Psychometric Properties and Construct Validity of the Knowledge Information Profile-Coumadin.

Background: Oral anticoagulation therapy using Coumadin (warfarin) requires significant patient involvement. Limited validated instruments exist to test patient knowledge of Coumadin, and low health literacy may impede patient self-management. Objective: This article reports the psychometric testing of the Knowledge Information Profile-Coumadin (KIP-C20) to determine (a) minimum number of items and dimensions, (b) reliability, and (c) construct validity. Methods: Participants (N = 192) were recruited from outpatient pharmacist-directed anticoagulation clinics associated with an urban teaching hospital in the Midwest United States. Instruments were the Animal Naming test (AN), Rapid Estimate of Adult Literacy in Medicine (REALM), and KIP-C20. Multidimensional item response theory modeling and exploratory factor analyses were used to determine the best fitting model. Results: The final instrument, renamed KIP-C14, with 3 factors and 14 items, had a good fit to data (M2 = 96.49, P < .0001; root mean square error of approximation = .04), and all factor loadings were .3 or larger. Internal consistency reliability was .65; test-retest correlation was .67. The KIP-C14 correlated positively, as expected, with years of Coumadin treatment. Subscales were differentially correlated with sociodemographic variables. Conclusions: The KIP-C14 had nearly identical, slightly higher reliability than the KIP-C20. Still, reliability was lower than expected, indicating a promising clinical assessment scale in need of further refinement.

A cross-sectional, comparative study of pain and activity in persons with and without injection-related venous ulcers.

Persons with leg ulcers, including venous ulcers, often report pain. A cross-sectional, comparative study was conducted among 61 patients receiving care in an urban clinic (31 with and 30 without a venous ulcer, mean age 54 years [range 40 to 65 years], 93% African American) to examine pain and its relation to activity and walking in persons with injectionrelated venous ulcers. The questionnaire included items about pain and its treatment, as well as activity and walking (ie, Brief Pain Inventory [BPI] Short Form, Self-Treatment of Pain, Pain and Narcotic Use, Difficulty with Activities, and Walking Scale questionnaires). Among those with a venous ulcer (VU+), worst pain significantly related to total interference (r = 0.65, P <0.0001) and total difficulty (r = 0.42, P = 0.02) BPI scores. The common pain sites for those VU+ involved the legs (24, 36.4%), wound sites (13, 19.7%), back (eight, 12.1%), general body (five, 7.6%), shoulder and knee (four, 6.1% each), and other (eight, 12.1%). Persons VU+ were more likely than those without a venous ulcer (VU-) to have received a prescription for narcotics in the past year (96% versus 41%, X(2) = 21.3, P <0.0001). Persons VU+ versus VU- were significantly (X(2) = 8.89, P = 0.003) more likely to resort to street drug use and relapse to addiction if pain was not adequately treated. They were also twice as likely to have decreased walking over the past 5 years (67% versus 33%, X(2) = 5.93, P <0.02). Among those VU+, venous ulcers added to chronic pain and decreased walking. These findings highlight the negative effects of injection-related venous ulcers on pain, activity, and walking, as well as the propensity of this groupto resort to illicit drug use for pain control. Persons VU+ should have pain assessed and treated.

Differing Relations to Early Atherosclerosis between Vitamin C from Supplements vs. Food in the Los Angeles Atherosclerosis Study: A Prospective Cohort Study.

