissonance evident amongst those in group three. CONCLUSIONS: This study showed that there are many factors that influence primary weight maintenance. Considering that we live in a society that is predominantly sedentary, predominantly overweight and with poor food choice options facing us every day, fighting our way through to ensure healthy weight maintenance requires active, conscious efforts. The factors identified in this study which are important in healthy weight maintenance are all potentially modifiable with life-coach, nutrition, exercise and cognitive interventions particularly if peer support and a whole family approach are incorporated.

Predictors of Food Insecurity among Older Adults in the United States.

OBJECTIVE: Food insecurity among U.S. households is a national concern. Since 2010, the U.S. Healthy People goal has been to reduce food insecurity to 6%. Despite this goal, 14.5% of households remained food insecure in 2013 (U.S. Department of Agriculture). The purpose of this study was to examine the antecedents of food insecurity among older adults through the lens of the social ecological model. DESIGN AND SAMPLE: This retrospective cross-sectional study utilized secondary data from the National Health and Nutrition Examination Survey (NHANES) from the years 2007 and 2008 from a sample that included 2,045 adults 60 years of age and older. MEASURES: Variables related to the constructs of the social ecological model were examined using descriptive, chi-square, and logistic regression analyses. RESULTS: Analyses of the model indicated that the severity of depression, reports of financial support, and having ever received household food stamp benefits had statistically significant main effects on food insecurity among older adults. CONCLUSIONS: The study findings have implications for nursing practice, education, and research and could facilitate the development of screening methods, interventions, and policy evaluation that focus on food insecurity at multiple spheres of influence among the targeted population.

Development of the Fogg Intent-to-Screen for HIV (ITS HIV) questionnaire.

In this paper, we describe the development and psychometric properties of the Fogg Intent-to-Screen for HIV questionnaire (ITS HIV), which measures peoples' beliefs and intentions toward HIV screening. The ITS HIV was developed using the Theory of Planned Behavior as the framework for a developmental process that included qualitative interviews, a validation phase, two pilot tests, and a field test of the final 55-item questionnaire. The field test involved 312 homeless persons from five New England states. Cronbach alphas of the direct measures scales ranged from .72 to .90. Findings from a path analysis verified the construct validity. The psychometric estimates from these analyses suggest the ITS HIV questionnaire is appropriate for use in clinical practice or to evaluate the effectiveness of interventions.

The context of unintended pregnancy among married women in the USA.

BACKGROUND AND METHODOLOGY: Unintended pregnancy is a concern in the USA due to its association with adverse physical, mental, social and economic outcomes. Few studies have examined this issue among married women from a social and contextual perspective. This study targeted married women to examine factors associated with unintended pregnancy using the ecological model of health promotion that focuses attention on both individual and social environmental factors. Data from the National Survey of Family Growth (NSFG) were merged with NSFG contextual files to examine the major predictive factors. RESULTS: Multilevel logistic regression modelling revealed that married women of lower socioeconomic status, higher parity, who lived in communities with a high rate of marital dissolution had a higher probability of an unintended pregnancy. Women reported that their husbands were likely to concur with the unintended designation of the pregnancy. DISCUSSION AND CONCLUSIONS: This study utilised a unique perspective to examine contextual factors related to unintended pregnancy among married women. The results support the need to focus on the couple as a unit for prevention efforts. Social policies to enhance access to family planning services are necessary to improve outcomes and prevent unintended pregnancies.

Health disparities among health care workers.

In this article we describe the process of an interdisciplinary case study that examined the social contexts of occupational and general health disparities among health care workers in two sets of New England hospitals and nursing homes. A political economy of the work environment framework guided the study, which incorporated dimensions related to market dynamics, technology, and political and economic power. The purpose of this article is to relate the challenges encountered in occupational health care settings and how these could have impacted the study results. An innovative data collection matrix that guided small-group analysis provided a firm foundation from which to make design modifications to address these challenges. Implications for policy and research include the use of a political and economic framework from which to frame future studies, and the need to maintain rigor while allowing flexibility in design to adapt to challenges in the field.

