Being Unprepared: A Grounded Theory of the Transition of Asthma Self-Care in College Students.

PURPOSE: The purpose of this study was to conceptualize the basic social process of how college students transition from home-based asthma management to independent self-care management. DESIGN AND METHODS: Classical grounded theory was used to explore the transition of asthma self-care in college students. Seventeen college students with asthma from a Midwestern urban university were interviewed. RESULTS: Being Unprepared emerged as the basic social process used by students transitioning from home-based management of their asthma to managing their asthma in college. Being Unprepared conceptualizes a process by which participants engaged in relying on others, primarily their mother, to manage their asthma while in high school. This reliance on others continued when participants became college students with asthma where they were found lacking preparation for self-management in college exemplified by their being relatively unprepared for dealing with the unexpected stressors associated with starting college or for managing asthma episodes safely and effectively as students. Participants acknowledged that they were unprepared for managing their asthma independently and the need for becoming better prepared for their own safe asthma self-management. CONCLUSIONS: Youth with asthma may be at risk for poor health outcomes as they transition to self-care in college. The grounded theory, Being Unprepared, derived from empirical data can provide a scientific basis for deriving practice protocols. PRACTICE IMPLICATIONS: These findings can be used to inform parents and healthcare providers about the need for early intervention designed to prepare students with asthma for the transition to college while in high school. The theory concepts can be operationalized as instrument items for future research studies.

Perceptions of Pediatric Hospital Safety Culture in the United States: An Analysis of the 2016 Hospital Survey on Patient Safety Culture.

INTRODUCTION: Medical errors in the pediatric population can quickly cause harm. Research identified that hospitals with positive safety cultures work collaboratively to reduce errors. Strategies that identify gaps in hospital's safety culture within the pediatric milieu have not been initiated. This study addressed this gap from an interprofessional perspective. METHODS: This cross-sectional descriptive study used data from the Agency for Healthcare Research and Quality's 2016 Hospital Patient Safety Culture survey measuring 12 safety culture dimensions for registered nurses (RNs), physician assistants/nurse practitioners (PAs/NPs), physicians (MDs), and administrators/managers (n = 6682) in the United States that were employed in 287 (42%) pediatric hospitals or specialty units. RESULTS: Findings indicated that in the United States, the overall safety culture had low levels of agreement. Pairings between pediatric RNs, PAs/NPs, and MDs had similar levels of agreement for all dimensions but the perceptions of these three practitioners differed when compared with pediatric administrators/managers in nine of the 12 dimensions. The perceptions of pediatric RNs and MDs differed in six of the 12 dimensions, with MDs indicating higher levels of agreement. All four professional groups rated teamwork within hospital units with the highest level of agreement (mean, 4.14), with hospital handoffs and transitions rated the lowest (mean, 2.64). All four professional groups found punitive cultures (mean, 2.71) throughout the pediatric specialty. CONCLUSIONS: Variations regarding pediatric professional's perception of safety culture exist within U.S. hospitals. Effective and creative management will support cultures that prevents harm and improves the overall safety of children's care with initiatives that are dedicated to excellence.

Implementation of an Asthma Self-Management Education Guideline in the Emergency Department: A Feasibility Study.

Patients often present to emergency departments (EDs) for the management of chronic asthma. Because of the nature of ED care, national guideline recommendations for asthma education are generally not initiated in the ED. There is evidence that asthma education can have a positive effect on patient outcomes (; ). This study examines the feasibility of implementing an asthma self-management guideline in a tertiary care center ED. Despite protocol utilization by physicians (87%), nurse practitioners and physician assistants (66.7%), and nurses (41.7%), total compliance with national guideline was accomplished in only 25.93% of cases. Barriers to protocol implementation included staff education, high workload, rapid turnover, and competing initiatives within the department. Linear regression analysis identified high daily census as a predictor of protocol noncompliance (p = 0.033).

Quality of Life and Health Outcomes in Overweight and Non-Overweight Children With Asthma.