OBJECTIVE: To determine the relationship of vitamin c intake from supplements vs food on early atherosclerosis detected by carotid intima media thickness (IMT). BACKGROUND: Oxidative stress and endothelial dysfunction play a critical role in the pathogenesis of atherosclerosis. Dietary vitamin C appears to have anti-oxidant properties and beneficial relations to endothelial function, yet vitamin C taken as a vitamin supplement does not appear to protect from cardiovascular events. The impact of vitamin c intake from supplements vs food on progression of atherosclerosis is unknown. METHODS: We examined 3-year progression of carotid IMT in a randomly sampled cohort of 573 healthy women and men aged 40-60 years. Progression of carotid IMT was determined bilaterally with B-mode ultrasound at 3 examinations (1.5-year intervals). Intake of dietary vitamin C was measured by six, 24-hour recall interviews. Intake of vitamin C from vitamin supplements was measured by questionnaire in quartiles of supplement intake and no supplement. Vitamin C wasmeasured in plasma as ascorbic acid. RESULTS: Carotid IMT progressed 10.0±16.5 µm/year (mean±SD) among all those with follow-up (n=500; 87%). For those who took vitamin C supplements, carotid IMT progression increased with dose (p-trend=0.0009). Among persons in the highest quartile (857-5000 mg/day) of vitamin C supplement intake compared to those not consuming any vitamin C supplements, carotid IMT progression increased three-fold (20.3±2.6 versus 7.6±1.8 µm/year (mean±SD); p<0.001). The adverse association of vitamin C supplement intake with carotid IMT was two-fold greater in the upper tertile of serum cholesterol compared to the lower two tertiles (p=0.01). In contrast to the adverse association of vitamin C supplements, vitamin C intake from food had a weak protective relationship on carotid IMT progression (reduced progression -5.0±1.9 µm/year; p=0.008). CONCLUSIONS: Vitamin C supplementation is associated with accelerated early atherosclerosis measured by carotid IMT compared to a protective association with vitamin C from food. Theadverse association of vitamin C supplementation may be greater in patients with higher serum cholesterol levels. The current results provide a potential mechanistic understanding for the observed differences between Vitamin C in supplements vs food in prior studies. Given these observations,vitamin C supplementation does not appear to be currently advisable for prevention or treatment of atherosclerosis.

Graphics for dissemination of meta-analyses to staff nurses.

Meta-analytic findings can be useful to nurses seeking research results to guide practice, but graphics used by meta-analysts take time to master. Simpler displays can be created by staff development educators if they understand commonly used meta-analytic displays. For instance, simplified versions of 'forest plots', a common metaphoric display can be created to introduce staff nurses to meta-analytic findings published in the Cochrane Database of Systematic Reviews and similar databases.

The influence of easy-to-read pamphlets about self-care management of radiation side effects on patients' knowledge.

PURPOSE/OBJECTIVES: To test patients' knowledge of side effects after they review six easy-to-read pamphlets on radiation side effects. DESIGN: Nonexperimental. SETTING: Urban radiation oncology clinic. SAMPLE: 47 patients receiving radiation treatment. METHODS: The Knowledge of Radiation Side Effects Test was administered. MAIN RESEARCH VARIABLES: Patient literacy and knowledge level. FINDINGS: The self-report of highest grade completed in school was 10th grade; however, the actual reading level was 4th-6th grade. Scores for each knowledge test increased with literacy level, with statistically significant correlations for pamphlets on fatigue, skin problems for women, and skin problems for men. Participants who read at the 4th-6th-grade level scored higher than expected. CONCLUSIONS: Although the pamphlets were deemed easy to read, patients who had the lowest reading levels still had difficulty understanding them. IMPLICATIONS FOR NURSING: In addition to written patient information, oncology nurses should use innovative teaching strategies to improve patient understanding and self-care behaviors. A need exists for continued nursing inquiry that will focus on self-care behaviors to manage radiation side effects, particularly for patients with low literacy.

The effect of low literacy on the self-care behaviors of men receiving radiation therapy.

Using Orem's theory as the framework, two purposes guided the study: (a) to test the effectiveness of an audio-visual education program and behavioral contracting to promote self-care behaviors in managing radiation side effects and (b) to determine the extent to which low literacy affects self-care abilities. Seventy men diagnosed with prostate cancer participated in this experimental study. The nursing interventions of education and behavioral contracting significantly increased the self-care behaviors of men in managing radiation side effects. An increase in self-care behaviors was especially shown in men with low-literacy skills.

Comparison of bodily pain: persons with and without venous ulcers in an indigent care clinic.

