A seven country comparison of nurses' perceptions of their professional practice environment.

Papastavrou E., Efstathiou G., Acaroglu R., da Luz M.D.A., Berg A., Idvall E., Kalafati M., Kanan N., Katajisto J., Leino-Kilpi H., Lemonidou C., Sendir M., Sousa V.D. & Suhonen R. (2011) Journal of Nursing Management A seven country comparison of nurses' perceptions of their professional practice environment Aims To describe and compare nurses' perceptions of their professional practice environment in seven countries. Background There is evidence of variation in the nursing professional practice environments internationally. These different work environments affect nurses' ability to perform and are linked to differing nurse and patient outcomes. Methods A descriptive, comparative survey was used to collect data from orthopaedic and trauma nurses (n = 1156) in Finland, Cyprus, Greece, Portugal, Sweden, Turkey and Kansas, USA using the 39-item Revised Professional Practice Environment instrument. Results Differences were found between participants from the northern countries of Europe, Kansas, USA, and the Mediterranean countries regarding perceptions about control over practice. No between-country differences were reported in the internal work motivation among the nurses from any of the participating countries. Conclusions Although between-country differences in nurses' professional practice environment were found, difficulties related to demographic, cultural and health system differences and the way in which nursing is defined in each country need to be considered in the interpretation of the results. Implications for Nursing Management The results support investment to improve nurse's work environment, which is important for improving the quality of patient care, optimizing patient outcomes and developing the nursing workforce.

Nurses' perceptions of individualized care: an international comparison.

AIM: This paper is a report of a study of internationally-based differences in nurses' perceptions of individualized care in orthopaedic surgical in-patient wards. BACKGROUND: Individualized care is valued in healthcare policy, practice and ethical statements as an indicator of care quality. However, nurses' assessments of individualized care are limited and comparative cross-cultural studies on individualized nursing care are lacking. METHODS: A descriptive comparative survey was used to sample orthopaedic surgical nurses (n = 1163) working in 91 inpatient wards in 34 acute hospitals in Finland, Cyprus, Greece, Portugal, Sweden, Turkey and the United States of America. Data were collected between March and November 2009 using the Individualized Care Scale-Nurse and analysed using descriptive and inferential statistics. RESULTS: Nurses in different countries perceived that they supported patients' individuality generally and provided individualized care during nursing activities. Although the highest scores were in support of patients' individuality in the clinical situation both through nursing provision and nurses' perceptions of individuality, there were between-country differences within these scores. Generally, the Greek and American nurses gave the highest scores and the Turkish, Cypriot and Portuguese nurses the lowest. CONCLUSIONS: Between-country differences found may be attributed to differing roles of nurses, care processes, healthcare systems and/or the ways nursing care is defined and organized. As this was the first time the Individualized Care Scale-Nurse was used in an international context, the results are formative and indicate the need to continue studies in this area.

Depression, coronary artery disease, type 2 diabetes, metabolic syndrome and quality of life in Taiwanese adults from a cardiovascular department of a major hospital in Southern Taiwan.

AIMS: To examine the relationships between depression, coronary artery disease, type 2 diabetes, metabolic syndrome and quality of life in Taiwanese adults from a cardiovascular department of a major hospital in Taiwan. BACKGROUND: Research suggests associations between depression, metabolic syndrome and quality of life. Despite this fact, few studies have investigated these relationships among Taiwanese. DESIGN: A cross-sectional descriptive correlational design was used to conduct this study. METHODS: A convenience sample of 140 adults participated in the study. Data were analysed with descriptive statistics, Pearson's correlations, hierarchical regression and t-tests. RESULTS: Almost a half of the subjects (46.5%) had metabolic syndrome. The most common combination of metabolic syndrome criteria was elevated blood glucose, central obesity and high blood pressure (23.7%). A greater number of individuals had coronary artery disease (72.9%), type 2 diabetes (35%) and/or depression (21.4%). Type 2 diabetes and depression were significant predictors of overall quality of life (ß = -0.16, p < 0.01 and ß = -0.63, p < 0.001, respectively). In addition, there were significant differences between individuals with and without type 2 diabetes and/or depression regarding overall quality of life scores; t (138) = 3.50, p < 0.01); and t (138) = 7.80, p < 0.001), respectively. CONCLUSIONS: Coronary artery disease, type 2 diabetes and depression were common among our sample of individuals with metabolic syndrome. Those with diabetes and/or depression had worse quality of life than those without those diseases. RELEVANCE TO CLINICAL PRACTICE: Nurses need to be prepared to assess and intervene in preventing or treating depression among patients with chronic diseases, especially those with coronary artery disease, type 2 diabetes and metabolic syndrome. When individuals are treated for depression, they are more likely to engage in self-management of their diseases, which will prevent complications and improve their quality of life.