BACKGROUND: During the past two decades, the number of children and adolescents who are obese has more than doubled. Following this trend in childhood obesity, there has been an alarming increase in the number of children with asthma who are overweight. OBJECTIVE: The aim of this study was to examine the differences in quality of life (QOL) and health outcomes of obese and overweight children with asthma compared with normal-weight children with asthma using a descriptive comparative survey design. METHODS: This comparative study consisted of 90 overweight and normal-weight 9- to 14-year-olds with asthma. Health outcomes examined included asthma-related missed number of school days, emergency department (ED) visits, hospitalizations, number of days wheezing, and number of night awakenings. QOL was measured using the Pediatric Asthma Quality of Life Questionnaire. RESULTS: The obese group reported the highest percentage of ED visits, hospitalizations, and number of days wheezing compared with the normal-weight group. A risk ratio analysis showed that the obese group had an overall 2.73 (95% confidence interval [CI] 2.15, 3.63) times higher likelihood of going to the ED and a 2.46 (95% CI 1.97, 3.19) times higher likelihood of hospitalization than the overweight and normal-weight groups. Asthma severity was a significant predictor of overall QOL (ß = -23.737, p = .002). CONCLUSIONS: The study results are consistent with other investigations that demonstrate that obese persons are at higher risk of experiencing severe asthma symptoms and support obesity as a potentially modifiable risk factor for asthma mitigation and prevention.

The Impact of Community Violence on School-Based Research.

Research conducted on youth exposure to violence has generally focused on documenting the prevalence of community violence and its emotional and behavioral implications. However, there is a dearth of information related to the impact of violence on the implementation and evaluation of community and school-based programs. This commentary examines the impact of community violence on a school-based research program. It is also a brief summary of the detrimental effects of exposure to community violence on psychological and academic functioning and health outcomes. An example of the impact of community violence on the implementation of a school-based asthma program will be addressed. Implications for school nurses will be discussed.

Factors predictive of depression in first-year college students.

Starting college is a challenging time for first-year students and is often accompanied by emotions such as depression, which can negatively affect academic performance and quality of life. This descriptive correlational study examined stress, coping, depressive symptomology, spirituality, and social support in a convenience sample of first-year students (N = 188) from two private colleges. Results indicated that 45% of students demonstrated greater than average levels of stress and 48% reported clinically significant depressive symptomology. Significant relationships existed between depressive symptoms and stress (p < 0.01) and depressive symptoms and social support (p < 0.01). Less social support was associated with more stress (p < 0.01). The results suggested that interventions targeting stress reduction in first-year students should be considered for decreasing depressive symptoms to enhance their college experience. \

Pediatric obesity and asthma quality of life.

Widely researched as separate entities, our understanding of the comorbid effects of childhood obesity and asthma on quality of life is limited. This article discusses the effects of childhood obesity and asthma on self-reported quality of life in low-income African American teens with asthma. When controlling for the influence of symptom frequency, asthma classification, asthma self-efficacy, and asthma self-care levels, body mass index remains a most important factor in determining self-reported quality of life among teens with asthma. Although overweight and obesity did not change the effectiveness of the asthma intervention program, obesity did affect participants quality of life scores.

Adolescent asthma education programs for teens: review and summary.

The purpose of this review is to describe and evaluate education programs for teens with asthma. Although asthma educational programs for children are plentiful, this is not the case for adolescents. The developmental tasks of adolescence require asthma education programs that are uniquely tailored to this age group. Although several well-designed studies appear in the literature, further research is needed to evaluate the efficacy of asthma education programs among teens. Although the quality of research varies, demonstrated program benefits include improved asthma self-management, self-efficacy, family support mechanisms, and quality of life. Practice implications point to the need for education programs in schools and camp settings that are consistent with national asthma guidelines.

Effects of coping-skills training in low-income urban African-American adolescents with asthma.