PURPOSE: The purpose of this study was to examine bodily pain and its relationship with functional status, perception of control, coping, and depression for patients with and without venous ulcers who were receiving care in an urban, primary care clinic for low-income adults. METHODS: We used an exploratory, cross-sectional design. Participants (N = 301) completed demographic, pain severity and pain interference with function, depression, control, and coping questionnaires. Seventy patients (23.3%) had venous ulcers and 231 (76.7%) did not. RESULTS: Participants were generally male (53%, n = 159), mostly African American (92%, n = 277), and ranged in age from 22 to 74 years (M = 49.5, SD = 8.5). Persons with and without venous ulcers did not differ significantly based on gender, race, number of pain sites (n = 3.3), or self-rated health. Those with leg ulcers were significantly older, had more health problems, and were more likely to have pain-related disability. The pain descriptors used by patients with venous ulcers were sharp (89%), nagging (87%), tiring (87%), and throbbing (87%). Patients with leg ulcers reported significantly lower average pain (M = 6.0) than those without leg ulcers (M = 6.6) and greater 24-hour pain relief from treatments or medications (55% vs 44%). Patients with venous ulcers reported greater control over their pain and greater coping with pain. The 2 groups did not differ significantly on depression, life control, or purpose in life scores. CONCLUSIONS: Compared to patients without venous ulcers, those patients with venous ulcers rated their pain lower and reported higher coping and control over pain, which may be reflected in better subjective pain management despite having more pain sites and disability related to pain. Pain management for indigent patients with and without venous ulcers remains a concern and needs further study.

Trust, mistrust, racial identity and patient satisfaction in urban African American primary care patients of nurse practitioners.

PURPOSE: To analyze relationships between cultural mistrust, medical mistrust, and racial identity and to predict patient satisfaction among African American adults who are cared for by primary-care nurse practitioners using Cox's Interaction Model of Client Health Behaviors. DESIGN: A descriptive-correlational study was conducted with a convenience sample of 100 community-dwelling adults. METHODS: Participants completed the Cultural Mistrust Inventory; Group Based Medical Mistrust Scale; Black Racial Identity Attitude Scale; Trust in Physician Scale; Michigan Academic Consortium Patient Satisfaction Questionnaire; and provided demographic and primary care data. ANALYSIS: Correlations and stepwise multiple regression techniques were used to examine the study aims and correlational links between the theoretical constructs of client singularity, client-professional interaction, and outcome. FINDINGS AND CONCLUSIONS: Cox's model indicated a complex view of African American patients' perspectives on nurse practitioners. Participants simultaneously held moderate cultural mistrust of European American providers and mistrust of the health care system, and high levels of trust and satisfaction with their nurse practitioners. One racial identity schema (conformity) and trust of nurse-practitioner (NP) providers explained 41% of variance in satisfaction. CLINICAL RELEVANCE: An African American patient's own attitudes about racial identity and the client-professional relationship have a significant effect on satisfaction with primary care.

Effectiveness of an intervention for disseminating Cochrane Reviews to nurses.

Disseminating research findings to clinicians can be a challenging task. In this study, researchers tested the effectiveness of disseminating summaries of systematic reviews to clinicians. The findings suggest that these summaries are well-accepted by nurses and increase their knowledge of research findings.

Web citations in the nursing literature: how accurate are they?

One problem with using Web citations is whether those documents will be available over time. We examined 573 Web citations in articles published in nursing journals and checked their availability (either by direct link or by searching the main site). There was a mean of 3.1 Web citations per article. Most Web citations were to documents that related to clinical practice, for example, clinical guidelines and explanations of clinical conditions and treatments. Of the 573 Web citations, 414 (72.3%) were still available; of those, 229 (55.3%) were able to be accessed by direct link and the other 185 (44.7%) by searching the main Web site. However, 159 (27.7%) of the references were not available, not even by searching the Internet using key terms from the citation. Considering that more than a fourth of the Web citations in this study were no longer available, authors need to be cautious about using the Web as a primary source of information for their publications.

Using the teach-back and Orem's Self-care Deficit Nursing theory to increase childhood immunization communication among low-income mothers.