Perceptions of breastfeeding and planned return to work or school among low-income pregnant women in the USA.

AIMS AND OBJECTIVES: To describe the perceptions of breastfeeding in low-income pregnant women to understand their needs better as they plan to return to work or school. BACKGROUND: Maternal employment has a negative impact on breastfeeding duration. Yet there is insufficient research on challenges and facilitators regarding breastfeeding and employment issue among low-income women in the USA. Knowing the perceptions of breastfeeding among low-income pregnant women and their plan to return to work or school may have implications for nurses and midwives in providing quality care. DESIGN: Qualitative study using focus group interviews. METHODS: The research setting consisted of three Women, Infants and Children clinics (WIC) in a midwestern city of the USA. Seventeen pregnant women (aged 19-35) participated in focus group interviews. Data were coded and analysed for themes and patterns using the QSR software - NVivo 6. RESULTS: Eleven participants were single. Ten women were primigravida, and seven were multipara. The following five themes were identified: (1) perceived benefits of breastfeeding; (2) general perceptions of breastfeeding; (3) maternal concerns; (4) having the right support; and (5) anticipated challenges of combining breastfeeding and work. Conclusions. Low-income women anticipated substantial barriers for breastfeeding when they planned to combine breastfeeding and work or school. The results of this study have many implications for public health practice, research and policy. Educating employers and the public at large about the health and economic benefits derived from long-term breastfeeding could help promote breastfeeding awareness. RELEVANCE TO CLINICAL PRACTICE: Strategies supporting breastfeeding among low-income working women must be provided at multiple levels to help overcome the barriers they concern. Health care providers should help women gain confidence by minimising their uncertainties and fears about breastfeeding to prepare them to continue breastfeeding successfully after returning to work.

Confirmatory factor analysis of the depressive cognition scale.

The purpose of this study was to validate the single-factor structure of the Depressive Cognition Scale (DCS) among individuals from the U.S. general population. The sample was composed of 629 adults from 42 states of the United States. All measures of model fit of the DCS exceeded the recommended criteria for the good model fit (χ(2)/df = 2.57, goodness-of-fitness index = .98, adjusted goodness-of-fitness index = .96, comparative fit index = .99, Tucker Lewis index = .98, root mean square error of approximation = .05, root mean residual = .01, and the P value for test of close fit = .464). Thus, the DCS was found to be a reliable and valid instrument to measure depressive cognitions among individuals from the general population.

Development of the Huntington disease family concerns and strategies survey from focus group data.

Health concerns and management strategies among families of young and middle-age adults with Huntington's disease (HD) are unknown. This study developed and tested psychometric properties of the Huntington Disease Family Concerns and Strategies Survey (HDFCSS). Focus group data from 91 adult family members were used to develop content. Content analysis yielded four domains that were transferred into Personal, Person With HD, Community Health Care Services, and Strategies scales. Focus group data, expert validation, and cognitive interviews demonstrated survey content validity. Cronbach's alpha internal consistency coefficients for the scales were 0.83 or above. The measure can be used to generate reliable and valid data to identify adult family members' health-related concerns and management strategies for themselves and persons with HD.

New measures of diabetes self-care agency, diabetes self-efficacy, and diabetes self-management for insulin-treated individuals with type 2 diabetes.

AIMS AND OBJECTIVES: To develop and refine three new scales that measure diabetes self-care agency, diabetes self-efficacy and diabetes self-management to reflect the American Diabetes Association current standards of diabetes care and the American Association of Diabetes Educators self-care behaviours. And, to establish the clarity, consistency and content validity of the scales. BACKGROUND: There is a need to have valid and reliable instruments or scales to assess an individual's diabetes self-care agency, self-efficacy and self-management to plan appropriate interventions that can be effective in improving glycaemic control and delaying or preventing diabetes-related complications. DESIGN: A methodological design was used to conduct this study. METHODS: Ten clinicians and 10 insulin-treated individuals with type 2 diabetes (T2DM) from a diabetes care center in the southern USA participated in this study. Analysis consisted of inter-rater agreement to determine clarity and consistency with standards of diabetes care and content validity of individual items on the scales (I-CVI) and the overall scales (S-CVI/Ave) to determine relevance for current diabetes care practice. RESULTS: All I-CVI and S-CVI/Ave of the DSES exceeded the minimum acceptable criteria. All I-CVI and the S-CVI of the DSMS also exceeded the minimum accepted criteria, except for one item that had I-CVI = 0.70. Evaluation of the items and the directions of the scales by the sample of insulin-treated individuals with T2DM exceeded the minimum criteria of 80% inter-rater agreement. RELEVANCE TO RESEARCH AND CLINICAL PRACTICE: Further psychometric testing of the scales with samples of insulin-treated individuals with diabetes is warranted and will lay the groundwork for further research and clinical practice to enhance the capability, confidence and actual performance of diabetes self-management activities among insulin-treated individuals with T2DM. CONCLUSIONS: The scales can be used by diabetes care providers to assess and follow-up individuals with diabetes who need intense case management. They also can be the measures of choice to conduct future research to test the effects of interventions among insulin-treated individuals with T2DM.

