Low-income Euro-American mothers' perceptions of health and self-care practices.

OBJECTIVE: Health promotion activities may decrease preventable diseases and health system overuse. This study examined how low-income Euro-American mothers described their health/wellness, self-care practices (SCP), and SCP benefits, barriers, and interpersonal influences (norms, modeling, and social support) affecting their SCP. DESIGN AND SAMPLE: This descriptive qualitative study used a convenience sample of 10 low-income, English-speaking mothers, 25-43 years old, seeking women's/children's health services at a large urban Texas health clinic. MEASURES: Data were collected via face-to-face interviews, using a standardized semistructured interview guide; data were analyzed using Miles and Huberman's qualitative research methods. RESULTS: All participants primarily described themselves positively and as mothers and workers. Most viewed health and wellness as distinct but typically included physical and emotional well-being. Mothers valued health and SCP for personal and family reasons. All identified SCP benefits. Most identified SCP barriers. Women viewed themselves as vital to family function and well-being, learned SCP primarily from parents during childhood, and described limited support for SCP. CONCLUSIONS: The results provide a better understanding of participants' self-care decision making and are useful in designing appropriate clinical health promotions. Reducing health inequities in low-income women requires further study of the underlying causes and development of effective policies and measures to address them.

Depression in family caregivers of elders: a theoretical model of caregiver burden, sociotropy, and autonomy.

To test the diathesis-stress model for family caregivers, two structural equation models were developed to explain depression measured by the Center for Epidemiologic Studies Depression Scale. A cross-sectional convenience sample of 112 caregivers completed questionnaires to measure burden, personality traits, dysfunctional attitudes, and depression. The final model included direct paths from caregiver burden to autonomy and sociotropy, and indirect paths from burden to depression through sociotropy and autonomy. The final model fit adequately (chi(2) [224, N = 112] = 308.60, p < .00; CFI = .951; RMSEA = .058). Levels of burden influenced caregiver depression scores. One pathway to depression was though the personality traits of sociotropy and autonomy; both had a larger influence on depression scores than burden alone.

Team-based learning in an undergraduate nursing course.

To increase student participation in the learning process, active learning methods, including small group learning, have become increasingly popular in modern curricula. One kind of small group learning, team-based learning, is a relatively new instructional strategy in health care education. Team-based learning uses theoretically based and empirically grounded strategies for ensuring the effectiveness of small groups working independently in classes with high student-to-faculty ratios (e.g., up to 200:1), without losing the benefits of faculty-led small groups with lower ratios (e.g., 7:1). To explore the effectiveness of this learning pedagogy, we evaluated students' level of engagement and attitudes toward the value of teams. Findings demonstrated that team-based learning is an effective teaching strategy for large groups of students.

The relationships among acculturation, body mass index, depression, and interleukin 1-receptor antagonist in Hispanic pregnant women.

OBJECTIVE: The purpose of this study was to determine relationships between acculturation, body mass index (BMI), and depressive symptoms with the Interleukin 1-mediated inflammatory response marker IL-1RA in pregnant Hispanic women at 22-24 weeks gestation. DESIGN: An observational, prospective design with data collected at 22-24 weeks gestation. SETTING: Public prenatal health clinics and private physician practices in central and south Texas serving low-income women. MAIN OUTCOME MEASURES: Body mass index (BMI), depression scores on the Center for Epidemiological Studies of Depression (CES-D), years in the United States, the Language Proficiency Scale (LPS), and Interleukin 1 receptor antagonist levels (IL-1RA). RESULTS: The longer the Hispanic women were in the United States, the higher the IL-1RA levels in plasma (F=4.55; P=.002). IL-1RA plasma levels were significantly different between low and normal BMI vs overweight and obese categories of BMI (F=8.54; P<.001). IL-1RA levels were significantly higher between those women who had high scores for depressive symptoms on the CES-D (using a cut off of 20) and those who had scores less than 20 (t-value=-2.41; P=.018). In structural equation modeling, years in the United States significantly positively predicted increased depressive symptoms, increased BMI, and increased IL-1RA levels with a good model fit. CONCLUSIONS: We found that increasing years of residency in the United States is associated with the elevated inflammatory marker IL-1RA, and increased BMI. Increased depressive symptoms also predict IL-1RA levels among Hispanic women at 22-24 weeks of pregnancy. The significance of these findings is discussed in relationship to the development and course of disease.

The Role of Linguistic Modification in Nursing Education.

BACKGROUND: English-as-a-second-language (ESL) nursing students fail to graduate from programs at alarming rates. For many of these students, academic failure results from poor performance on multiple choice examinations, which frequently contain linguistic errors. A remedy for these errors is to linguistically modify examination questions. This study assessed the effects of linguistic modification on examination scores. METHOD: Scores of ESL and non-ESL nursing students were compared on an experimental multiple choice examination and a control examination. RESULTS: After exclusion, 67 ESL and 252 non-ESL students completed the experimental examination; 68 ESL and 257 non-ESL students completed the control examination. CONCLUSION: Both ESL and non-ESL students scored higher on the experimental examination than on the control examination. For ESL students, the increase in observed means between the experimental and control examination was 0.6%; for non-ESL students, the increase was 0.48%. [J Nurs Educ. 2016;55(6):309-315.].