Guided by Orem's Self-care Deficit Nursing theory, the purpose of the pilot study was to assess the relationship between maternal health literacy and the mother's ability to comprehend and communicate information about childhood immunizations. Communication is the key to positive health results, particularly for patients with low literacy skills, yet few studies have examined patients' ability to converse about health information taught to them by providers. The study was conducted in an urban walk-in immunization clinic. A quantitative-qualitative research design was used. Convenience sampling was applied to obtain 15 mothers with one child (M1) and 15 mothers with more than one child (M>1). The Rapid Estimate of Adult Literacy (REALM) was used to assess literacy level. Vaccine information statements on inactive poliovirus (IPV) and pneumococcal conjugate vaccine (PCV) were instructional materials used in the teach- back procedure. Although the results of the study were mixed, patterns and trends were noted. Mothers with higher literacy levels provided more correct responses for the benefits of the polio vaccine than did those mothers with lower literacy levels (F(2,25)=4.70, p= .02). For both IPV and PCV vaccines, more mothers gave correct answers for risks and benefits, but more mothers gave incorrect answers for safety. There also was some relationship between mother's age and correctness of responses regarding risk of pneumonia vaccination (F(2,24)=3.79, p= .04). The inconsistency of the mothers' responses to communicate critical immunization information about vaccines indicates the need to further assess how best to increase parents' vaccine knowledge and communication skills.

Dissemination of research in clinical nursing journals.

AIM: The purposes of the study were to describe the extent of research, clinical and evidence-based practice articles published in clinical nursing journals and to explore the communication of research and practice knowledge in the clinical nursing literature using citation analysis. BACKGROUND: For nursing research to have an impact on clinical practice and build evidence for practice, findings from research must transfer into the clinical practice literature. By analysing the extent of research published in clinical nursing journals, the citations in those articles, and other characteristics of the nursing literature, we can learn more about the linkages between research and practice in nursing. DESIGN: This was a descriptive study of 768 articles and 18901 citations in those articles. METHODS: Feature articles were classified into four groups - (i) original research reports; (ii) clinical practice articles (non-data based papers on a clinical topic); (iii) systematic reviews, integrative literature reviews, guidelines and papers describing evidence-based practice; and (iv) others. Each citation was then examined to determine if it was a reference to a research study or to a document on clinical practice. RESULTS: Nearly a third of the articles in clinical nursing journals were reports on research studies; another third addressed clinical practice. Of the 14232 citations analysed in clinical nursing journals, 6142 were to research reports (43.2%) and about the same number of citations were to clinical documents (n = 5844, 41.1%). Medical research articles were cited most frequently - 27.1% of the citations in clinical journal articles. Nursing research articles were only 7.6% of the cited documents in clinical publications. CONCLUSIONS: Dissemination of research findings in the clinical nursing literature occurred at two levels: through articles that reported studies of potential value to the nurse's practice and citations to research publications within articles. Relevance to clinical practice. Disseminating research in journals that are geared to clinicians is essential to increase nurses' awareness of research findings that might be relevant to their practice. This study documented that articles in clinical nursing journals disseminated not only information about clinical practice, but also informed readers about research of potential value to the nurse's practice.

Information sources for developing the nursing literature.

BACKGROUND: Journals are an important method for disseminating research findings and other evidence for practice to nurses. Bibliometric analyses of nursing journals can reveal information about authorship, types of documents cited, and how information is communicated in nursing, among other characteristics. OBJECTIVES: The purposes of our study were to describe the types of documents used to develop the clinical and research literature in nursing, and extent of gray literature cited in those publications. DESIGN: This was a descriptive study of 18,901 citations of articles in clinical specialty and research journals in nursing published between January 2004 and June 2005. METHODS: The research team reviewed each citation to assess if the cited document was a journal article, book chapter or book, or document falling into the category of gray literature. Frequency counts for each type of cited document were recorded. RESULTS: Most of the citations were to journal articles (n=14,392, 76.1%) and among those, to articles in medical journals (n=7719, 40.8% of all the citations). This was true for the literature as a whole and for the clinical specialty and research literature separately. Although citations to medical journals were most common, in the clinical nursing literature there was a significantly higher proportion of citations to medical journal articles (n=6332, 44.5%) than in the nursing research literature (n=1387, 29.7%) (LR(X)(2)=326.7, p<0.0001). Nearly 10% of the citations were to gray literature. There was an increase in citations to websites (5.7%) compared to a study done only a few years earlier. CONCLUSIONS: Our study documented that journal literature was the primary source of information for communication within nursing. This is consistent with other biomedical and hard sciences where the transfer, assimilation, and use of information occur mainly within the scientific community. With a reliance on journal articles for dissemination of research and evidence for clinical practice, improved methods will be needed for integrating this knowledge and presenting it in a usable form to clinicians. As journals proliferate, it will become increasingly difficult for clinicians to keep current with research findings to guide their practice. The development and testing of new methods for integrating and disseminating research evidence to busy clinicians will be increasingly important in nursing. Gray literature was nearly 10% of the citations. The study also revealed an increase in citations to websites, which is anticipated to continue in the future. Further study is needed on the indexing of gray literature relevant to research use and evidence-based practice in nursing and on how to make this literature easily available to clinicians.