Stressors, social support, depressive symptoms and general health status of Taiwanese caregivers of persons with stroke or Alzheimer's disease.

AIMS AND OBJECTIVES: This study examined the relationships among stressors, social support, depressive symptoms and the general health status of Taiwanese caregivers of individuals with stroke or Alzheimer's disease. BACKGROUND: Caring for a disabled or cognitively impaired person can be extremely stressful and often has adverse effects on caregivers' health. While research on caregiving in Taiwan has examined caregivers' characteristics, caregivers' need and caregivers' burden in caring for older people in general, little is known about Taiwanese caregivers of individuals with stroke or Alzheimer's disease. DESIGN: Cross-sectional, descriptive correlation design. METHODS: Data were obtained from a convenience sample of 103 Taiwanese informal caregivers in the South of Taiwan and analysed using descriptive statistics, Pearson's correlations, multiple and hierarchical regressions and t-tests. RESULTS: Caregivers who had lower household incomes and were taking care of individuals with more behaviour problems had more depressive symptoms. In addition, caregivers who were older and were taking care of individuals with more behaviour problems had worse general health. Caregivers who had more emotional support had less depressive symptoms. CONCLUSIONS: Caregivers of persons with Alzheimer's disease had more depressive symptoms and worse general health than caregivers of persons with stroke. Only emotional support moderated the relationship between one of the stressors (household income) and depressive symptoms. RELEVANCE TO CLINICAL PRACTICE: The findings of this study may be helpful for nurses and other health care professionals in designing effective interventions to minimise the negative impacts of stressors on the psychological and general health of caregivers in Taiwan.

Assessment of depressive symptoms and cognitive impairment in elders from rural areas of the Brazilian State of Rio Grande do Sul.

OBJECTIVE: The main objective of this study was to examine the relationships among demographic characteristics, depressive symptoms, and cognitive impairment in oldest-old elders from rural areas of the Brazilian State of Rio Grande do Sul. DESIGN: A cross-sectional, descriptive correlational design was used to conduct the study. SAMPLE: 137 Brazilian elders age 80 years or over. MEASUREMENTS: A target population data form, a county data form, a demographic questionnaire, the Mini-Mental State Examination, and the Depressive Cognition Scale were used to collect the data. RESULTS: A significant difference was found between males and females in regard to cognitive impairment. In addition, educational level and depressive symptoms were correlated with cognitive impairment. Depressive symptoms were a weak but significant predictor of cognitive impairment after controlling for the effect of age, gender, and educational level of the oldest-old elders. CONCLUSIONS: The findings need to be interpreted cautiously since the sample scored above the cutoff points for cognitive impairment, and had low scores on depressive symptoms. Despite several limitations, findings from this study can be a foundation for further studies, and well-designed correlational or experimental approaches, are warranted.

Body piercing among Brazilian surgical patients.

The practice of body piercing is becoming more common worldwide. Surgical patients with body piercings require special preoperative assessment to ensure safety during and after surgery. In a study of Brazilian surgical patients at one facility, only 0.6% had body piercings. An RN or nursing student instructed each patient on piercing removal, and piercings were removed by the patients before surgery.

Knowledge and attitude: important components in diabetes education.

This descriptive cross-sectional study was conducted from March to November 2007 at a research and community services center of a Brazilian university. It aimed to explore the knowledge and attitude of people with diabetes mellitus who were attending a diabetes self-care education program. The sample was composed of 82 adults with diabetes mellitus. Data were collected through the Portuguese versions of the Diabetes Knowledge Questionnaire (DKN-A) and the Diabetes Attitude Questionnaire (ATT-19). Results revealed that 78.05% of the participants obtained scores higher than eight on knowledge about diabetes, which indicates they have knowledge and understand the disease. Scores on attitude ranged from 25 to 71 suggesting difficulty in coping with the disease. We conclude that although participants obtained a good score on knowledge, their attitude did not change so as to more adequately cope with the disease.

Factor analysis of the Appraisal of Self-care Agency Scale in American adults with diabetes mellitus.

