A Theory of Transitions Influencing Diabetes Self-management Among Emerging Adults With Type 1 Diabetes.

Emerging adults with type 1 diabetes are experiencing numerous transitions, potentially affecting diabetes self-management. For example, when transitioning to college, these emerging adults may experience changes in their daily routines and usual reminders or triggers for habitual behavior such as checking blood glucose levels. In turn, these emerging adults may omit checking glucose levels, impacting decisional and adaptational diabetes self-management behavior associated with their insulin dose or bolus. Thus, we propose a theory on transitions influencing daily routines, diabetes self-management habitual behavior triggers, and, in turn, diabetes self-management habitual and decisional/adaptational behaviors for emerging adults with type 1 diabetes.

Glycemic Variability Within 1 Year Following Surgery for Stage II-III Colon Cancer.

OBJECTIVE: To examine glycemic variability within 1 month and 1 year following surgery among adult patients, with and without Type 2 Diabetes (T2D), treated for stage II-III colon cancer. METHOD: A retrospective analysis of electronic health record data was conducted. Glycemic variability (i.e., standard deviation [SD] and coefficient of variation [CV] of > 2 blood glucose measures) was assessed within 1 month and within 1 year following colon surgery. Chi-square (χ2), Fisher's exact, and Mann-Whitney U tests were used for the analyses. RESULTS: Among the sample of 165 patients with stage II-III colon cancer, those with T2D had higher glycemic variability compared to patients without T2D (p < .001), with values within 1 month following surgery (SD = 44.69 mg/dL, CV = 27.4%) vs (SD = 20.55 mg/dL, CV = 17.53%); and within 1 year following surgery (SD = 45.04 mg/dL, CV = 29.04%) vs (SD = 21.36 mg/dL, CV = 18.6%). Associations were found between lower body mass index and higher glycemic variability (i.e., SD [r = -.413, p < .05] and CV [r = -.481, p < .01]) within 1 month following surgery in patients with T2D. Higher preoperative glucose was associated with higher glycemic variability (i.e., SD r = .448, p < .01) within 1 year in patients with T2D. Demographic and clinical characteristics were weakly associated with glycemic variability in patients without T2D. CONCLUSIONS: Patients with stage II-III colon cancer with T2D experienced higher glycemic variability within 1 month and within 1 year following surgery compared to those without T2D. Associations between glycemic variability and demographic and clinical characteristics differed by T2D status. Further research in prospective studies is warranted.

Habit and Routine Interventions with Emerging Adults with Diabetes: An Integrative Review.

Although theoretical and empirical writings on habits and routines are a promising body of science to guide interventions, little is known about such interventions among emerging adults with type 1 diabetes. Thus, an integrative review was conducted to describe interventions in relation to habits and routines, their influence on outcomes, and users' perspectives. A medical librarian conducted a search. Teams screened titles, abstracts, and articles based upon predefined criteria. Evidence from the final 11 articles was synthesized. A minority of investigators explicitly articulated habits and routines theoretical underpinnings as part of the interventions. However, text messaging or feedback via technology used in other interventions could be implicitly linked to habits and routines. For the most part, these interventions positively influenced diabetes self-management-related behaviors and health outcomes. In general, the interventions were perceived positively by users. Future research is advocated using habit and routine theoretical underpinnings to guide interventions.

Testing the Psychometric Characteristics of the Revised Mastery of Stress Instrument in Adults With Type 2 Diabetes.

Background and Purpose: A promising, yet lengthy measure to identify mastery of patient-identified stress is Younger's (1991, 1993) Mastery of Stress Instrument (MSI). With a goal for a parsimonious and valid measure, this study determined the psychometric properties of a reduced item instrument with adults diagnosed with type 2 diabetes. Methods: First, an expert content analysis was completed. Second, item and confirmatory factor analysis were completed with a sample of 200 adults with a diagnosis of type 2 diabetes. Results: Eight items were removed through content validity and seven items were removed with Item analysis. Factor analysis supported Younger's four sub-concepts. Conclusions: Future research with this revised MSI scale is advocated to identify those who may need strategies to increase their mastery of stress.

Female teachers' child abuse reporting role in Oman: Results from focus groups.

