Ethnic influences on body awareness, trait anxiety, perceived risk, and breast and gynecologic cancer screening practices.

PURPOSE/OBJECTIVES: To examine ethnic influences on body awareness, trait anxiety, perceived risk, and breast and gynecologic cancer screening practices. DESIGN: Descriptive, correlational secondary analysis. SETTING: Urban and rural home and community populations. SAMPLE: 233 women: 138 (59%) Caucasian, 37 (17%) African American, 29 (12%) Hispanic, and 29 (12%) American Indian women (X = 46.86 years) were recruited through mailings, churches, and community organizations. METHODS: Structured questionnaires. MAIN RESEARCH VARIABLES: Body awareness, trait anxiety, perceived risk, and breast and gynecologic cancer screening practices. FINDINGS: Ethnicity predicted breast and gynecologic cancer screening practices (except clinical breast examination), body awareness, trait anxiety, and perceived risk. Hispanic and American Indian women reported greater breast self-examination frequency than Caucasian and African American women. Caucasian and African American women reported more mammogram use than Hispanic and American Indian women. Increased body awareness was related to fewer gynecologic exams for American Indian women. CONCLUSIONS: Women of different ethnic backgrounds respond differently to breast and gynecologic cancer screening practices. The influence of psychosocial variables on these practices varied with different groups. IMPLICATIONS FOR NURSING PRACTICE: Nursing interventions to increase breast and gynecologic cancer screening should be ethnic-specific, with particular attention to the meaning of body awareness to American Indian women and trait anxiety and perceived risk to African American women.

Ethnic differences in breast self-examination practice and health beliefs.

Thirty-two African American nurses (AAN) and 78 Caucasian nurses (CN) were compared on breast self-examination (BSE) practice and health beliefs. Relationships between these variables were also examined. The Health Belief Model provided the framework for the study. The sample is a subset of 269 women from a larger study. AANs were recruited from a professional nurses' group. CNs were recruited from a list of female employees of a university medical centre. The results of t-tests revealed no significant group differences on BSE frequency (P = 0.06) or BSE proficiency (P = 0.10). Noted was that 42% of AANs compared to 20% of CNs examined their breasts 12 or more times during the year. AANs were more likely to consider BSE beneficial (P = 0.002) and to feel confident (P = 0.006) about doing BSE; CNs perceived more barriers (P = 0.001) to BSE. For AANs, BSE frequency and proficiency were positively related to confidence and inversely related to barriers; BSE frequency was also related to health motivation. For CNs, BSE frequency and proficiency were inversely related to seriousness. Implications include additional research to validate findings and to increase the knowledge base of all nurses regarding BSE.

Coping style, health beliefs, and breast self-examination.

The purpose of this study was to determine the role of coping style in women's practice of breast self-examination (BSE). The framework was adapted from the Cognitive Transactional Model of Stress and Coping and the Health Belief Model. The convenience sample consisted of 269 women recruited from an employee list of a medical center and a membership list of a professional nurses' group. Survey booklets were distributed via interdepartmental or U.S. mail and contained measures of trait anxiety and defensiveness and questions related to health beliefs, BSE practice, and demographics. The sample was categorized by coping style (i.e., repressive, true high anxious, defensive high anxious, or true low anxious), and data were analyzed via MANOVAs, ANOVAs, and hierarchical regression. Results indicated that coping style predicted BSE practice (i.e., proficiency, frequency) and health beliefs of barriers, confidence, seriousness, and susceptibility. The findings provide nurses with information for developing interventions to foster BSE.

Burden and health outcomes of family caregivers of hospitalized bone marrow transplant patients.