PURPOSE: The purpose of this methodological secondary data analysis study is to examine the reliability, construct validity, and dimensionality of the Appraisal of Self-care Agency Scale (ASAS) in an American sample of adults with diabetes mellitus. METHODS: The sample consisted of 141 insulin-requiring adults with diabetes mellitus recruited from a Diabetes Care Center in the southern United States. The ASAS, along with Hurley's Insulin Management Diabetes Self-efficacy and Insulin Management Diabetes Self-care Scales, was used in the study to determine convergent validity, thus contributing to the construct validity of the ASAS. Other data analysis consisted of internal consistency estimates of reliability, Pearson correlations, and factor analysis. RESULTS: The findings suggest that the ASAS consists of a single substantive dimension and has adequate construct validity and reliability. CONCLUSION: Revision of certain items and conducting further analysis of the scale, prior to its adoption in clinical practice, should be considered.

Social support and adaptation of Taiwanese adults with mental illness.

AIMS AND OBJECTIVES: The present study examined the relationships among contextual factors, dimensions of social support, adaptations and psychiatric symptoms among mentally ill Taiwanese adults in a mental health hospital in southern Taiwan. In addition, this study tested the effect of the dimensions of social support on adaptation as well as whether social support moderated the relationship between psychiatric symptoms and adaptation. BACKGROUND: Social support enhances an individual's ability to cope and adapt to daily life events and stressors. Although the relationships among social support, stress and adaptation have been widely studied in the general population, little is known among individuals with mental illness, especially in Taiwan. DESIGN: A cross-sectional, descriptive correlation design was used. METHODS: The sample consisted of 129 adults, ranging in age from 21-67, who were diagnosed with a major mental illness (schizophrenia, bipolar disorder, depression, manic depression or organic mental disorder) and who could communicate in Chinese or Taiwanese. A demographic information sheet, the Interpersonal Support Evaluation List (ISEL), the Brief Psychiatric Rating Scale (BPRS) and the Life Skills Profile (LSP), were used to collect data. Data were analysed with Pearson's correlation and multiple regressions. RESULTS: The findings suggest that individuals who were older, male, independent and had higher education, a shorter duration of mental illness and fewer psychiatric symptoms had higher life skills. Three dimensions of social support (belonging, tangible and self-esteem) moderated the relationship between psychiatric symptoms and number of hospitalisations. CONCLUSION: Life skills and social support play important roles in the adaptation of Taiwanese adults with mental illness in the community as well as in decreasing their psychiatric symptoms and number of hospitalisations. RELEVANCE TO CLINICAL PRACTICE: The findings have implications for Taiwanese clinical nurses who provide care to mentally ill patients and their family. They can provide psycho-education programs to teach life skills to mentally ill patients. Clinical nurses can also provide positive feedback on the behaviours displayed by mentally ill patients and assist them to develop better life skills to adapt to the community.

Psychometric properties of the Portuguese version of the Depressive Cognition Scale in Brazilian adults with diabetes mellitus.

Identifying depressive cognitions in Brazilians with diabetes can be important step to prevent the development of clinical depression, which is negatively associated with diabetes self-management. This study focused on the psychometric testing of the Portuguese version of the Depressive Cognition Scale, the Escala Cognitiva de Depressão (ECD), among 82 Brazilian adults with diabetes mellitus. The questionnaire was assessed for internal consistency, homogeneity, and construct validity using factor analysis and convergent validity assessment with the Portuguese version of the Beck Depression Inventory, the Inventário de Depressão Beck (IDB). Cronbach's alpha for the ECD was .88. The homogeneity of the instrument was supported by item-to-total correlations between .30 and .70. Factor extraction generated only one factor with eigenvalues greater than 1, which is consistent with the English version. The ECD's total score had a weak but significant correlation with the IDB's total score (r = .24, p < .05), indicating convergent validity. Evidence for the reliability and construct validity of the ECD was provided by this study. This scale has the potential to become a useful screening tool for depressive cognitions among Brazilians with diabetes.

An overview of research designs relevant to nursing: Part 1: Quantitative research designs.

This three part series of articles provides a brief overview of relevant research designs in nursing. The first article in the series presents the most frequently used quantitative research designs. Strategies for non-experimental and experimental research designs used to generate and refine nursing knowledge are described. In addition, the importance of quantitative designs and the role they play in developing evidence-based practice are discussed. Nursing care needs to be determined by the results of sound research rather than by clinical preferences or tradition.

An Overview of Research Designs Relevant to Nursing: part 2: qualitative research designs.