BACKGROUND: Schoolteachers are in a good position to identify and report suspected child abuse and neglect cases; however, they still fail to report all the cases. Recently, the Sultanate of Oman, which is a collectivistic culture, mandated schoolteachers to report any suspected case. However, there is a lack of evidence known to us about the factors associated with Omani teachers' reporting behavior. Such evidence is needed to inform the interventions that are designed to enhance teachers' reporting behavior. OBJECTIVE: The current study was designed to address this gap by exploring the factors that affect Omani schoolteachers reporting behavior of suspected child abuse and neglect cases. PARTICIPANTS AND SETTING: A total of 26 participants were recruited from five basic education schools in the Muscat governorate in Oman. METHODS: This is a descriptive qualitative study. Five focus group discussions were conducted. Thematic coding was used for data analysis. RESULTS: Three themes were discerned from the data analysis. The factors that affect Omani schoolteachers as described by the participants were: 1) reporting within an environment of educational resource scarcity; 2) reporting within an environment of competing female social roles and their professional reporting role; and 3) reporting within an environment of complex and diverse abuse and neglect cases. CONCLUSIONS: Our findings highlight the role of culture in reporting behavior. Implications for research and practice are discussed.

Health Ownership: A Concept Analysis.

Health ownership has been discussed by authors in many disciplines, but a definition does not currently exist for this concept. The purpose of this concept analysis was to explore health ownership in the context of healthcare delivery in the United States. Walker and Avant's method was used to identify the defining attributes, antecedents, consequences, and empirical referents. Cases are provided to show a conceptual definition of health ownership. This concept analysis allows healthcare professionals to improve health outcomes by guiding individuals to take accountability, control, and accept responsibility for their health.

An integrative review of maternal distress during neonatal intensive care hospitalization.

To synthesize literature addressing maternal distress and associated variables in response to infant hospitalization in the NICU. CINAHL, Medline, PubMed, PsychINFO, and Scopus were searched for studies addressing maternal distress during NICU hospitalization published between January 2009 and August 2019. The initial literature search yielded 862 articles. Articles were included for analysis if (a) they were peer-reviewed, (b) maternal distress was defined or measured, and (c) maternal distress occurred in the NICU. Ultimately, 33 articles were included for analysis. Distress symptoms were not consistently measured across the literature by one specific instrument. However, despite the variety of instruments, distress was prevalent in this population. Individual elements of maternal distress in the NICU include depression, anxiety, trauma, and post-traumatic stress symptoms. These elements often occur together and tend to follow a specific trajectory during hospitalization. This body of literature was inconsistent regarding the timing of distress measurement as well as the relationship between relevant associated variables (e.g., marital status or infant illness severity) and maternal distress. Additionally, researchers often excluded mothers of non-preterm infants and infants with congenital anomalies from investigation. Researchers and clinicians should carefully consider timing and instrumentation in their interpretations of maternal distress measurement during a NICU hospitalization. Future work should focus on developing a comprehensive, valid, and reliable screening tool for clinicians and researchers to use to identify maternal distress in the NICU. Additionally, future research should address gaps in the populations included in studies.

Formal Caregiver Burden in Nursing Homes: A Concept Analysis.

Caregiver burden is a phrase often used interchangeably with the concepts of stress, strain, and burnout. Distinct differences may be relevant in formal caregiver burden; however, previous concept analyses have not addressed formal caregiver burden in nursing homes, which would be useful as a foundation for theory development and empirical testing. In the current study, based on Walker and Avant's concept analysis guidelines, articles were reviewed to identify the attributes, antecedents, and consequences of formal caregiver burden. Formal caregiver burden was defined as the demands of caring for dependent older adults with a level of competency and responsibility within the context of perceived stress. Antecedents were associated with the organization and environment, such as regulatory restraints, whereas consequences were associated with changes in physical and mental health status. The conceptualization of formal caregiver burden may lead to the development of psychometric instruments and interventions for the well-being of direct care staff in multiple care settings for older adults. [Journal of Gerontological Nursing, 46(9), 19-24.].

Habits and Routines during Transitions among Emerging Adults with Type 1 Diabetes.

