The Role of Cognitive Appraisal in Quality of Life Over Time in Patients With Cancer.

OBJECTIVES: To better understand how personal factors, contextual factors, and cognitive appraisals predict quality of life. SAMPLE & SETTING: 81 patients with a new diagnosis of cancer were recruited from two oncologists' offices in the midwestern United States. METHODS & VARIABLES: A longitudinal design was used to collect data at three time points. RESULTS: Individuals identified a variety of primary appraisals at the same time and more consistently identified their cancer as a challenge rather than a harm/loss or a threat. The greatest variation in appraisals and quality of life occurred about six months after diagnosis. Hierarchical regression analyses demonstrated that age and primary and secondary appraisals explained a significant amount of variance in quality of life at all three time points. IMPLICATIONS FOR NURSING: Interventions to improve quality of life for individuals newly diagnosed with cancer are needed and may be more helpful if they target cognitive appraisals. Nurses should assess what matters to the individual; it is important to evaluate how each person appraises a cancer diagnosis so providers can support coping and adjustment from diagnosis through individual treatment trajectories.

Influencing the Binge-Drinking Culture on a College Campus.

BACKGROUND: The college years are a time of transition in which students experiment with behaviors including use of alcohol. Nursing students can be instrumental in supporting positive health behaviors and influencing the drinking culture. PURPOSE: This article describes the findings of a collaborative nursing student-faculty research project about alcohol use with a focus on binge drinking. METHODS: Using a nursing student-faculty collaborative model, a longitudinal design was used to evaluate a mass media campaign with social norming messages and education to influence the drinking culture on a college campus. RESULTS: Students in Greek life and athletics engaged in binge drinking significantly more than other students. Students observed the mass media messages, with 81.9% viewing posters. A significant decrease in binge drinking was reported. CONCLUSIONS: The nursing student-faculty team implemented a mass media campaign, which was effective at influencing the drinking culture on a college campus.

A Grounded Theory Investigation Into Sophomore Students' Recall of Depression During Their Freshman Year in College: A Pilot Study.

Using a grounded theory approach, the current descriptive qualitative design was conducted with sophomore students to understand the meaning participants gave their freshman experiences with depression. Twelve participants were recruited using scripted class announcements across campus. After informed consent, interviews began with the question: What was the experience of your freshman year in college? All interviews were completed with the primary investigator and transcribed verbatim. Interviews were analyzed using constant comparative methodology. Data collection continued until saturation was achieved. Four major categories emerged, including the category of symptoms and emotions. This category included the subcategories expressions of stress, changes in eating habits, sleep issues, and procrastination. Descriptive examples of each were found throughout the interview data. With greater understanding of living with depression as a college freshman, health care and college student affairs professionals will have additional evidence to guide their practices. [Journal of Psychosocial Nursing and Mental Health Services, 56(9),44-50.].

Cervical Cancer: Prevention and Early Detection.

OBJECTIVE: To review effective methods of prevention that can be used to control the incidence of cervical cancer and detection strategies that can identify the precancerous lesions before they become true cancer. DATA SOURCES: Current medical, scientific and nursing literature, and national and international guidelines of cervical cancer. CONCLUSION: Nearly all cervical cancers are caused by specific types of human papillomavirus (HPV). Prophylactic vaccination for HPV provides the most effective method of primary prevention against HPV-related diseases. The use of the Pap test and HPV test, according to published guidelines, provides the most effective means of screening for cervical cancer. IMPLICATIONS FOR NURSING PRACTICE: Nurses are in a key position to provide health education with the goal of supporting vaccine uptake and screening guidelines.

Journey of a Woman With Terminal Cervical Cancer.

When a cervical cancer diagnosis is made during a terminal stage, a woman is faced with many challenges. Although a terminal illness has many negative effects, such as physical pain, scarring, fear, and sexual dysfunction, women may experience a positive impact on their life, such as improved well-being and a greater appreciation of daily life. The individual experience can lead to personal revelations. Sometimes, the diagnosis can even be seen as a blessing. Understanding a personal experience in a real-life context of the terminal stages of disease is important. This story shares the day-to-day journey of a woman living with a terminal illness of cervical cancer.

Physical activity and nutritional weight loss interventions in obese, low-income women: an integrative review.

