Childhood Loss Experiences, Religiousness/Spirituality, and Hope as Predictors of Adult Life Satisfaction.

Purpose The purpose of this study was to explore how adaptive patterns of religiousness/spirituality and hope predict adult life satisfaction in adults, even if they had childhood loss experiences.Design and Methods Using a cross-sectional survey design with132 adult participants (mean age 33.8 ± 15.2, 82% female, 78% Caucasian) we estimated two hierarchical regression models to examine how dimensions of religiousness/spirituality (Brief Multidimensional Measure of Religiousness/Spirituality) and hope (Herth Hope Index) predicted adult life satisfaction (Satisfaction with Life Scale) after controlling for effects of adverse childhood experiences (Adverse Childhood Experiences Study Questionnaire) or chronic sorrow from childhood loss (Kendall Chronic Sorrow Instrument).Results When effects of adverse childhood experiences (ACE) were controlled, higher levels of hope (ß = .416, p < .001) and forgiveness (ß = .273, p = .023) and lower levels of religious/spiritual values/beliefs (ß = -.298, p = .014) predicted higher levels of adult life satisfaction. ACE remained a significant predictor of adult life satisfaction in the final model. When controlling for effects of chronic sorrow, higher life satisfaction was predicted only by forgiveness (ß = .379, p = .003), values/beliefs (ß = -.354, p = .007), and hope (ß = .357, p < .001), with chronic sorrow not a significant predictor of adult life satisfaction in the final model.Conclusion: Greater life satisfaction for adult survivors of childhood loss experiences could be promoted by interventions to enhance hope and foster forgiveness. These adult survivors may also need support as they engage with religious/spiritual struggle to reconcile their values and beliefs with childhood loss.

Perceptions of an Obstetric Clinical Rotation by Nursing Students Who Are Men.

BACKGROUND: Maternity nursing is perceived as an unwelcoming specialty to many nursing students who are men. The purpose of this qualitative study was to describe the experiences of nursing students who are men at a Southeastern university before, during, and after their obstetric clinical rotations. METHODS: Students were interviewed individually. The sessions were recorded and transcribed. The transcripts were analyzed individually and collectively by a three-person study team using existential phenomenology. RESULTS: Seven nursing students who are men participated. Four major themes were discovered: preconceptions, welcoming, perceived rejection (of and by participants), and maternity unit culture. Students' perceptions appeared to be grounded in their level of comfort with maternity nursing. CONCLUSIONS: This study adds to the scant amount of information available about experiences of nursing students who are men during their clinical maternity nursing rotation and may help to explain why some men may feel unwelcome in women's health nursing.

Psychotherapy Experiences of Perpetrators of Child Sexual Abuse.

Cynicism about treatment of sex offenders pervades both professional and lay literature. A Cochrane review of randomized controlled trials concluded there is no evidence to support any psychological intervention for sex offenders, but RCT design has limitations for evaluating sex offender treatment. Rarely has a qualitative approach been used to explore perceptions of offenders themselves about their psychotherapy experiences. The purpose of this study was to discover the meaning of therapy experiences to 11 community-dwelling perpetrators of child sexual abuse. They had received therapy during incarceration or after release, or both. Secondary analysis was conducted of phenomenological interviews about participants' early life, during which they spontaneously revealed insights gleaned during therapy in adulthood. Rigor of the analysis was enhanced by reading transcripts aloud and thematizing them in an interdisciplinary interpretive group. Five interrelated themes constituted a gestalt comprising the essence of the therapy experience: "This treatment, it's just totally changed my whole world." Themes included: "It just stripped away all the pretense, all the lies, all the manipulation;" "I didn't understand myself; I found out all about myself through this;" "Nobody knew any of my secrets; that (therapy) was the first time that I got to tell my story;" "The group has become a family for me;" and "I'm very ashamed of what I've done; this treatment has really helped me, gave me a second chance." These findings stand in contrast to cynicism about sex offender therapy and lend support to the increased optimism expressed by several contemporary scholars.

Psychometric Properties of the Dietary Salt Reduction Self-Care Behavior Scale.

Valid, reliable, and culturally-specific scales to measure salt reduction self-care behavior in older adults are needed. The purpose of this study was to develop the Dietary Salt Reduction Self-Care Behavior Scale (DSR-SCB) for use in hypertensive older adults with Orem's self-care deficit theory as a base. Exploratory factor analysis, Rasch modeling, and reliability were performed on data from 242 older Thai adults. Nine items loaded on one factor (factor loadings = 0.63 to 0.79) and accounted for 52.28% of the variance (Eigenvalue = 4.71). The Kaiser-Meyer-Olkin method of sampling adequacy was 0.89, and the Bartlett's test showed significance (χ2 (df =36) = 916.48, p < 0.0001). Infit and outfit mean squares ranged from 0.81 to 1.25, while infit and outfit standardized mean squares were located at ±2. Cronbach's alpha was 0.88. The 9-item DSR-SCB is a short and reliable scale.