To provide insight into poorly understood diabetes self-management among emerging adults with type 1 diabetes (TID) experiencing transitions, this study described their diabetes self-management-related habits, routines, and disruptions as well as explored relationships among habits and routines. A qualitative study, guided by critical incidence technique, was conducted. Participants were asked to describe situations when they did and did not check blood glucose, administer insulin, eat meals, and exercise as planned. They were also asked to describe activities in a typical day and in association with diabetes self-management. Content analysis with a priori definitions of habits and routines was performed. Participants described diabetes self-management-related transitional disruption as forgetting and disorder. They described habits associated with checking a blood glucose, giving an insulin dose, eating a meal, and initiating exercise. They described routines in association with meals, exercise, and overall diabetes management. These findings provide information on variables to target in intervention research.

Maternal Distress in the Neonatal Intensive Care Unit: A Concept Analysis.

BACKGROUND: The neonatal intensive care unit (NICU) can cause significant psychological distress in a mother. There is no common definition of maternal distress in the NICU currently in use. PURPOSE: To develop a clear conceptual understanding of maternal distress in the NICU using conceptual definitions and empirical findings. METHODS/SEARCH STRATEGY: A literature search was conducted using EBSCOhost, MEDLINE, CINAHL, PsychINFO, and Google Scholar. The concept analysis was guided by Walker and Avant's (2011) guide. FINDINGS/RESULTS: Maternal distress in the NICU consists of a combination of depressive, anxiety, trauma, and posttraumatic stress symptoms. The symptoms occur together on a spectrum and present differently in each mother. The antecedents to maternal distress are a NICU hospitalization and a perceived interruption to the transition to motherhood. Consequences of maternal distress in the NICU are issues with developing a healthy maternal-infant bond, adverse infant development, and decreased maternal quality of life. IMPLICATIONS FOR PRACTICE: A complete understanding of maternal distress in the NICU will lead to increased awareness of adverse mental health states in this population. IMPLICATIONS FOR RESEARCH: Identification of mothers at risk for maternal distress in the NICU, as well as the identification of antecedents and consequences related to the mother and the infant from maternal distress in the NICU. Using a single, clear definition of maternal distress in the NICU population will lead to a more cohesive body of literature.

Systematic Review: Feasibility, Reliability, and Validity of Maternal/Caregiver Attachment and Bonding Screening Tools for Clinical Use.

INTRODUCTION: Infant-caregiver attachment is crucial for an infant's immediate and long-term social-emotional development and health. Despite advocacy by the National Institute of Children's Health Quality for infant social-emotional development screening, there is a lack of identified tools for use in primary care. Therefore, we conducted a systematic review to identify caretaker-infant attachment self-report screening tools that would be feasible, reliable, and valid for use in primary care. METHOD: A systematic search identified 340 abstracts/articles, which were screened using inclusion and exclusion criteria. Twelve articles and six self-report attachment tools were examined for reliability, validity, and feasibility characteristics. RESULTS: Six caregiver-infant attachment self-report tools were identified. Establishment of feasibility, reliability, and validity are in the early stages. DISCUSSION: Potential infant-caretaker attachment screening tools were identified for use in primary care practices. Suggestions for research and practice include informal screening, additional psychometric testing, and development of policies supporting implementation of screening.

Experiences of College Students Who Are Newly Diagnosed With Type 1 Diabetes Mellitus.

PURPOSE: To gain insight and understanding of emerging adult experiences after a diagnosed with type 1 diabetes mellitus (T1DM) and prior to or during college life experiences. DESIGN AND METHODS: A qualitative research design using a focus group was conducted with 12 college students recently diagnosed with T1DM during emerging adulthood. The focus group took place during a College Diabetes Network retreat. Using Braun and Clarke's six phase process, two researchers independently conducted a thematic analysis from the transcribed, verbatim audiotaped narratives. RESULTS: The 12 participants attended colleges in 11 different states. The mean age was 21 years (SD = 6.3) and the majority were female (n = 7). Qualitative analysis revealed four themes: 1) diabetes affects all aspects of life and complicates college living; 2) college environment affects diabetes management; 3) diabetes diagnosis facilitates growth and maturity; and 4) strategies used for diabetes management in college. CONCLUSION: T1DM is complex to manage in the college environment. However, these emerging adults newly diagnosed with T1DM highlight strategies for diabetes management while in college and the pivotal role of pediatric providers play in the successful management of T1DM. PRACTICE IMPLICATIONS: Diabetes education for emerging adults in college requires an adaptive focus that supports the developmental needs of this population. Nurses should focus on teaching healthy, modifiable behaviors of sleep, physical activity, and nutrition to improve glycemic control as well as adapting to the college life choices.