Twenty-four family caregivers of bone marrow transplant (BMT) patients were interviewed to describe the burden of care and health outcomes (anxiety, depression, symptom distress and fatigue). A descriptive correlational research design with repeated measures was used. Data were collected in a conference room in the oncology unit of a midwestern university hospital using a battery of questionnaires. Questionnaires were administered pre-BMT (prior to the patient's hospitalization) and 5 and 20 days post-BMT. Objective burden remained at a similar level throughout the study (mean range 31.4 to 32.9), whereas subjective burden was highest pre-BMT (mean range 25.3-21.7). Significant correlations were found between objective burden and all health outcomes (P < 0.01 to P < 0.001) on day 5. Symptom distress was significantly correlated to subjective burden pre-BMT and to both types of burden on days 5 and 20. Results of this study suggest that family caregivers of BMT patients may experience more objective burden than subjective burden, and that burden of care may contribute to negative health outcomes, especially on day 5 post-BMT. Interventions designed to reduce sources of caregiver burden and negative health outcomes should be planned according to critical time periods of the BMT patient's hospitalization.

Loneliness and social support in infertile couples.

OBJECTIVE: To determine differences between infertile wives' and husbands' levels of loneliness and perception of social support and to determine if there is a relationship between loneliness and social support. DESIGN: Comparative descriptive. SETTING: University infertility clinic and RESOLVE, an infertility support group. PARTICIPANTS: Convenience sample of 62 couples diagnosed as experiencing either primary or secondary infertility. OUTCOME MEASURES: Loneliness was measured using the Revised UCLA Loneliness Scale; social support was measured using the Interpersonal Relationship Inventory with subscales of Social Support, Reciprocity, and Conflict. RESULTS: Wives were significantly more lonely than husbands (t = 2.053, p = 0.04). There was no significant group difference on the social support total score or three subscale scores. Loneliness was inversely related to social support and reciprocity both for wives (r = -0.62, p = 0.001, and r = -0.50, p = 0.002, respectively) and husbands (r = -0.74, p = 0.001, and r = -0.56, p = 0.001, respectively); loneliness correlated with conflict for wives only (r = 0.48, p = 0.007). CONCLUSIONS: Although wives and husbands differed in loneliness, they were similar in perceived social support. Greater social support and reciprocity lessened feelings of loneliness for both groups. Wives who perceived increased conflict in their social relationships were more lonely.

Quality of life and coping in patients with gynecologic cancer and their spouses.

PURPOSE/OBJECTIVES: To examine differences in and relationships between quality of life (QOL) and coping of patients with gynecologic (GYN) cancer and their spouses. SETTING: An oncology ambulatory care center in the midwestern United States. DESIGN: Cross-sectional. SAMPLE: 40 patients with GYN cancer and their spouses. METHODS: Patients and spouses completed the Quality of Life-Cancer Version scale and the Coping Scale. FINDINGS: Patients with GYN cancer and their spouses recorded similar responses. They were fairly satisfied with their QOL especially regarding family. Similarities and differences existed in the use of coping strategies between the two groups. Patients were more inclined to do something about their situation, whereas spouses tended to hope that problems would go away. For spouses, finding positive aspects of the illness experience correlated with three QOL indicators; correlations also were found between health/functioning and three coping strategies. CONCLUSIONS: In this study, no significant differences were found between patients with GYN cancer and their spouses in overall QOL or QOL domains. Family was the highest QOL domain for both groups. Patients reported significantly more use of cognitive restructuring and threat minimization than spouses. For both groups, especially patients, different strategies correlated with different QOL areas. IMPLICATIONS FOR NURSING PRACTICE: Nurses working in GYN oncology ambulatory care centers are in a key position to assess areas of QOL with which patients and spouses are most and least satisfied and the types of coping strategies they are using. Differences in coping strategies used suggest that patients and spouses might benefit by being assessed separately.

Low-vision elders living arrangements, loneliness, and social support.

1. Loneliness was not found to be a significant problem in a study of low-vision older clients with various living arrangements. Different types of support networks did serve different functions depending on whether clients lived alone or with others. 2. Clients living alone were more satisfied with supporters who helped them when they were feeling down, whereas clients living with others were more satisfied with supporters who cared about them. 3. Clients living alone relied on friends and children as the most important sources of support; clients living with others relied most on children for the majority of their needs. 4. Supportive expectations should be shared with supporters in the network to prevent burnout of the support person and lack of support for the client in crises if the supportive person is not available.