BACKGROUND: Minority teens with asthma are at particular risk for this life-threatening disease due to increased morbidity and mortality rates in addition to the normal challenges of adolescence. OBJECTIVE: The purpose of this randomized controlled trial (n = 137) was to determine the effects of a coping-skills training program (intervention) compared with standard asthma education (attention control) in African-American teens with asthma. METHODS: Adolescents were recruited from five African-American dominant high schools serving low-income areas of Chicago. Data were collected at baseline, 2 months (immediately following the intervention), 6 months, and 12 months. Results. Both groups improved over time, with significant increases in asthma-related quality of life, asthma knowledge, and asthma self-efficacy, accompanied by decreases in symptom days and asthma-related school absences. CONCLUSIONS: Findings suggest that coping-skills training as implemented in this study provided no additional benefit beyond that experienced in the control group. However, group-based interventions delivered in the school setting may be beneficial for low-income, minority teens with asthma.

The effects of coping skills training among teens with asthma.

This pilot study used a pretest and posttest design to examine the effect of a school-based intervention, Coping Skills Training, among teens with asthma (N = 39) aged 14 to 18 years randomly assigned to treatment and control groups from three midwestern high schools. Variables included asthma self-efficacy, social support, asthma-related quality of life, peak expiratory flow rate, asthma diary symptoms, and rescue medication usage. The treatment group scored significantly higher on self-efficacy (p < .001), activity-related quality of life (p = .05), and social support (p < .001) compared with the control group after using ANCOVA to adjust for baseline scores. Significant improvements were also noted from pre- to posttest in the treatment group for self-efficacy (p < .001) and quality of life (p = .02). This study indicates that Coping Skills Training is an important intervention for further study with teens with asthma.

The relationships among self-esteem, stress, coping, eating behavior, and depressive mood in adolescents.

The prevalence of adolescent overweight is significant, almost 25% in some minorities, and often is associated with depressive symptoms. Psychological and psychosocial factors as well as poor coping skills have been correlated with unhealthy eating and obesity. The purpose of this study was to examine relationships among self-esteem, stress, social support, and coping; and to test a model of their effects on eating behavior and depressive mood in a sample of 102 high school students (87% minority). Results indicate that (a) stress and low self-esteem were related to avoidant coping and depressive mood, and that (b) low self-esteem and avoidant coping were related to unhealthy eating behavior. Results suggest that teaching adolescents skills to reduce stress, build self-esteem, and use more positive approaches to coping may prevent unhealthy eating and subsequent obesity, and lower risk of depressive symptoms.

Switching from CFC to HFA Inhalers: What NPs and Their Patients Need to Know.

The aim of this article is to provide nurse practitioners with a better understanding of the transition from chlorofluorocarbon (CFC) to hydrofluoralkane (HFA) metered-dose inhalers (MDIs). The authors discuss the differences in these products' propellants; the proper use, cost, and efficacy of the HFA inhalers; and the implications of the switch for NPs and for their patients with asthma.

Interdisciplinary collaboration for healthcare professionals.

Interdisciplinary collaboration has the capacity to affect both healthcare providers and patients. Research has shown that the lack of communication and collaboration may be responsible for as much as 70% of the adverse events currently reported. The purpose of this article is 2-fold: to examine factors that may influence interdisciplinary collaboration and consequently patient outcomes and to examine the relationship between interdisciplinary collaboration and King's theory of goal attainment as a theory to support the phenomenon of interdisciplinary collaboration.

The psychological impact of living with diabetes: women's day-to-day experiences.

PURPOSE: The purpose of this study is to understand the feelings of depression, anxiety, and anger experienced by women with type 2 diabetes and the impact these feelings have on their overall quality of life. METHODS: Four focus groups (2 white, 2 African American) were conducted by ethnically matched professional moderators. Sessions were audiotaped, and transcriptions were analyzed using an inductive approach. Forty-one women (mean age, 55.6 years; SD = 7.9) who had type 2 diabetes for an average of 8.7 years (SD = 6.3) participated. Forty-two percent of the sample was African American. RESULTS: The themes generated directly from the focus group data are (1) struggling with the changing health situation; (2) encountering challenges in relationships with self, family, and others; (3) worrying about the present and future; (4) bearing multiple responsibilities for self and others; and (5) choosing to take a break. Women also expressed feelings of depression, anxiety, and anger, which were primarily related to having diabetes as well as managing the multiple responsibilities of being a caregiver. There were more similarities than differences noted by race. CONCLUSIONS: Women with type 2 diabetes experience feelings of depression, anxiety, and anger, which affect their health and overall quality of life. The findings suggest that health care providers should assess the psychological health of women with type 2 diabetes when developing plans of care. By understanding and addressing the emotional health of women with type 2 diabetes, the relationships between the patient, family, and health care provider may improve, allowing for more successful diabetes management.

