Depression burden, self-help interventions, and side effect experience in women receiving treatment for breast cancer.

PURPOSE/OBJECTIVES: To describe effects of a set of Self-Help Intervention Project (SHIP) interventions with self-reported depression burden on the side effect experience of women receiving treatment for breast cancer. DESIGN: Repeated measures, experimental design. SETTING: Outpatient sites at a regional cancer center, private practices, and health maintenance organizations. SAMPLE: 169 women who completed data at all three data-collection points were used to answer the research questions. METHODS: Following random assignment, individuals in the treatment group participated in five different, but complementary, self-help interventions for six weeks. The control group received the usual care. Variables were measured at baseline after radiation, chemotherapy, or hormone therapies were started to allow for the side effects to emerge at six to eight weeks after treatment and three months following time 2. MAIN VARIABLES: Depression burden, fatigue burden, pain burden, nausea burden, difficulty concentrating burden, anxiety burden, number of side effects, severity of side effects, and participation in the interventions. FINDINGS: Self-reported depression burden was found to significantly influence severity of side effects, number of side effects, and the burdens of fatigue, difficulty concentrating, and anxiety. Depression burden did not significantly influence the side effect burdens of nausea or pain. Depression burden interacted with the self-help interventions over time for the side effect of fatigue, but the intervention effect on pain burden and nausea burden was not influenced by depression burden over time. No significant intervention effects were found for the burden of difficulty concentrating or anxiety, the number of side effects, or perceived severity of side effects. The interventions significantly reduced the fatigue, pain, and nausea burden in women with breast cancer. CONCLUSIONS: The interventions were particularly helpful, relative to their fatigue experience, for women reporting a high level of depression burden. Findings also contribute to conceptual clarification of essential aspects of the side effect experience and provide a basis for measure and intervention refinement. IMPLICATIONS FOR NURSING PRACTICE: Every woman who is undergoing cancer treatment should be assessed for depression and depression burden. Self-help interventions are effective and convenient treatments that reduce side effects and promote quality of life in women with breast cancer.

Community analysis for health planning with vulnerable populations.

This article describes how advanced practice nurses used a theory-based community health analysis process to examine the healthcare services most needed and used by an adult public housing community and to examine the satisfaction of the community with those services. The goal of the project was to determine if the identified needs would be amenable to an alternative healthcare delivery model, such as an academic nursing clinic. Data were collected using the Health Needs and Health Status Survey, Center for Epidemiological Studies-Depression scale, interactive participant interviews, key informant interviews and observations. Community residents (N = 242) were typically unmarried, middle-aged, and low income and had multiple chronic physical illnesses, serious and persistent mental illnesses, and/or disabilities. Despite the high identified service need, use of preventative or routine healthcare services was low, with residents using emergency services inappropriately or delaying care until requiring more expensive intensive healthcare services.

Depression, service need, and use in vulnerable populations.

Health care reform has created opportunities for mental health nurses to develop innovative health care delivery models to provide integrated behavioral health and primary health care. A community health analysis is one method to ensure appropriate services are planned. This study examined the health care services most needed and those used by depressed and nondepressed participants (N = 231), and their satisfaction with these services. Individual and system characteristics were examined using a framework developed by Anderson and Aday. Significant differences were found between the 2 groups for predisposing characteristics, enabling characteristics, need for care, service use, and satisfaction with services.

Depression, psychosocial resources, and functional ability in older adults.

The purpose of this study was twofold: to examine the differences between two groups of older adults (depressed, nondepressed) for physical health impairment, psychosocial resources, and functional abilities, and to describe the impact of depression, physical health impairment, and psychosocial resources on functional ability. Seventy-eight community-dwelling older adults, age 60 to 75 years, were divided into two groups based on their depression scores. Depressed and nondepressed participants were not significantly different for demographic and illness characteristics, except for income. Depressed participants reported greater physical health impairment, decreased social resources, diminished feelings of economic well-being, and decreased functional abilities when compared to nondepressed participants. Mastery, physical health impairment, and social support were significant predictor variables of functional ability. Mastery was a particularly salient psychological resource for total functional abilities and interventions should be targeted to increasing mastery in older adults.

Nurse practitioner interventions for domestic violence.