Collecting data by telephone from low-income African Americans.

The purposes of this report are to (a) describe challenges associated with collecting data by telephone from 368 urban-dwelling African Americans and (b) describe characteristics of easy-to-reach participants. Data collected through four telephone interviews were used for these analyses. Over 1 year, 55 (15.0%) participants had at least one telephone number change; 75 (20.4%) had their telephone disconnected. The mean (+/-SD) number of attempted telephone calls per participant was 9.5 (+/-4.0). Those who were easy to reach, requiring eight or fewer call attempts over 1 year (n = 170; 46%), were older (t = 3.0, p = .003), female (chi(2) = 4.6, p = .03), and currently not working (chi(2) = 7.9, p = .005).

Citation analysis of the maternal/child nursing literature.

Few bibliometric studies have been done of the nursing literature; however, much can be learned about nursing and specialty areas of clinical practice by examining the articles published in nursing journals. The purposes of this study were to describe the extent of research, clinical, and evidence-based practice articles published in maternal/child nursing journals and the information sources used to develop that literature. A total of 112 articles and 2571 citations from three randomly selected maternal/child nursing journals were analyzed. Nearly half (n=51, 46%) of all articles were reports of original research studies. Research publications were cited most frequently including research studies published in medical journals (n=687, 26.7% of all the cited documents), followed by research studies published in nursing journals (n=371, 14.4%) and journals in other disciplines. The maternal/child nursing journals examined in this study are disseminating research findings to nurses for use in clinical practice.

Effects of nurse-managed telemonitoring on blood pressure at 12-month follow-up among urban African Americans.

BACKGROUND: Nearly one in three adults in the United States has hypertension. Hypertension is one of the largest risk factors for cardiovascular diseases, and it is growing in prevalence, especially among African Americans. OBJECTIVES: To test the hypothesis that individuals who participate in usual care (UC) plus blood pressure (BP) telemonitoring (TM) will have a greater reduction in BP from baseline to 12-month follow-up than would individuals who receive UC only. METHODS: A two-group, experimental, longitudinal design with block stratified randomization for antihypertensive medication use was used. African Americans with hypertension were recruited through free BP screenings offered in the community. Data were collected through a structured interview and brief physical exam. Cross tabs, repeated measures analysis of variance, and independent t tests were used to analyze the study's hypothesis. RESULTS: The TM intervention group had a greater reduction in systolic BP (13.0 mm Hg) than the enhanced UC group (7.5 mm Hg; t = -2.09, p = .04) from baseline to the 12-month follow-up. Although the TM intervention group had a greater reduction in diastolic BP (6.3 mm Hg) compared with the enhanced UC group (4.1 mm Hg), the differences were not statistically significant (t = -1.56, p = .12). DISCUSSION: : Telemonitoring of BP resulted in clinically and statistically significant reductions in systolic BP over a 12-month period; if maintained over a longer period of time, the reductions could improve care and outcomes significantly for African Americans with hypertension.

Mothers' knowledge and information needs relating to childhood immunizations.