Health promotion in adolescents: a review of Pender's health promotion model.

Adolescents have unique health considerations as they transition from parent-managed healthcare to personal responsibility for health behavior. One question to consider is the goodness-of-fit of available theoretical models for explaining and predicting adolescent health-promoting behavior. This integrative review explored Pender's health promotion model in relation to adolescent health. Specifically, this review summarizes the components of Pender's model and the supporting theoretical underpinnings based in the social cognitive theory. Research literature related to the health promotion model and various aspects of teen health is explored. Recommendations for further research and theory development are discussed.

A practitioner-based asthma intervention program with African American inner-city school children.

INTRODUCTION: Asthma is the most prevalent chronic illness, affecting more than 7 million children younger than 17 years. Asthma has become a leading public health concern because of the dramatic rise in the incidence of this disease during the past 15 years, particularly in minority populations. This study tested a two-part intervention on selected psychosocial and health outcomes of 8- to 13-year-old inner city minority students with asthma. METHOD: The intervention consisted of participation in an asthma education program (Open Airways) followed by 5 monthly visits with a nurse practitioner. The total sample of 52 children was composed of 28 children in the treatment group who received the intervention and 24 children who served as a control group. RESULTS: Students in the treatment group scored significantly higher than the control group over time on measures of asthma knowledge, asthma self-efficacy, general self-care practices, and asthma self-care practices. No significant differences were found between the two groups on health outcomes. DISCUSSION: A school-based intervention program can improve psychosocial outcomes for inner-city minority children with asthma. Recommendations for future research and clinical practice are discussed.

The effects of a school-based intervention on the self-care and health of African-American inner-city children with asthma.

Asthma is a chronic illness that affects 5% to 10% or about 5 million children in this country. Morbidity and rising mortality rates are of particular concern in minority children. This study addresses a serious knowledge deficit about the management of asthma in minority children by testing the effect of a school-based asthma education program on psychosocial and health outcomes of 8-13-year-old inner-city minority students. Although the mean scores of the treatment group were higher than the control group on several of the psychosocial measures, these changes were not significant. However, significant differences were found between the groups on health outcomes. Recommendations for future research and clinical practice are discussed.

Talking with teens about asthma management.

Asthma is a chronic illness that affects approximately 7 million children and adolescents in the United States. Teens seem to be at higher risk for poor asthma health outcomes because of the tumultuous changes associated with adolescence. The purpose of this study was to explore experiences and behaviors related to the self-management of teens with asthma. Teens from four different high schools participated in one of four focus groups. Based on these discussions, the following themes emerged related to teens' management of their asthma: wanting to be normal, the unpredictability of the disease, the credibility of the teen with asthma, and self- management issues. Recommendations for developing education and management strategies for teens with asthma are discussed.

The asthma belief survey: development and testing.

Accurate evaluation of asthma self-efficacy is essential to the effective management of asthma. This article describes the development and testing of the Asthma Belief Survey (ABS). The instrument is a 15-item tool that uses a 5-point self-report scale to measure asthma self-efficacy in relation to daily asthma maintenance and an asthma crisis. This instrument was tested with a sample of 79 African American school children, who attended eight inner-city elementary schools. The mean age of the sample was 11.05 years with a range of 8 to 14 years. The majority of students had been diagnosed with asthma prior to the age of 5 years. The Asthma Belief Survey demonstrated good psychometric properties: good Cronbach's alpha reliability coefficient (.83), coherence as a single scale measuring children's self-efficacy in treating their own asthma, and significant relationships with scales of asthma knowledge (r = .51, p < .000) and asthma self-care practices (r = .52, p < .001). The Asthma Belief Survey has sound reliability and validity evidence to support its use to measure a child's asthma self-management self-efficacy. The practitioner can use this instrument to assess a child's self-efficacy in the areas of asthma health maintenance and avoidance of asthma episodes.