The purposes of this study were to (1) identify interventions used by a sample of adult and family nurse practitioners (NPs) with suspected cases of domestic violence and (2) determine if the interventions used had theoretical and empirical support. Sixty vignette responses from 20 NPs were analyzed using content analysis and compared with the literature. The NPs in this sample diagnosed domestic violence in only 60% of the cases. A total of 12 intervention categories (e.g., screening, physical examination, medical treatment, or counseling) were developed. Twelve categories were theoretically supported, and one category had empirical support. These findings support the need for heightened awareness of domestic violence for proper diagnosis and for use of theoretically and empirically supported interventions.

Depression, physical health impairment and service use among older adults.

The purposes of this study were: (1) to compare service use and need among 80 community-dwelling older adults (55 women and 25 men); and (2) to examine the influence of depression on service use and need. Participants were divided into three groups based on their depression scores (no depression, mild depression, severe depression) and compared on a wide range of services. (e.g., medical services, social/recreational, transportation) typically used by older adults. There were no significant differences among the three groups for demographic characteristics and chronic illness types, but there were significant differences for physical health impairment (PHI). When controlling for PHI, significant differences were found among the groups for mental health services, psychotropic medications, number of sick days, hospitalizations, home help, frequency of transportation, social/recreational services, and sports-related activities. Mildly and severely depressed older adults used and needed more medical services than did their non-depressed cohorts, but used less of other types of services (e.g., social/recreational services). Depression was a significant predictor of social/recreational service use, and for need of mental health services, psychotropic medications, financial assistance, and assessment and referral services. A consistent pattern was found of depression influencing service use and need.

Family members' experiences living with members with depression.

Using interview data from 11 family members and grounded theory methods, this study describes family members' experiences in living with a member with depression. Findings suggest that this process can be described as family transformations. In the first stage of this process--acknowledging the strangers within--family members described observing the metamorphosis of the person and other family members, finding socially acceptable explanations, living two lives, searching for reasons and solutions, and hoping for what was. In the second stage--fighting the battle--family members alternated between the strategies of holding our ground (protective) and of moving forward (coercive) to counteract the metamorphosis, and the strategy of working the system to get help for their ill member. In the third and final stage, family members described gaining a new perspective and identified preserving oneself, refocusing on others, redesigning the relationship, and becoming hopeful as strategies used in this stage.

Knowledge of depression and application to practice: a program evaluation.

The purposes of this program were to determine whether participants gained more comprehensive knowledge about depression and if that knowledge was applied in practice following attendance at a 3-day educational workshop. Twelve programs were conducted in three southwestern states. The majority of the 363 participants were Anglo-White female registered nurses whose ages ranged from 23 to 74 years and who worked in general medical-surgical units, nursing homes, or community health settings. This study was a repeated-measures design to evaluate the effects of depression education on depression knowledge and its clinical application. Participants demonstrated increased depression knowledge and practice application following the program. Knowledge of depression remained stable across postprogram measures. Although application of interventions decreased between 6 weeks and 6 months, assessment skills remained stable. Mental health nurses can improve patient outcomes through programs such as the one described by educating nurses in the detection and management of depression.

The challenge of detection and management of alcohol abuse among elders.

Alcohol abuse and dependence, defined in the Diagnostic and Statistical Manual of Mental Disorders (3rd edition, revised), is a serious mental health problem in older adults. It affects an estimated 2.5 million older adults. The true extent of alcohol abuse and dependence among elders is likely even greater as many problem drinkers go undetected. Alcohol abuse can seriously predispose the elderly to accidents, nutritional deficiencies, and diseases, and eventually result in loss of independence. The purpose of this article is to (1) describe the profile of older alcoholics in the acute care setting who typically mask as medical management seekers, (2) relate some of the difficulties involved in accurately identifying the problem of elder alcohol abuse, and (3) suggest strategies to improve intervention by CNSs.

Physical health impairment and depression among older adults.

Factors were examined that contribute to depression among older adults, aged 60 to 75 years. A convenience sample of 80 older adults living independently in the community was used. There were no differences found between participants with high or low physical impairment for demographic characteristics. Significant differences were found between the two groups for mastery, social resources and depression. Mastery, social resources and economic resources were significant predictors of depression. The findings support the empirical and theoretical links between stressful life events, specifically physical health impairment, and depression.

Children's knowledge of internal anatomy: conceptual orientation and review of research.