Bullying in the workplace--a qualitative study of newly licensed registered nurses.

Bullying in the workplace is associated with negative job satisfaction and retention. It has also been found to have adverse effects on the health of employees. Using a qualitative descriptive design, this study examined the stories of bullying among nurses based on actual or witnessed experiences. One hundred eighty-four newly licensed U.S. nurses responded to an open-ended question on a survey about bullying mailed to their homes. Four major themes emerged that related to varying types of bullying behaviors, perceived causes of bullying, and the impact of bullying behaviors. The themes included structural bullying; nurses "eating their young"; being out of the clique; and leaving the job. Bullying is experienced firsthand and secondhand by nurses, and particularly by vulnerable, newly graduated nurses. Workplace bullying must be explored fully to develop effective strategies to eliminate it.

Self-Management of Type 2 Diabetes in Adult Haitian Immigrants: A Qualitative Study.

Introduction: A large body of literature exists on self-management of type 2 diabetes (T2D) in a variety of populations. However, research is limited on how Haitian immigrants self-manage their T2D despite a prevalence of 6.9% in Haiti. The purpose of this study was to explore and describe the lived experience of adult Haitian immigrants managing T2D living in the United States. Methodology: Moustakas's phenomenological approach guided this qualitative study. Adult Haitian immigrants diagnosed with T2D for at least 1 year were interviewed. Individual interviews were audio-recorded, transcribed verbatim, uploaded into NVivo, and analyzed using Moustakas's existential data analysis process. Results: We interviewed 16 participants (mean age 56;12 females; an average of 11 years living in the United States; mean hemoglobin A1c 8.1%). Four themes emerged: self-reliance, spirituality, nostalgia for home, and a desire for positive patient-provider relationships. Cultural influences and health beliefs may affect individual self-management of T2D in this population. Conclusions: These results may assist clinicians in identifying factors that contribute to suboptimal self-management in Haitian immigrants and help patients reach glycemic control. Culturally competent assessment and interventions for Haitian immigrants with T2D may not be provided without considering these four themes.

Bhutanese Older Adult Refugees Recently Resettled in the United States: A Better Life With Little Sorrows.

PURPOSE: This study explores the experiences and adjustment process among older Bhutanese refugees resettled in the United States and identifies their unmet health and social service needs. DESIGN: This phenomenological study design included the conduction of nine in-depth semistructured interviews in the respondents' native language. The researchers adhered to the steps outlined by Moustakas for data analysis. RESULTS: The five identified themes included the following: a better life but with little sorrows, cultural tensions related to adaptation, language as a barrier to success in the United States, isolation and loneliness, and worries about citizenship and its impact on the future. Discussion/Implications for Practice: Psychological adjustment to life in the United States can have profound impact on the health of Bhutanese older adults. Nurses and health care providers should integrate culturally congruent health care, raise awareness of the unique needs, and advocate for policy changes that will benefit this group of older adult refugees whose lives have frequently been upended.

The moderating effect of social cognitive factors on self-management activities and HbA1c in Thai adults with type-2 diabetes.

BACKGROUND: Diabetes mellitus (DM) has become a serious chronic disease. Self-management strategies help persons with DM make choices which will develop skills needed to reach their goal of blood glucose control and allow them to be successful in reaching goals. OBJECTIVE: To examine the impact of self-management activities on HbA1c for persons with DM and to examine the impact of social support, self-efficacy and Buddhist values as moderators on the relationship between the self-management activities and HbA1c. METHOD: This study is a cross-sectional design. The sample included 401 Thai adults diagnosed with type 2 diabetes, aged 20-65 years old who had at least one HbA1c test in the last three months were recruited. Participants completed four questionnaires to measure self-management activities, as well as self-efficacy, Buddhist values and social support as moderating factors on self-management activities and HbA1c. RESULTS: The self-management activities were negatively associated (ß = -2.05, p ≤ 0.001) with HbA1c. The Social support, self-efficacy and Buddhist values had a significant interaction effect between selfmanagement activities and HbA1c (ß = -0.97, p ≤ 0.05, ß = -0.18, p ≤ 0.05 and ß = -2.76, p ≤ 0.001). CONCLUSION: The diabetes self-management activities were more strongly associated with HbA1c under conditions of high social support, self-efficacy and health beliefs with Buddhist values. Future interventions for T2DM self-management programs should incorporate mechanisms to measure and support these factors.