The purpose of this pilot study was to determine mothers' literacy level and knowledge, information needs, and information-seeking behaviors related to the vaccine(s) their children were receiving. A convenience sample of 15 mothers with one child and 15 mothers with two or more children was recruited at a free, urban, walk-in immunization clinic in Detroit. Participants completed the REALM test and a demographic form. Structured interviews were conducted to assess a mother's knowledge, information needs, and information-seeking behavior relating to the vaccines. The average reading skills were at the 7th- to 8th-grade level. Only four mothers knew the name and purpose of the vaccine their child was receiving. Information needs of the 26 mothers who did not know the name or purpose of the vaccine were categorized as immediate or deferred according to Krikelas's model of information seeking. More mothers with one child had immediate information needs, while more mothers with two or more children had deferred information needs. Primary sources of vaccine information were physicians and nurses. More research needs to be done to determine which nursing interventions work best to satisfy a mother's information needs.

Socioeconomic position and incident mobility impairment in the Cardiovascular Health Study.

BACKGROUND: We investigated if personal socioeconomic position (SEP) factors and neighborhood characteristics were associated with incident mobility impairment in the elderly. METHODS: We used data from the Cardiovascular Health Study, a longitudinal, population-based examination of coronary heart disease and stroke among persons aged 65 and older in the United States. RESULTS: Among 3,684 persons without baseline mobility impairment, lower baseline SEP was associated with increased risk of incident mobility disability during the 10-year follow-up period, although the strengths of these associations varied by socioeconomic indicator and race/sex group. CONCLUSION: Among independent-living elderly, SEP affected development of mobility impairment into later life. Particular effort should be made to prevent or delay its onset among the elderly with low income, education, and/or who live in economically disadvantaged neighborhoods.

Discharge knowledge and concerns of patients going home with a wound.

PURPOSE: To examine patients' wound care knowledge and concerns prior to discharge from an acute care hospital. DESIGN: Comparative descriptive study of patients with wounds. SETTING AND SUBJECTS: Participants (N = 76) included 17 men and 59 women who were African American (n = 33, 43.4%) or Caucasian (n = 43, 56.6%) and ranged in age from 20 to 83 years (M = 48, SD = 13). There were 67 persons with acute wounds and 9 with chronic wounds. All were scheduled to be discharged home from a large urban acute care hospital. INSTRUMENTS: The questionnaire for this study included the following sections: Demographic, Admission and Discharge, Health, Wound Care, Beliefs about Wounds and their Care, Pain and Wounds, Literacy and Learning, and Discharge Concerns. RESULTS: Participants' greatest concerns about going home were: (1) how active to be at home, (2) wound pain, (3) looking for wound complications, and (4) watching for wound infection. Many participants did not know the dressing (38.2%) or solution to cleanse the wound (58.7%) at home. Most had taken care of a wound before (67.1%), could see (68.4%) and reach (69.7%) the wound, and had looked at it (64.5%) during the hospitalization. Patients with acute and chronic wounds did not differ significantly in their concerns about their wound or their fear of taking care of their wound. Participants generally had appropriate knowledge about wounds and hand washing, nutrition, going out of the home, and cigarette smoking. They had incorrect information about drying out wounds and leaving them open to breathe the air. The majority of patients with chronic wounds preferred getting answers to questions about their wound and its care from their physician followed by their clinic and family/friends. Patients with acute wounds overwhelmingly chose their physician as a source of information about their wound and its care, followed by calling a nurse at the hospital and using the Internet. CONCLUSIONS: Patients were able to verbalize their concerns about going home with a wound. Concerns about discharge may help to direct patient teaching in preparation for discharge. Teaching literature could include the most common concerns, as well as ways to avoid misinformation about wound care. Discharge teaching needs to begin early so that patients feel they have adequate time to learn and ask questions. Further research is needed about patients' wound care knowledge and discharge concerns.

Effectiveness of an intervention for disseminating Cochrane reviews to nurses.

Disseminating research findings to clinicians can be a challenging task. In this study, researchers tested the effectiveness of disseminating summaries of systematic reviews to clinicians. The findings suggest that these summaries are well-accepted by nurses and increase their knowledge of research findings.