This second article of the series "An Overview of Research Designs Relevant to Nursing" presents qualitative research designs. Phenomenological, ground theory, ethnography, narrative inquiry, and other related qualitative-related research methodologies are described. In addition, the importance of qualitative research as groundwork for quantitative studies is discussed. This link between qualitative and quantitative research is fundamental to promote evidence-based nursing practice.

An overview of research designs relevant to nursing: Part 3: mixed and multiple methods.

This third article of the series "An Overview of Research Designs Relevant to Nursing" presents the use of mixed or multiple methods in nursing research. The use of mixed or multiple methods is a growing trend that offers another option for researchers in addressing the complex health problems faced in nursing today. Understanding of all methods and all combinations of methods facilitate the conduction and dissemination of research to serve nursing practice.

Cross-cultural equivalence and psychometric properties of the Portuguese version of the Depressive Cognition Scale.

There is a great need for researchers to have access to reliable and valid research instruments in their own language to measure a concept of interest or concern. Therefore, the purpose of this study was to determine semantic equivalency and psychometric properties of the Depressive Cognition Scale (DCS) in a Brazilian sample of diabetics. Back-translation and field testing methodology was used to determine the DCS semantic equivalency and psychometric properties. A convenience sample of 40 bilingual Brazilian adults was used to conduct the field testing of the scale. The findings suggested that the translation of the DCS was adequate and initial estimates of internal consistency and construct validity were adequate for both the DCS and its Portuguese version. Psychometric testing of the Portuguese language version of the DCS in this small sample appears to have sufficient reliability and validity for use in examining depressive cognitions in Brazilian adults. Further psychometric testing of the Portuguese version of the DCS in a larger Portuguese-speaking sample with diabetes is recommended.

Translation, adaptation and validation of instruments or scales for use in cross-cultural health care research: a clear and user-friendly guideline.

RATIONALE, AIMS AND OBJECTIVES: The diversity of the population worldwide suggests a great need for cross-culturally validated research instruments or scales. Researchers and clinicians must have access to reliable and valid measures of concepts of interest in their own cultures and languages to conduct cross-cultural research and/or provide quality patient care. Although there are well-established methodological approaches for translating, adapting and validating instruments or scales for use in cross-cultural health care research, a great variation in the use of these approaches continues to prevail in the health care literature. Therefore, the objectives of this scholarly paper were to review published recommendations of cross-cultural validation of instruments and scales, and to propose and present a clear and user-friendly guideline for the translation, adaptation and validation of instruments or scales for cross-cultural health care research. METHODS: A review of highly recommended methodological approaches to translation, adaptation and cross-cultural validation of research instruments or scales was performed. Recommendations were summarized and incorporated into a seven-step guideline. Each one of the steps was described and key points were highlighted. Example of a project using the proposed steps of the guideline was fully described. CONCLUSIONS: Translation, adaptation and validation of instruments or scales for cross-cultural research is very time-consuming and requires careful planning and the adoption of rigorous methodological approaches to derive a reliable and valid measure of the concept of interest in the target population.

Major depressive disorder and insulin resistance in nondiabetic young adults in the United States: the National Health and Nutrition Examination Survey, 1999-2002.

OBJECTIVE: The association between depression and insulin resistance has been evaluated in previous studies with conflicting results. This study aimed to explore the relationship between major depressive disorder (MDD) and insulin resistance among nondiabetic young adult men and women in the United States. METHOD: Analyses of cross-sectional data from the National Health and Nutrition Examination Survey (NHANES), 1999-2002, were conducted. The nationally representative sample consisted of 279 men and 358 women aged 20-39 years. MDD was determined by the WHO Composite International Diagnostic Interview (CIDI). Insulin resistance was measured by the homeostasis model assessment for insulin resistance. RESULTS: Of 637 subjects, 16 men and 18 women had MDD (weighted percentage = 6.6%, SE = 1.2). Using logistic regression, no significant association was found between MDD and insulin resistance among the nondiabetic young adults in bivariate analysis (ß = -0.01, OR = 0.99, 95% CI = [0.38, 2.57], p = .98). A significant interaction effect between gender and MDD was observed. For men, MDD was negatively associated with insulin resistance after adjusting for age, race/ethnicity, waist circumference, smoking status, systolic blood pressure and triglyceride level (ß = -2.12, OR = 0.12, 95% CI = [0.02, 0.62], p = .01). No significant association between MDD and insulin resistance among women was found (ß = 0.61, OR = 1.84, 95% CI = [0.47, 7.14], p = .38). CONCLUSIONS: Overall findings suggest there is no significant association between MDD and insulin resistance among nondiabetic young adults aged 20-39 years. However, gender differences in this relationship were noted.