Psychometric evaluation of the Thai translation of the Diabetes Self-management Questionnaire in type 2 diabetes.

OBJECTIVES: To explore the content validity and the internal consistency of the diabetes Self-management Questionnaire (DSMQ) for persons with T2DM in Thailand. METHODS: Diabetes Self-management Questionnaire (DSMQ) was developed in English. The translation of DSMQ into Thai language was performed by native Thai translators. A panel of five experts in Thailand evaluated the translation. Content validity was quantified by the content validity index (CVI). A cross-sectional design was used to test internal consistency by calculating Cronbach's alpha. RESULTS: The DSMQ contains 16 items. There are eleven items (69%) which showed excellent CVI; two items (12.5%) showed good CVI and three items showed acceptable CVI. The average scale of CVI was 0.90. The internal consistency of the DSMQ was 0.73. CONCLUSION: The Thai version of DSMQ showed excellent content validity; good internal consistency. The instruments can be used among Thai adults with DM in future research studies.

Exploring Transition to Self-Management Within the Culture of Sickle Cell Disease.

PURPOSE: The aim of this study was to explore the meaning of transition to self-management in sickle cell disease. DESIGN/METHOD: Twelve audio-recorded semistructured interviews were conducted with a sample of 21- to 25-year-olds recruited from a comprehensive sickle cell center in the northeast region of the United States. Data were analyzed using an existential framework according to van Manen's phenomenological method. FINDINGS: The meaning of transition to self-management was found in lived time, space, body, and human relationship. The emerging themes highlighted in this article include: Best Mother Ever, Growing up in the Hospital, I'm Not Trying that Again, Doing it on My Own, Living Day-by-Day, and Not a Kid any Longer. The themes reflected meaning and insight into this unique experience. CONCLUSION/PRACTICE IMPLICATIONS: Study results emphasize the culturally constructed meaning of transition to sickle cell disease self-management and need to integrate transcultural perspectives into nursing practice to support this emerging phenomenon.

Quality of Life of College Students Living With Type 1 Diabetes: A Qualitative View.

The purpose of this phenomenological qualitative study was to examine the quality of life among college students living with Type 1 diabetes (T1D). Inclusion criteria included age 18 to 24, current college student, and a diagnosis of T1D for at least 1 year. Semi-structured interviews were conducted, in-person and by phone. During these interviews, college students shared stories of living with T1D and its impact on their quality of life. Three major themes emerged, which included "planning ahead," "thinking positive," and "seeking support." These findings provide a better understanding of the transitional experience of living with T1D and the impact on perceived quality of life while attending college. Techniques and strategies aimed at the enhancement of perceived quality of life for college students living with T1D were identified. These findings will provide valuable insight for professionals working with this population.

Occupational Hazards in the Thai Healthcare Sector.

Healthcare personnel work in vulnerable conditions that can adversely impact physical and/or mental health. This paper aims to synthesize the state of knowledge on work-related illnesses, injuries, and risks experienced by Thai healthcare workers. We found that Thai healthcare personnel, like others worldwide, are at risk for injury related to needle sticks and sharp instruments; infectious diseases due to biological hazards exposure such as airborne pathogens and patient secretions; muscle pain due to workload and long duration of work; and psychological disorders related to stressful working conditions. Because detailed surveillance data are limited for the Thai healthcare workforce, we recommend that additional surveillance data on Thai healthcare workers' health outcomes be collected. Future research efforts should also focus on evidence-based interventions in order to develop methods to prevent and treat occupational health injuries and illnesses acquired in the workplace for Thai healthcare sector workers.