Children's understanding of health and illness is influenced by their knowledge of internal anatomy and physiological functioning. This article provides a comprehensive review of studies of children's knowledge of internal anatomy, one component of internal body image. Consistencies, controversies, and methodological issues that emerge across the studies are discussed. A conceptual framework for the development of children's internal body image is presented. The framework posits relationships between cognitive development, health status, knowledge of internal body image, and understanding of physiological functioning. Future studies are needed to test and refine the conceptual framework and to develop interventions to facilitate children's internal body image.

Coping, life-style changes, health perceptions, and martial adjustment in middle-aged women and men with cardiovascular disease and their spouses.

This descriptive study was designed to compare the coping responses, life-style changes, health perceptions, and current marital adjustment in 11 middle-aged women (CD women) with those of 37 men (CD men) who had been diagnosed as having cardiovascular disease. A secondary purpose was to compare their spouses' responses on these same measures. Participants were comparable on demographic and illness characteristics. CD women differed from CD men for the three coping responses of distancing, accepting responsibility, and planful problem-solving; for the total health perceptions scale; and for the current health and resistance to illness subscales. The CD women and CD men differed from their partners in total health perceptions, current health, and resistance to illness. CD women and their husbands were more dissimilar in their coping responses than were CD men and their wives. Age and pre-illness satisfaction were significant predictor variables for the coping strategies of distancing and accepting responsibility.

Depression assessment and management: evaluating a community-based mental health training program for nurses.

This mental health training program was designed to increase primary care nurses' knowledge and skills about depression. The program emphasized criteria for assessing depression, presented psychopharmacologic and psychotherapeutic content, discussed care coordination among several agencies and providers, and addressed referral resources. Cultural and developmental issues were highlighted. The 237 participants had significant knowledge gains after the program on comparison of pretest and posttest measures. Client record audit found significant increases in the assessment of and intervention with depression. The training program successfully increased primary care nurses' abilities to use knowledge about depression in clinical practice.

Men with cardiovascular disease and their spouses: coping, health, and marital adjustment.

This study examined the coping methods, health perceptions, and marital adjustment of 37 middle-aged men with chronic cardiovascular disease and their spouses. Despite variation in disease types and the absence of disease among the spouses, the couples were similar in their coping responses. Both partners used more emotionally focused strategies than problem-focused strategies to cope with chronic illness. Subjective health perceptions were more useful than objective indices for predicting coping. Preillness and current marital adjustment were satisfactory for both partners. The major implications for nursing practice are in the area of assessment, and suggested interventions are discussed.

Assessment and management of depression: an imperative for community-based practice.

The purpose of this mental health training program was to increase primary care nurses' knowledge and skills about depression. The program emphasized criteria for assessing depression, presented psychopharmacological and psychotherapeutic content, discussed care coordination among multiple agencies and providers, and addressed referral resources. Highlighted were cultural and developmental issues for Native Americans, Mexican-Americans, the elderly, and adolescents. The training program successfully increased primary care nurses' knowledge about depression and their abilities to use this knowledge in clinical practice.

Deaf and hearing children's conceptions of the body interior.

PURPOSE: To determine if deaf and hearing children differ in their conceptions of the body interior and to examine children's conceptions of their internal bodies at three different age stages. METHOD: Eighty deaf children and 190 hearing children ages 5 to 15 years were grouped by age to reflect preoperation, concrete operation, and formal operation stages of cognitive development. The Goodenough-Harris Draw-A-Person and Inside-the-Body Test were administered. Results were analyzed by ANOVA. RESULTS: Deaf children in each of the three groups knew significantly fewer body parts than the hearing children. Adolescents knew significantly more about their body interiors than did the younger age groups. CONCLUSION: Results of this study lend empirical support to Crider's (1981) development theory of how conceptions of the body interior develop.

Using motivational theory with the long-term psychiatric client.

This article discusses how psychiatric nurses or nursing students can use motivational theory to work with the long-term client. It is primarily nurses who work most continually with all phases of the long-term client's responses to his or her illness and deal most directly with his or her frustration and despair. This article describes the practical application of motivational theory with a group of clients who demonstrate typical variability in their illness responses. A combination of paper-and-pencil exercises, the Goal Attainment Scaling form (Garwick & Brintelli, 1977) and Checklist for In-Session Achievement, can be used with role play to assist clients to achieve their goals. Nurses and clients are both more likely to experience success when reasonable goals are set, and the focus for treatment is on ability rather than disability.