Marital status, social support, and loneliness in visually impaired elderly people.

The purpose of this study was to investigate relationships between marital status, social support, and loneliness in visually impaired elderly people. The sample was derived from a larger study designed to examine loneliness in low-vision adults (Foxall et al. 1992). Subjects were 87 visually impaired elderly people who were at least 65 years of age, had a visual acuity of 20/70 or less in the better eye, had been visually impaired for at least 1 year, and were not totally blind. Data were collected by interview using the Revised UCLA Loneliness Scale, the Social Support Questionnaire, and a demographic and health information form. Results indicate marital status was not directly related to loneliness but may be indirectly related through social support. Loneliness was associated with greater network dissatisfaction related to caring and relaxation. Findings provide direction for nursing assessment of and intervention into loneliness with visually impaired elderly people.

Loneliness, depression, and social support of patients with COPD and their spouses.

Thirty clients with chronic obstructive pulmonary disease (COPD) and their spouses were interviewed to examine differences in the relationships among loneliness, depression, and social support. Data were collected during structured in-home interviews using the UCLA loneliness scale, the Center for Epidemiological Studies depression scale, and the social support questionnaire. The clients and spouses did not differ significantly on measures of loneliness and depression, with mean scores for both groups higher than those in other comparable groups. Spouses, however, tended to be a little lonelier than clients, and clients tended to be a little more depressed than spouses. The two groups were also similar with respect to the number of people in their social networks but different as to network composition. Spouses were less satisfied with their networks than clients. Social support satisfaction was linked to loneliness and depression for clients but not for spouses. Results of the study suggest that community nurses working in home settings must be sensitive to clients' and spouses' psychologic reactions to COPD, which may be expressed in feelings of loneliness and depression.

Living arrangements, loneliness, and social support of low-vision older clients.

1. Loneliness has been linked to both psychological and medical problems. The study of loneliness and social support should interest nurses because nursing interventions may assist in preventing or alleviating potential health problems. 2. Study results indicate that low-vision older clients who lived alone were no lonelier than those who lived with others. Clients who lived alone were as satisfied with their social networks as those who lived with others. The actual number of supporters in the social network had no effect on loneliness for either group. 3. Neither group was particularly lonely. The nurse cannot assume that the combination of low-vision and living alone results in loneliness. Because different categories of supporters were linked to different areas of need, nurses need to help clients determine their emotional needs and identify who in the clients' network can best meet these needs.

Loneliness in low-vision older women.

The purpose of this analysis was to identify predictors of loneliness in women 75 years of age and older with low vision. The sample of 56 women was derived from a larger study of low-vision adults. Women's loneliness, optimism, social support, living arrangement, vision, and perceived health were examined using the revised University of California, Los Angeles, Loneliness Scale, the Life Orientation Test, the Social Support Questionnaire, and a demographic questionnaire. Data were analyzed using descriptive statistics, Pearson correlations, multiple regressions, and t-tests. Optimism and social support satisfaction were found to predict degree of loneliness in the sample. Women who were less optimistic and less satisfied with their social support system experienced higher levels of loneliness. Duration of visual impairment was associated with duration of loneliness. The findings provide nurses with information for identifying low-vision older women who are at risk for loneliness.

Stress and coping in families of children with myelomeningocele.

This pilot study examined differences in and relationships between parent health-related stressors (child care needs and parental concerns), daily hassles, and coping strategies of 17 mothers and 17 fathers of preschool and school-age children with myelomeningocele (MMC). Help related to play was the most frequent need among mothers; fathers needed the most help with school activities. Among the greatest concerns of both parents were their child's future and sufficient income. Too many things to do was a frequently mentioned hassle by both parents. Having faith in God was the coping strategy mentioned most often by both parents.