Psychological correlates of HIV-related symptom distress.

This investigation sought to determine the association of symptom distress with selected psychological factors in HIV-infected persons. Data from a randomized controlled trial were used; all subjects who completed baseline data collection were included (N = 99). Data packets included these questionnaires: the Perceived Stress Scale, HIV-related Symptom Distress Scale, and Profile of Mood State. Significant correlations were included in a final regression model. The Perceived Stress Scale, total mood disturbance (including the Profile of Mood State subscales), self-rated current health, and HIV status were independently associated with both frequency of symptoms and symptom distress. Symptom frequency, depression, anger, and fatigue retained significance in the final regression model. Findings from this study indicated significant associations of multiple psychological correlates, suggesting that symptom distress is a complex outcome with a multifactorial etiology. Psychological factors such as depression, anger, and fatigue contribute to the level of distress experienced with HIV-related symptoms.

Development and validation of the dietary sodium reduction self-care agency scale.

A scale did not exist for measuring the capability or self-care agency of lowering salt consumption in older adults with hypertension. Therefore, our objectives were to develop and validate the Dietary Sodium Reduction Self-Care Agency Scale (DSR-SCA Scale). A 24-item scale was developed and tested in 242 older adults with hypertension. Exploratory factor analysis using principal components extraction, Rasch analysis, and internal consistency reliability were used to evaluate the DSR-SCA Scale. Principal components extraction with Promax rotation was used. An 11-item DSR-SCA Scale with three factor loadings, which measure proficiency, persuasiveness, and resourcefulness, was finalized after it was found to meet the criteria of a minimal factor loading of 0.40, with eigenvalues of 2.20, 1.73, and 1.64, respectively. The Kaiser-Meyer-Olkin was 0.80, and Bartlett's test was significant, χ(2) (df = 55) 403.71, p < 0.0001. The measures accounted for 51% of the total variance. Item infit and outfit mean square ranged from 0.88 to 1.18 and the infit and outfit standardized mean square was -1.8 to 1.7. The 11-item scale demonstrated internal consistency with a Cronbach's alpha coefficient of 0.73 for the total scale. The results showed that the DSR-SCA Scale consisted of three factors that have adequate construct validity and reliability to measure power components and enabling capability related to Orem's self-care theory. This scale is brief, easy-to-complete, and useful for measuring salt reduction self-care agency in older adults with hypertension

Comparison of temporal artery and axillary temperatures in healthy newborns.

OBJECTIVE: To compare temperature readings of temporal artery and axillary thermometers in healthy late preterm and term infants in an effort to standardize practice. DESIGN: Descriptive comparative. SETTING: Thirty-bed, healthy mother/baby unit in an inner-city Level-1 trauma center, averaging 2,500 births per year. PARTICIPANTS: Healthy newborns (N = 125) admitted to mother/baby unit after birth, at least 35 weeks gestation, and weighing greater than 1,900 grams. METHODS: Temperatures were taken at regular intervals per unit protocol. At each interval temporal and axillary temperatures were recorded. RESULTS: Temporal temperatures were significantly higher (M = 36.9°C, SD = .59) than axillary temperatures (M = 36.7°C, SD = .68), t(124) = 6.74, p < .0001. Although statistical significance was shown between the two groups, no meaningful clinical difference was detected. CONCLUSION: Our study findings supported a new nursing practice standard for measuring infant temperatures in our mother/baby unit. Using temporal artery thermometers is now our unit's standard of care for healthy newborns.

Conceptual development of an instrument to measure the internalized stigma of AIDS based on the Roy adaptation model.

In this column the author describes the development of an instrument to measure internalized stigma of HIV/AIDS based on the self-concept adaptive mode of the Roy adaptation model. The Internalized Stigma of AIDS Tool is a 10-item instrument that is derived from the physical self (body sensation and image) and personal self (self-consistency, self-ideal and moral-ethical-spiritual self) as set forth by Roy. An overview of the Roy adaptation model and the theory of the person as an adaptive system illustrates how this instrument was derived.

Development of an instrument to measure internalized stigma in those with HIV/AIDS.