A Scoping Review of Transitions, Stress, and Adaptation Among Emerging Adults.

This scoping review examined research on transitions among emerging adults, 18- to 30-year-olds, to identify designs, populations, frameworks, transition types, and transition outcomes. A librarian conducted the search, yielding 2067 articles. Using predefined criteria, teams screened abstracts and reviewed articles, with 82% to 100% interrater agreement. Data from the final 160 articles were placed in evidence tables and summarized. Most frequently, the studies had exploratory-descriptive designs (69%), nondiagnosed samples (58%), no theoretical frameworks (58%), developmental transitions (34%), and health-related behavior outcomes (34%). This transition research is in an early stage of knowledge development and would benefit from further theory development.

Social Support, Parenting Competence, and Parenting Satisfaction Among Adolescent, African American, Mothers.

This secondary analysis explored how social support changed during the first 6 months postpartum and examined the relationships among social support, parenting competence, and parenting role satisfaction. Single, low-income, adolescent, new mothers ( N = 34) completed measures of perceived parenting competence, parenting role satisfaction, and four types of received social support (emotional, informational, tangible, problematic) from the entire social network at 1 week, 6 weeks, 3 months, and 6 months postpartum. Results indicated that social support did not change over time. Emotional, informational, and tangible social support were significantly correlated, concurrently and predictively, with perceived competence and satisfaction at most data collection points. Future social support intervention studies using social support as a modifiable variable with this high-risk group of African American adolescent new mothers are advocated. Health care professionals are encouraged to examine existing social support within these mothers' identified family units.

Enhanced New Mothers Network Cell Phone Application Intervention: Interdisciplinary Team Development and Lessons Learned.

Single, low-income, African American mothers experience challenges caring for themselves and their infants. Nurse researchers, providing creative and theoretically based approaches for complex client health care, are increasingly becoming interdisciplinary leaders on research teams. The first purpose of this article was to describe this interdisciplinary team's development of a cellular (cell) phone application (app), the Enhanced New Mothers Network (ENMN). The second purpose of this article was to describe lessons learned by nursing members of the interdisciplinary team members about developing a cell phone app for delivery of the ENMN intervention. Interdisciplinary research is beneficial where providing interventions to assist patients to achieve optimal health outcomes is rarely dependent on the work of one profession.

Social Support and Psychosocial Well-being Among Low-Income, Adolescent, African American, First-Time Mothers.

AIMS: The aims of this study are to describe for single, low-income, adolescent, African American new mothers how (1) primary sources of social support changed over time, (2) the level of social support (emotional, informational, tangible, and problematic) from these primary sources changed over time, and (3) social support from the primary supporter was associated with mothers' psychosocial well-being (self-esteem and loneliness) over time. DESIGN: A secondary analysis was conducted of data from a previous social support intervention study. SAMPLE: The sample consisted of 35 single, low-income, adolescent (mean [SD] age, 18.3 [1.7] years), African American new mothers. METHODS: Mothers completed social support, self-esteem, and loneliness instruments at 1 and 6 weeks and 3 and 6 months postpartum. RESULTS: Most mothers (64.7%) had changes in their primary social support provider during the first 6 months postpartum. The combination of the adolescent's mother and boyfriend provided the highest level of support, no matter the type, relative to any other source of support. At every time point, positive correlations were found between emotional support and self-esteem and between problematic support and loneliness. CONCLUSION: Single, low-income, African American, adolescent new mothers are at risk for not having a consistent source of support, which may lead to lower self-esteem and greater loneliness. IMPLICATIONS: Clinical nurse specialists could facilitate care guidelines for these new mothers to identify their sources of support at each home visit and advocate for the adolescent's mother and boyfriend to work together to provide support. Bolstering the mothers' natural sources of support can potentially improve self-esteem and reduce loneliness. Improvement in these sources of support could prevent a decline in the mothers' psychosocial well-being. Development and testing support interventions are advocated; findings could guide clinical nurse specialists in addressing these new mothers' needs.