Cancer risk management decision making for BRCA+ women.

Women with pathogenic BRCA genetic mutations face high risks for cancer development. Estimates vary among mutation carriers, with lifetime risks ranging from 41% to 90% for breast cancer and 8% to 62% for ovarian cancer. Cancer risk management options for BRCA mutation positive (BRCA+) women have life-altering implications. This qualitative, phenomenological study explored the experience of cancer risk management decision making for women who are unaffected carriers of a BRCA mutation (previvors). Fifteen previvors recruited from Facing Our Risk of Cancer Empowered (FORCE), an online informational and support group, were interviewed. Findings consisted of four major themes: the early previvor experience, intense emotional upheaval; the decisional journey, navigating a personal plan for survival; lack of knowledge and experience among health care providers; and support is essential. Findings highlight the different decisional perspectives of previvors based on age and individual factors and the need for increased competence among health care providers.

Conducting interdisciplinary research to promote healthy and safe employment in health care: promises and pitfalls.

Due to the complexity of human health, emphasis is increasingly being placed on the need for and conduct of multidisciplinary and/or interdisciplinary health research. Yet many academic and research organizations--and the discipline-specific associations and journals--may not yet be prepared to adopt changes necessary to optimally support interdisciplinary work. This article presents an ongoing interdisciplinary research project's efforts to investigate mechanisms and pathways that lead to occupational health disparities among healthcare workers. It describes the promises and pitfalls encountered during the research,and outlines effective strategies that emerged as a result. Lessons learned include: conflict resolution regarding theoretical and methodological differences; establishing a sense of intellectual ownership of the research, as well as guidelines for multiple authorship; and development and utilization of protocols, communication systems, and tools. This experience suggests a need for the establishment of supportive structures and processes to promote successful interdisciplinary research.

The changing horizons of U.S. families living with pediatric HIV.

Although HIV is considered a chronic pediatric illness that is on the wane in the United States, challenges remain for those affected. The purpose of this longitudinal qualitative study was to examine the phenomenon of raising an HIV-positive child in the United States from the parental perspective. This study incorporated a longitudinal, phenomenological approach. The purposive sample included parents and guardians from 10 families from the northeast region of the United States with children diagnosed with asymptomatic HIV infection at the study onset. The researcher conducted in-depth interviews with the parents over a 7-year period. The common themes identified included: balancing normalcy with uncertainty, facing the multifaceted dilemmas associated with disclosure, and addressing the evolving medication and treatment challenges. The findings of this study can enhance the understanding of nurses and other health care professionals to improve policies, standards of care, and interventions for children and families living with pediatric HIV infection.

Trends in the nursing doctoral comprehensive examination process: a national survey.

The doctoral comprehensive or qualifying examination (CE/QE) is a traditional rite of passage into the community of scholars for the nursing profession. This exploratory, descriptive cross-sectional study examined trends in the process, timing, and methodology of comprehensive and qualifying examinations in nursing doctoral programs in the United States. Administrators from 45 schools responded to an online survey from 27 states across the country (37% response rate). Participants reported wide variations in the process. The most common method of implementation was the written take-home test (47%), two thirds of which had a subsequent oral examination. Eleven survey respondents (24%) reported using a form of the traditional written, timed, on-site examination; however, only 4 of these also followed up with an oral defense. Nine schools (20%) moved to a requirement for a written publishable paper; three schools consider the written proposal and its defense as the CE/QE. Approximately half had changed their policy in the past 5 years. With the increase in nursing doctor of philosophy programs over the past decade, information is needed to facilitate the development of methods to achieve program outcomes. An understanding of national CE/QE trends can provide a starting point for discussion and allow innovative ideas to meet the need of individual programs.