Knowledge and health beliefs related to heart disease risk among adults with type 2 diabetes.

PURPOSE: The purpose of this descriptive correlational study was to describe knowledge of cardiovascular disease (CVD) risk and to explore relationships between this knowledge and health beliefs and adherence among adults with type 2 diabetes. DATA SOURCES: A convenience sample of 212 adults with type 2 diabetes completed the Heart Disease Fact Questionnaire and the health beliefs related to CVD Scale. CONCLUSIONS: Knowledge was high for the majority of the sample. Deficits included the link between cholesterol and heart disease; CVD risk factors; and exercises for lowering CVD risk. Significant between-group differences occurred across education level (p = .021) and race (p = .045); participants with less education and who were Hispanic had the lowest knowledge scores. Among the health belief model variables, knowledge was only a significant predictor of perceived benefits (p = .033) and barriers (p = .00). The most common sources of information about diabetes and CVD were TV/radio/magazine/newspaper, healthcare providers, and patient education brochures, with substantially less exposure to CVD information. IMPLICATIONS FOR PRACTICE: This study identified content to emphasize in interventions to improve awareness of CVD risk among adults with diabetes. Hispanic patients and those with low education levels are particularly in need of interventions appropriate to their education level and cultural orientation.

NEXus: evaluation of an innovative educational consortium for doctoral education in nursing.

The purpose of this article is to describe the evaluation of the Nursing Education Xchange (NEXus), a national consortium of doctor of philosophy in nursing (PhD) and doctor of nursing practice programs, administered by the Western Institute of Nursing, which offers courses on-line. An external evaluator surveyed and interviewed faculty and staff coordinators, students, and the Western Institute of Nursing Board Members about their experiences with NEXus. Overall, individuals' perceptions of the NEXus program were positive. Some challenges in registering at other universities were addressed. The program helped PhD in nursing students complete their programs of study on time. Expansion of the program was recommended to offer more opportunities for students to take courses with experts in their areas of interest. Challenges and successes are discussed to assist others contemplating a consortium approach.

Case management in the undergraduate curriculum.

The redesign of an undergraduate curriculum at one baccalaureate nursing program resulted in adoption of a required course on case management for chronic illnesses. The course is structured around rehabilitation standards and medical-surgical and community health principles of nursing care. A service-learning model was used to develop the clinical experience, which involved student nurses visiting the homes of individuals with chronic illnesses. These visits were made in collaboration with personnel from community-based agencies or programs. This article discusses the design of the course and some of the content areas and clinical activities.

Measuring student perceptions of clinical competence.

In a large, southwestern, Gulf coast school of nursing, the faculty sought additional information to enhance their clinical evaluations of students. To gather such information, the faculty developed a rapid and psychometrically sound evaluation tool that elicited students' self-efficacy beliefs for newly learned clinical skills, and the perceived importance of the clinical skills they were mastering. The Self-Efficacy for Clinical Evaluation Scale (SECS) is a 30-item, dual-response scale that demonstrates strong psychometric properties. Scores on the SECS help faculty identify skills or content areas that students feel little confidence in using, even when students value those skills or content as very important. These insights are assisting course leaders in tailoring the course structure and teaching strategies to better meet students' educational and practice needs.

Psychosocial and biological indicators of depression in the caregiving population.

Estimates suggest that 25-50% of family caregivers experience depression. Recent research has linked psychological stress and depression symptoms to increased cytokine activity. This study was designed to investigate the predictors of high cytokine levels and their influence with personality factors on depression in a caregiving population. The authors examined the relationship between caregiving burden and depression through the influence of sociotropy, autonomy, and cytokine levels in a sample of 106 caregivers who were actively caring for an elderly dependent in the community. Though the authors did not establish a mediation model, they found that the personality sub-factors of sociotropy, predicted tumor necrosis factor receptor (TNFR1) levels, while burden significantly predicted interleukin-6 and C-reactive protein (CRP) levels. Additionally, burden and TNFR1 levels predicted depression, with greater burden and TNFR1 levels predicting increased depression severity. Study findings point to a need for early interventions for caregivers to prevent increases in stress and cytokine levels and the development of depression.

Evaluating if patient self-perceptions of competencies have an influence on biological indicators for cardio-metabolic health.

The purpose of this retrospective exploratory study was to evaluate how two important aspects of Bandura's theory, conviction of the importance of the behavior, and the self-efficacy to perform the behavior, motivates an individual to change or improve life style behaviors.