A qualitative study of young people's perspectives of living with type 1 diabetes: do perceptions vary by levels of metabolic control?

AIM: To explore if young people with higher and lower levels of metabolic control of type 1 diabetes have different perceptions about their lives and illness. BACKGROUND: Adolescence through emerging adulthood is a developmental stage made more challenging when the person has type 1 diabetes. Little research has investigated if individuals with high and low levels of metabolic control in this age group perceive their disease differently. DESIGN: Qualitative descriptive. METHODS: In this study, 14 participants, ages 11-22 years were interviewed in 2008 about their perceptions of living with type 1 diabetes. Through a process of induction, major themes were identified. RESULTS/FINDINGS: Participants with high and low metabolic control levels reported similar themes related to reactions of others, knowledge about type 1 diabetes, and believed healthcare providers used authoritarian interactions. However, high metabolic control level participants believed type 1 diabetes would be cured; had negative initial responses to being diagnosed; rarely received parental support in managing their diabetes; and were negligent in self-care activities. Participants with low metabolic control levels did not believe a cure was imminent or have negative responses to being diagnosed; received parental support in managing diabetes; and were diligent in self-care activities. CONCLUSION: Nurses should give information to young people with type 1 diabetes beyond initial diagnosis and help and support this age group learn appropriate ways to manage their disease, develop positive relationships with healthcare professionals, and participate in interactions with others their age successfully managing type 1 diabetes.

Young people's experiences living with type 1 diabetes.

Young people with type 1 diabetes mellitus face a unique set of challenges: their own and their family's perspectives of the disease and treatment impact on how well they manage metabolic control. Hormonal changes, desire for autonomy and emotional distress can influence self-management. This study aimed to better understand the perspective of young people with diabetes and to find out whether metabolic rate affects how individuals' view the disease and treatment. The findings are used to make suggestions for treatment approaches.

The psychometric properties of the self-assessment of the Interpersonal Relationship Scale.

PURPOSE: The specific aims of this study were to establish the reliability and validity of the Self-Assessment of the Interpersonal Relationship Scale (SAIRS) and to ascertain whether the SAIRS measured the development of interpersonal competencies. DESIGN AND METHOD: This was an exploratory methodological study undertaken to analyze the psychometric properties of the SAIRS. The sample was composed of 248 subjects between the ages of 18 and 60. FINDINGS: The factor analysis yielded a one-factor solution that explained 33.3% of the variance with one component explaining 21% of the variance. Cronbach's alpha (0.92), demonstrated high internal consistency. PRACTICE IMPLICATIONS: SAIRS can provide nurses, supervisors, and educators with information regarding competency areas that need further instruction/practice to enhance the interpersonal relationship.

Association between the catechol-O-methyltransferase Val158Met polymorphism and self-perceived social acceptance in adolescent girls.

Low perceived social acceptance is a significant risk factor for emotional difficulties in children. No studies, however, have examined genetic factors that may underlie individual differences in perceived social acceptance. In the present study we examined the relation between polymorphisms on the catechol-O-methyltransferase (COMT) Val158Met and serotonin transporter promoter (5-HTTLPR) genes and perceived social acceptance in 103 adolescent girls. Only the COMT polymorphism was related to perceived social acceptance: Val-allele carriers reported greater perceived social acceptance than did homozygous Met-allele carriers. In a subsample of these participants, homozygous Val-allele carriers reported greater maintenance of positive emotions during stress. This, in turn, predicted social acceptance, suggesting that COMT exerts its effects on social functioning through emotion regulation. These data are the first to show an association between COMT and social functioning in children. Future research might profitably examine emotion regulation as a mediator between COMT and social acceptance.

Enhancing intellectual empathy: the lived experience of voice simulation.