Low-Income, African American, Adolescent Mothers' Depressive Symptoms, Perceived Stress, and Social Support.

The purpose of this descriptive repeated-measures study was to describe depressive symptom patterns and report changes over time in levels of perceived stress and social support depending on patterns of depressive symptoms in single, low-income, African American, adolescent mothers during the initial, 6-month postpartum period. Thirty-five adolescent subjects between the ages of 16 and 22 years old were recruited at health care clinics in two Midwestern cities. Data collections by advanced practice nurses were completed at 1 week, 6 weeks, 3 months, and 6 months postpartum at mothers' homes. Established instruments were used to measure depressive symptoms, perceived stress and social support. Results indicated 63% of adolescent mothers' experienced depressive symptoms sometime during this transition period and 11.4% of these subjects had depressive symptoms at all 4 time points. Depressive symptoms were associated with perceived stress at each time point. Emotional support was inversely associated with depressive symptoms at 2 of the 4 time points. Depressive symptoms and problematic support were significantly related at 3 months and 6 months. Although single, low-income, African American, adolescent mothers are considered a high risk group, some are at even greater risk. This extremely high risk group have depressive symptoms throughout the first 6 months postpartum with the highest level of perceived stress and the most variability in social support relative to groups that were never depressed or were in and out of depression. More studies are needed to understand how to best help these high risk adolescents successfully transition to motherhood.

Association of Self-Efficacy and Self-Regulation with Nutrition and Exercise Behaviors in a Community Sample of Adults.

This study examined the association of self-efficacy and self-regulation with nutrition and exercise behaviors. The study used a cross-sectional design and included 108 participants (54 men, 54 women). Nutrition behaviors (fruit/vegetable consumption, dinner cooking, and restaurant eating) and exercise were measured using total days in last week a behavior was reported. Instruments measuring self-efficacy and self-regulation demonstrated excellent Cronbach's alphas (.93-.95). Path analysis indicated only fruit/vegetable consumption and exercise were associated with self-efficacy and self-regulation. Self-regulation showed direct association with fruit/vegetable consumption and exercise, but self-efficacy had direct association only with exercise. Self-efficacy and self-regulation should be strategically used to promote health behaviors.

Factors Associated with Asthma Self-Management in African American Adolescents.

Few studies have focused on asthma self-management in African American adolescents, a group with high rates of the disease. This study examined factors associated with asthma self-management in 133 African Americans aged 14-16 years including gender, asthma impairment, prior asthma education, cognitive and emotional illness representations. Twenty-five percent of the variance in asthma self-management was explained by having attended an asthma education program, perceiving more asthma consequences (illness consequences), and reporting greater understanding of asthma as an illness (illness coherence). Findings suggest that these variables may be important targets of interventions to improve asthma self-management in African American middle adolescents.

Weight control behaviors among emerging adults with type 1 diabetes.

PURPOSE: The purpose of this study was to examine the association of weight control behaviors (WCBs) with living and educational situations among emerging adults with type 1 diabetes during the first year after high school graduation. METHODS: Among 184 emerging adults with type 1 diabetes, data were collected every 3 months for 12 months on WCBs, body mass index (BMI), living and educational situations; at baseline and 12 months, on impulse control; and at baseline, on sex, depressive symptoms, and glycemic control. Generalized linear models incorporated repeated measures (0, 3, 6, 9, and 12 months). RESULTS: No significant associations existed between WCBs and living or educational situations, when controlling for covariates. More depressive symptoms and higher BMIs were associated with a greater likelihood of involvement in unhealthy WCBs, whereas more depressive symptoms-not higher BMI-were associated with higher odds for involvement in very unhealthy WCBs. Although healthy WCBs were also associated with more depressive symptoms and higher BMIs, they were also associated with greater impulse control. CONCLUSIONS: Health care professionals should assess emerging adults with type 1 diabetes for WCBs along with BMI, depressive symptoms, and impulse control.