INTRODUCTION: Obesity is epidemic in the United States and is considered a public health issue that disproportionally affects low-income women. Combating obesity among low-income women presents unique challenges that must be addressed if weight loss interventions are to be successful. The aim of this integrative review was to explore and synthesize the literature that addresses physical activity and nutrition interventions used to combat obesity in obese, low-income women. METHODS: A search for original research published between 2006 and 2011 was conducted in online databases. In addition, a hand search of references was performed, and one author was contacted to clarify outcome data. Articles that met inclusion criteria targeted obese, low-income adult women; focused on physical activity or nutrition behavior as an intervention; and measured change in weight as a primary outcome. Studies that focused on women who were postpartum or breastfeeding and those that used pharmacologic or surgical interventions to augment weight loss were excluded. RESULTS: A total of 7 articles were chosen for critical appraisal. According to a synthesis of the current studies, specific weight loss interventions for physical activity and nutrition behavior change for obese, low-income women produced the desired outcome of weight loss. Participants among these studies voiced a preference for group interventions led by peers or medical professionals. Interventions led by peer educators were successful and had the advantage of lowering cost and increasing sustainability. Pragmatic nutrition education worked best, especially when cognizant of cost, food preferences, and culture. Even small increases in physical activity augmented weight loss; however, safety concerns prevented some low-income women from engaging in exercise. DISCUSSION: According to this synthesis of the best-available evidence, customized weight loss interventions are effective in obese, low-income women. By incorporating these evidence-based interventions, clinicians can be instrumental in decreasing the burden of obesity in obese, low-income women.

Influence of lifestyle, health behavior, and health indices on the health status of underserved adults.

PURPOSE: To examine how lifestyle, health behavior, and health indices best predict health status in underserved adults. DATA SOURCES: Eighty-four underserved adults from a nurse-managed center completed an investigator-developed instrument to measure lifestyle, health behavior, and health indices. The SF-12 Health Survey measured general (SF-1), physical (PCS), and mental (MCS) health status. CONCLUSIONS: The majority of the sample was female (64%). Sixty-three percent were at or below 200% of the federal poverty level. For nonsmokers, five independent variables accounted for 47.1% of the variance in SF1 (p < .000), 33.5% in PCS-12 scores (p < .001), and 23.2% in MCS-12 scores (p = .017). For smokers, six variables accounted for 48.7% of the variance in SF1 (p = .024), 41.7% in PCS-12 scores (p = .067), and 25.4% in MCS-12 scores (p = .378). IMPLICATIONS FOR PRACTICE: Findings provide partial support for the impact of lifestyle and health behaviors on health status outcomes. Focusing concurrent interventions on improving multiple behaviors may have the greatest impact on health status outcomes.

Relationships between lifestyle, health behaviors, and health status outcomes for underserved adults.

PURPOSE: To examine the relationships between lifestyle, health behaviors, and health status for underserved adults. DATA SOURCES: A convenience sample of 84 adults responded to a questionnaire on lifestyle, health behaviors, health indices, and health status. Health status was measured by the 12-Item Short-Form Health Survey (SF-12). CONCLUSIONS: The majority of the sample was white, female, ranged in age from 19 to 64 years, and had an annual income range of $0-$25,000. Lifestyle factors reported included smoking (44%), consuming alcohol (59%), using street drugs previously (43%), exercising regularly (45%), and having adequate sleep (M= 7.16 h). Sixty-five percent engaged in at least one screening behavior during the past 12 months and used at least one prescription medication. Data for health indices demonstrated subjects had at least one current symptom (89%), at least one current medical condition (72%), and a body mass index classified as overweight (48%). No significant relationships were found between lifestyle and health status. Findings indicated health indices rather than lifestyle were related to health status. IMPLICATIONS FOR PRACTICE: Findings provided selective support for the links between lifestyle, health behaviors, and health status. Nurses can use the results as a basis for future assessments and interventions with underserved adults.

Increasing mammography and cervical cancer knowledge and screening behaviors with an educational program.

PURPOSE/OBJECTIVES: To evaluate the effectiveness of using an educational program based on self-efficacy to increase knowledge and create behavior change regarding recommended mammography and Papanicolaou (Pap) test screening guidelines. DESIGN: Pretest and post-test, prospective. SETTING: An urban county in northern Indiana. SAMPLE: 56 women who attended one of four educational programs and 47 women who responded 15 months later. METHODS: The one-hour educational programs based on self-efficacy included vicarious experiences and verbal persuasion regarding breast and cervical screening practices. Two programs were offered to local church groups as part of a health fair, and two were offered through health promotion initiatives sponsored by private businesses. MAIN RESEARCH VARIABLES: Demographics, knowledge of breast and cervical cancer, and screening behaviors. FINDINGS: Knowledge of risk and screening guidelines increased significantly immediately following the educational program (p < 0.001) and did not decrease significantly 15 months later (p = 0.57). Family history and history of human papillomavirus and sexually transmitted diseases were the top known risk factors for breast and cervical cancers, respectively. Participant-reported rates of screening behaviors increased 15 months later for mammography (100%) and Pap test (84%). CONCLUSIONS: Educational interventions based on self-efficacy increased knowledge of breast and cervical health and helped increase the rate of mammography and Pap tests. IMPLICATIONS FOR NURSING: Preparing women with strategies to complete a mammogram and Pap test is an important approach to enhancing self-efficacy and increasing screening behaviors.