Stigma has grave consequences for persons living with HIV/AIDS. Stigma hampers prevention of HIV transmission to sexual partners and to unborn babies, diagnosis, and early treatment, and negatively affects mental and physical health, quality of life, and life satisfaction. Internalized stigma of HIV/AIDS may have even more severe consequences than perceived or enacted stigma. The purpose of this study was to develop an instrument to measure internalized stigma in those with HIV/AIDS. Data were drawn from the Rural Women's Health Project. Research assistants administered structured interviews at baseline, 3 months, and 6 months. Instruments used in these analyses included a demographic data form, the Centers for Epidemiological Studies Depression Scale (CES-D), the Perceived Stigma Scale (PSS), and the Internalized Stigma of AIDS Tool (ISAT). Exploratory factor analysis confirmed that the ten items of the ISAT measure a single factor that explains 88% of the variance in the construct. Internal consistency was demonstrated by a Cronbach's alpha of .91 (Time 1), .92 (Time 2), and .92 (Time 3). Convergent validity was supported with significant positive correlations with the CES-D (rho = 0.33, p < 0.0001) and the PSS (rho = 0.56, < 0.0001). The Internalized Stigma of AIDS Tool appears to be a reliable and valid instrument to measure internalization of the stigma of HIV/AIDS. It may be of value in research and clinical assessment.

Social context of rural Women with HIV/AIDS.

The South has more AIDS cases than any other region of the US, with most new diagnoses among African American women (56%). In a previous study, a peer counseling intervention for rural women with HIV/AIDS was developed and tested. The purpose of this analysis was to describe, from the peer counselors' perspective, the predominant concerns of the women, contextualized by living in isolated, impoverished circumstances in the rural Deep South. Following home visits, peer counselors recorded a description of the encounter. A multidisciplinary qualitative research group extracted, coded, and thematized the chief concerns and context of the women's lives. Findings provide a vivid portrait of HIV-infected women experiencing deeply troubling psychological and physiological symptoms of HIV/AIDS against the contextual ground of poverty and isolation. Themes include: (1) struggle/effort; (2) stigma/hiding; (3) loss/depression; and (4) independence/ dependence. These women lived in extremely difficult life circumstances that reflected not only a devastating chronic illness, but a life of poverty and abuse. Appropriate care for HIV-infected women living in the rural Deep South will need to address the whole context of their lives.

Cranial electrotherapy stimulation for the treatment of depression.

More prevalent in women than men, clinical depression affects approximately 15 million American adults in a given year. Psychopharmaceutical therapy accompanied by psychotherapy and wellness interventions (e.g., nutrition, exercise, counseling) is effective in 80% of diagnosed cases. A lesser known adjunctive therapy is that of cranial electrotherapy stimulation (CES). The major hypothesis for the use of CES in depression is that it may reset the brain to pre-stress homeostasis levels. It is conjectured that the pulsed electrical currents emitted by cranial electrical stimulators affect changes in the limbic system, the reticular activating system, and/or the hypothalamus that result in neurotransmitter secretion and downstream hormone production. While evidence is good for applied research, basic research about the mechanisms of action for CES remains in its infancy. A review of the literature provides an overview of current research findings and implications for clinical mental health practice.

Understanding and responding to HIV/AIDS stigma and disclosure: an international challenge for mental health nurses.

Stigma and discrimination are challenges in the care and treatment of persons with HIV infection worldwide. Fear of negative social consequences often causes persons with HIV/AIDS to keep their infection secret, resulting in negative psychological and physical outcomes and continued spread of the disease. Mental health nurses have a unique opportunity to influence the trajectory of HIV/AIDS though counseling and interventions that address HIV/AIDS stigma with clients, communities, and society. This article provides an in-depth examination of HIV/AIDS stigma and its relationship to nondisclosure as well as strategies to deal with these issues at individual and group levels.

Men seeking sex on an intergenerational gay Internet website: an exploratory study.

OBJECTIVE: This study explored the characteristics and sexual behaviors reported by men who have sex with men (MSM) seeking sex on an intergenerational website. Of special interest was to determine whether and how seeking sex on the Internet contributed to risky sex behaviors. METHODS: This descriptive exploratory study extracted data from a stratified random sample of 1,020 profiles posted by men seeking sex on a gay intergenerational website. Frequencies and percentages were calculated for all categorical variables. Analysis of variance was used to test for differences in subgroup categories. RESULTS: The men in the sample were primarily Caucasian (92.3%) with a mean age of 50 years (range: 18-88 years). More than one-fourth of the men (28.5%) reported being married. Of the married men, 76.0% indicated they would engage in receptive anal intercourse. Only a small number of men in the total sample expressed interest in safe sex (17.5%), while 91 men (8.9%) directly stated that they wanted unsafe sex. Most men in the sample were seeking intergenerational sexual encounters, with 71.0% of younger men expressing a preference for older men. CONCLUSIONS: The Internet can play a significant role in seeking same-sex encounters across generational groups. Safe sex was not a stated priority for most men in this study, and the Internet provides an effective method of seeking unsafe sex. A number of MSM seeking sex on the Internet were married and Caucasian. This finding suggests the need for greater attention to married and/or publicly identified Caucasian, heterosexual men in human immunodeficiency virus prevention efforts. Effective Internet-based prevention programs need to be implemented and researched.