Death anxiety and job stress in hospice and medical-surgical nurses.

This study compared death anxiety and frequency and severity of job stress in 30 hospice and 40 medical-surgical nurses. Death anxiety was assessed through the Templer/McMordie Death Anxiety Scale, job stress through the Gray-Toft/Anderson Nursing Stress Scale. There were no significant group differences in the death anxiety scores nor in the total scores for the frequency segment of the nursing stress scale. The medical-surgical nurses scored a significantly higher total for the severity segment of the nursing stress scale. Death anxiety correlated significantly with frequency and severity of job stress for medical-surgical nurses but not for hospice nurses. Death anxiety correlated highly significantly with death and dying as a source of stress for the medical-surgical nurses.

A comparison of frequency and sources of nursing job stress perceived by intensive care, hospice and medical-surgical nurses.

This study compared the frequency and sources of nursing job stress perceived by 35 intensive care (ICU), 30 hospice and 73 medical-surgical nurses. Analysis of variance revealed no significant differences among the three groups of nurses on the overall frequency of job stress. Post-hoc Tukey tests demonstrated a significant difference in three stress subscales among the three groups. ICU and hospice nurses perceived significantly more stress than medical-surgical nurses related to death and dying; ICU and medical-surgical nurses perceived significantly more stress than hospice nurses related to floating; and medical-surgical nurses perceived significantly more stress than ICU and hospice nurses related to work-overload/staffing. Spearman-Rank Correlation revealed no significant correlations among the three groups in their rank-ordering of the eight stress subscales. Death and dying situations were the most stressful to ICU and hospice nurses, while work-overload/staffing situations were the most stressful to medical-surgical nurses. Results of the study, although not generalizable, have implications for nurse managers.

Family stress and coping in rheumatoid arthritis.

Stress and coping were examined in a sample of 30 rheumatoid arthritis (RA) patients and their 30 spouses. Two components of stress were measured: concerns and help needs. Results showed a significant agreement between patients and spouses on total concerns. The area of greatest concern for both groups was wondering about the future. The only help need that showed a significant difference between groups was diet and nutrition. Need for information about RA was the greatest need cited by both groups. Patients used significantly more coping strategies than spouses in dealing with RA-related stressors. Overall, cognitive restructuring was used most often by both groups. The study suggests that RA patients and spouses have similar concerns and help needs, and that while families may have lived with the RA for an extended period of time, health professionals should continuously assess concerns about the future and information needs in these families. The study results also suggest that spouses may need assistance in the use of effective coping strategies.

Loneliness of chronically ill adults and their spouses.

This comparative descriptive study was designed to determine if there was a significant difference in loneliness between 80 chronically ill adults and their spouses [N = 160] and to determine whether a significant relationship existed between loneliness and selected characteristics in the two groups. Chronically ill adults were purposively selected from several sources and represented a variety of illnesses. Loneliness of both groups was assessed using a single dichotomous item from the Oars Multidimensional Functional Assessment Questionnaire (1975). Data on selected characteristics were collected through four instruments: subscales from the Oars, Disability Classification Index, Social Role Rating Scale, and Life Satisfaction Index-Z Scale. Wilcoxon 2-Sample Test revealed no significant difference in loneliness between groups. For both groups, women were more lonely than men and this difference was significant for the ill group (p less than .001). The highest correlation between loneliness and sociodemographic characteristics was need for financial assistance for ill respondents and inability to afford luxuries for spouses; between lonely and disease-related characteristics, it was the number of chronic illnesses for ill and disability of the ill partner for spouses; between lonely and sociological characteristics, it was decrease in the homemaker role for ill and decrease in the leisure role for spouses. For both groups, loneliness was significantly related to lower life satisfaction and unrelated to mental health. Findings indicate that chronically ill adults and spouses are similar in frequency of self-reported loneliness. Differences in characteristics associated with loneliness found between the two groups suggest a need for different approaches in nursing interventions for ill adults and spouses.