Evaluating the effect of teaching modules on underserved clients' perceived health.

Underserved individuals need comprehensive health care. Educational resources that meet health care needs can promote wellness. This descriptive study evaluated effects of preferred teaching modules on perceived health of underserved clients of a nurse-managed center. Participants (N = 101) were between 19 and 61 (M = 38.7); the majority was female (68.3%) with a high-school education (M = 12.17). Most participants (65%) identified health education as very important; 92% used at least one teaching module. Age, gender, and education were not related to importance of health education. Use of various teaching modules was positively correlated with perceived improved health (p < .05). Participants who used a combination of videos and pamphlets reported the greatest improvement (p < .000).

Concerns expressed by underserved individuals regarding family and community healthcare needs.

This descriptive study examines the health concerns that underserved individuals have for their family and community. Of 82 subjects completing a self-report instrument, 29% reported specific health needs for their community and 20% reported health needs for their family. Their major concerns for the community included acquired immunodeficiency syndrome and human immunodeficiency virus; their major concerns for the family related to heart disease and diabetes. Study subjects were mostly concerned with healthcare needs facing specific individuals within their family and community. Results indicated that subjects had difficulty focusing on broader health concerns because of the multiple constraints of being underserved and uninsured.

Solutions to finding graduate clinical sites for advanced health assessment.

Finding pediatric clinical sites for students in advanced health assessment courses can be challenging. By using creative planning, new methods of acquiring additional clinical sites can be developed. Three specific ideas for new site acquisition, as well as potential limitations, are suggested.

Health concerns and learning styles of underserved and uninsured clients at a nurse managed center.

The medically underserved and uninsured often seek care for immediate health concerns rather than use health promotion activities. To facilitate health promotion activities, it is important to understand the health concerns and learning styles of these underserved clients. The purpose of this descriptive study was to assess specific health concerns and identify learning styles of clients seeking care at a nurse managed center. Eighty-two participants completed the Hilltop Health Questionnaire, a self-report instrument developed by the research team. Top reasons for seeking care included upper respiratory infections (17%), routine physical (17%), medication refill (12%), and low back pain (11%). Preference for learning style included hands-on instruction (82%), reading (63%), and listening (59%). These data were used to obtain or customize teaching modules based on the clients' health concerns and preferred style of learning. Continued emphasis should be placed on health education that engages the underserved and uninsured in their care and health promotion activities.

Contextual variables, emotional state, and current and expected quality of life in breast cancer survivors.

PURPOSE/OBJECTIVES: To determine the relationship between contextual variables, emotional state, and quality of life (QOL) now and expectations for the future in survivors of breast cancer. DESIGN: Descriptive and nonexperimental. SETTING AND SAMPLE: 148 volunteers and women with breast cancer involved in a program by the American Cancer Society. Most subjects were middle-aged (mean = 52.4, SD = 11.56), were married (72%), and had graduated high school (38%). Time since diagnosis was 0.3-19 years (mean = 3.54, SD = 3.61); 74% were diagnosed more than five years ago, 54% were not receiving any treatment, and 66% had localized breast cancer. METHODS: At home, participants completed a self-report survey for personal and contextual variables, Positive and Negative Affect Scale, QOL Measurement, and Global Life Satisfaction Scale. MAIN RESEARCH VARIABLES: Time since diagnosis, extent of cancer, emotional state, QOL, and global life satisfaction. FINDINGS: Women had high positive affect (mean = 37.96) and low negative affect (mean = 17.13). QOL and life satisfaction were high. Time since diagnosis and extent of disease were related weakly to negative affect and QOL (p < 0.001). Positive and negative affect were related moderately to QOL and life satisfaction (p < 0.001). Current personal life satisfaction was significantly greater than breast cancer survivors' estimates for "most people," and survivors expected life satisfaction to increase significantly in five years (p < 0.001). Significant differences in QOL were found between those who were diagnosed recently and those who were diagnosed 10 or more years previously. CONCLUSIONS: Despite breast cancer, women have positive affect, good QOL, and life satisfaction. Contextual variables were related weakly to outcomes; emotions were related more strongly to outcomes. Survivors were more satisfied with life than they estimated others to be and expected satisfaction to increase in the future. IMPLICATIONS FOR NURSING: Nurses may use these findings to encourage patients who are newly diagnosed with breast cancer. Women with breast cancer adapt well despite potential negative outcomes, and survivors even report better QOL than they estimate for most people.