PURPOSE: This study aimed to understand the lived experience of voice simulation with the novice nurse and to describe the impact on the nurse's empathy and desire to develop a therapeutic relationship. DESIGN AND METHODS: Twenty-eight women and men participated in a detailed narrative investigation of reflective writing of the lived experience of hearing voices through a voice simulation experience. FINDINGS: A sense of insight was developed, and participants felt they could empathize with this type of suffering. The ability to change attitudes to focus on the development of therapeutic relationships was enhanced. PRACTICE IMPLICATION: Voice simulation assists the novice nurse in developing intellectual empathy.

Interpretation of ambiguous information in girls at risk for depression.

Research has consistently documented that depressed individuals process information in a negatively biased manner. There is little evidence, however, concerning whether these biases represent risk factors for depression, as is hypothesized by cognitive models. In the present study we investigated whether a particular cognitive bias observed in currently depressed individuals, the tendency to interpret ambiguous information negatively, characterizes daughters of depressed mothers, a population known to be at increased risk for depression. Following a negative mood induction, young daughters of depressed and never-disordered mothers completed two information-processing tasks in which their interpretations of emotionally ambiguous stimuli were evaluated. Daughters of depressed mothers interpreted ambiguous words more negatively and less positively, and ambiguous stories more negatively, than did daughters of never-disordered mothers. These results provide support for cognitive vulnerability models of depression.

Nurse practitioners' communication styles and their impact on patient outcomes: an integrated literature review.

PURPOSE: The purpose of this review was to examine the published research from 1999 to 2005 describing nurse practitioner (NP)-patient interactions and to determine the best practice to enhance patient outcomes. DATA SOURCES: Databases searched included Academic Search Elite, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Health Source Consumer Edition, Health Source Nursing/Academic Edition, Medline, and PsychInfo. CONCLUSIONS: Two communication styles described in the literature and determined by authors were (a) biomedical and (b) biopsychosocial. The biopsychosocial style is identified as patient-centered communication. Seven studies were then analyzed for NPs' communication styles and the impact that they had on patient outcomes. The studies analyzed demonstrated that biopsychosocial (patient-centered) communication style positively influences patient outcomes as evidenced by (a) improved patient satisfaction, (b) increased adherence to treatment plans, and (c) improved patient health. IMPLICATIONS FOR PRACTICE: The results of this review indicate that patient-centered communication incorporated into the NPs' practice is associated with improving patient outcomes such as (a) improved patient satisfaction, (b) increased adherence to treatment plans, and (c) improved patient health. Future research needs to be performed in order to fully study the relationship between NPs using patient-centered communication style and its impact on patient outcomes. Clinical recommendations are made based on findings of the integrated literature review.

Challenging stereotyping and bias: a voice simulation study.

Stigma is a barrier to mental health care access for patients with schizophrenia and can interfere with developing therapeutic relationships. This study demonstrates success of a voice simulation experience during orientation in changing the biases of nursing students and the effect on the development of the nurse-patient relationship. Ninety-four individuals participated; 52 received a voice simulation experience during orientation, and 42 received orientation with no voice simulation experience. The Medical Condition Regard Scale was administered before and after orientation. Posttest paired t test results show significant differences in attitudes toward patients with voice hearing experiences between the two groups. The themes of personal growth from the focus groups postorientation include Affective Experience, Physical Experience, and Empathy. Findings demonstrate that the orientation process should include methods to challenge stereotyping and bias to decrease stigma, improve service access, and enhance the ability to develop therapeutic relationships.

Patient-centered care and adherence: definitions and applications to improve outcomes.

PURPOSE: The implementation of patient-centered care (PCC) has been hampered by the lack of a clear definition and method of measurement. The purpose of this review is to identify the fundamental characteristics of PCC to clarify its definition, propose a method for measurement of PCC, and recommend effective PCC practices. DATA SOURCES: Review of literature related to PCC, adherence and communication from Cinahl, PubMed Academic Search Premier, and Cochrane Library databases. CONCLUSIONS: Research has shown that patient-centered interactions promote adherence and lead to improved health outcomes. The fundamental characteristics of PCC were identified as (a) patient involvement in care and (b) the individualization of patient care. The use of a numeric rating scale to measure the presence of these characteristics allows quantification from the patient perspective. Effective PCC practices were related to communication, shared decision making, and patient education. IMPLICATIONS FOR PRACTICE: PCC is a measure of the quality of health care. Understanding the characteristics of PCC facilitates its implementation and measurement. Promoting PCC activities will improve adherence and encourage patient responsibility for health status.