Embodied work: insider perspectives on the work of HIV/AIDS peer counselors.

Our aim in this study was to explore HIV/AIDS peer counseling from the perspective of women actively engaged in this work within the context of a community-based program in rural areas of the southeastern United States. Based on this research we suggest that the embodied work of HIV/AIDS peer counselors is constructed around their personal identities and experiences. This work involves gaining entry to other HIV-positive women's lives, building relationships, drawing on personal experiences, facing issues of fear and stigma, tailoring peer counseling for diversity, balancing risks and benefits, and terminating relationships. Peer counselors recognize the personal and collective value of their work, which, like much of women's work within the context of family and community, lacks public visibility and acknowledgment. We discuss implications for the training and support of peer-based interventions for HIV and other women's health issues across diverse contexts and settings.

Moderate intensity exercise training reverses functional aerobic impairment in HIV-infected individuals.

HIV infection and HIV drug therapies result in physical and psychological challenges to those living with HIV. These conditions contribute to decreased functional aerobic capacity (FAC). The aim of this study was to determine the effects of a combined moderate-intensity aerobic and resistance exercise intervention on the FAC of HIV-infected individuals. Forty HIV-infected individuals were randomized to an exercise group (EX) who completed six weeks of moderate-intensity exercise training, or to a control group (CON) that did not receive the exercise intervention. Twice weekly, the EX group completed 30 minutes of moderate-intensity aerobic training followed by moderate-intensity resistance training. Prior to, and following, the intervention the FAC for each subject was determined by graded exercise treadmill stress test (GXT). At baseline testing, the mean FAC as determined by treadmill time-based estimation of maximal oxygen consumption was 25% below age-predicted values, a level of reduction indicating the presence of functional aerobic impairment (FAI). Following the intervention, the EX had a significant increase in time to fatigue and estimated VO(2) max (p<.001). Further, FAI was eliminated (1% above age predicted values) during the exercise training. The EX group also experienced decreased heart rates during Stages 1 (p=.02), 2 (p=.01), 4 (p=.05) and 6 (p=.02) of the GXT. The CON had no significant changes during the intervention period. These data indicate that six weeks of combined moderate-intensity aerobic and resistance training can improve FAC and eliminate FAI in those with HIV. Results suggest that the functional limitations common in HIV-infected individuals are due in part to detraining that is reversible through moderate exercise adherence.

Social support, coping, and medication adherence among HIV-positive women with depression living in rural areas of the southeastern United States.

This study examined the relationships among sociodemographic factors, social support, coping, and adherence to antiretroviral therapy (ART) among HIV-positive women with depression. The analyses reported here were limited to the 224 women receiving ART of 280 women recruited from community-based HIV/AIDS organizations serving rural areas of three states in the southeastern United States. Two indicators of medication adherence were measured; self-report of missed medications and reasons for missed medications in the past month. Descriptive statistics, correlation, and regression analyses were performed to systematically identify sociodemographic, coping, and social support variables that predicted medication adherence. In regression analysis, three variables were determined to be significant predictors accounting for approximately 30% of the variability in the self-report of reasons for missed medications. Coping focused on managing HIV disease was negatively associated, while coping focused on avoidance/denial and number of children were positively associated with reasons for missed medications. Coping by spiritual activities and focusing on the present mediated the effect of social support on self-reported missed medications. The relationship of predictor variables to self-report of missed medications was assessed using t test statistics and logistic regression analysis to determine the odds of self-reported medication adherence. Satisfaction with social support (p = 0.04), and coping focused on managing HIV disease (p = 0.002) were the best positive predictors, whereas number of children (p = 0.02) was the lone significant negative predictor of medication adherence. The study findings have implications for designing, implementing, and testing interventions based on social support and coping theories for achieving better adherence to HIV medications.

Creativity in older adults: a plethora of possibilities.

Aging continues to be an important topic of study. For many older adults, the elder years can be a challenging, if not difficult, time. Creativity interventions have been shown to positively affect mental and physiological health indicators. The process of creating and one's attitude toward life may be more important than the actual product or tangible outcome. While many activities are those typically thought of as creative, such as painting, there are also a number of useful interventions that are not traditionally identified as creative ones, but that are, in fact, creative activities. This paper describes recent work with creativity in older adults, including research and clinical projects, and earlier works that could be refined as creative interventions. Recommendations for further investigation of creativity also are presented.