Overt and Relational Aggression and Victimization: Multiple Perspectives within the School Setting.

The current study involved a comprehensive comparative examination of overt and relational aggression and victimization across multiple perspectives in the school setting (peers, teachers, observers in the lunchroom, self-report). Patterns of results involving sociometic status, ethnicity and gender were explored among 4(th) graders, with particular emphasis on girls. Controversial and rejected children were perceived as higher on both forms of aggression than other status groups, but only rejected children were reported as victims. Both European American and African American girls showed a greater tendency toward relational aggression and victimization than overt aggression or victimization. Results indicated negative outcomes associated with both relational and overt victimization and especially overt aggression for the target girl sample. Poorer adjustment and a socially unskillful behavioral profile were found to be associated with these three behaviors. However, relational aggression did not evidence a similar negative relation to adjustment nor was it related to many of the behaviors examined in the current study. Implications of these results are discussed.

St. John's wort and the treatment of mild to moderate depression: a systematic review.

A systematic review of randomized controlled trials was conducted to determine the efficacy of St. John's Wort (SJW) in the treatment of mild to moderate depression. The Boyak and Lookinland Methodological Quality Index was used to evaluate the studies. Despite methodological concerns, all studies demonstrated a significant drop in the Hamilton Depression Rating Scale scores for clients taking SJW compared with placebo or pharmaceutical antidepressants. Practitioners may find SJW a viable complementary treatment alternative to traditional medical treatment. The results should encourage further research to validate these findings and seek the most appropriate preparations and dosing for this popular herb.

Reactive and proactive aggression: stability of constructs and relations to correlates.

The authors examined short-term temporal stability of reactive and proactive aggression, as well as short-term consistency of differential relations of reactive versus proactive aggression to 4 correlates. The authors used parent, teacher, peer, and self-report measures twice across 1 year to assess reactive aggression, proactive aggression, hyperactivity, social skills, anger expression, and depressive symptoms of 2nd-grade boys and girls (N = 57). Both subtypes of aggression remained stable across the year, even when the other subtype of aggression was explained at each assessment. Reactive aggression, but not proactive aggression, was consistently positively related to hyperactivity, poor social skills, and anger expression at each assessment.

Getting it, together: how the nurse patient relationship influences treatment compliance for patients with schizophrenia.

The importance of the nurse/patient relationship is a central concept for psychiatric nursing. The present research provides a model of the nursing process identifying aspects of the nurse/patient relationship that influence treatment compliance. Five expert nurses and 15 patients participated in the study. Data collection included participant observation, field notes, memos, demographic questionnaires, interviews with the nurses post observation, and a secondary literature review. The grounded theory investigation identified a substantive theory, Getting It, Together, as the basic social process. The core category of the theory is knowing, and subcategories are socializing, normalizing, and celebrating.

Observational, physiological, and self-report measures of children's anger: relations to reactive versus proactive aggression.

The goal of this study was to examine the relations of reactive versus proactive aggression to children's anger, as assessed using observational, physiological, and self-report measures. Anger was hypothesized to be related to reactive aggression, but not to proactive aggression. Children (N = 272 second-grade boys and girls) participated in a procedure in which they lost a board game and prize to a confederate who cheated. Skin conductance reactivity and heart rate reactivity were measured throughout the procedure. Following the interaction, children viewed a videotape of the game and self-reported on their level of anger after each turn of the game. Observational coding of children's angry facial expressions and angry nonverbal behaviors was conducted. Reactive aggression, but not proactive aggression, was positively related to skin conductance reactivity and angry nonverbal behaviors, both at an aggregated level and in terms of rate of increase over the time span of the game.