Patient factors associated with initiation of behavioral weight loss treatment: a prospective observational study in an integrated care setting.

Low enrollment in behavioral weight loss treatments limits their impact. We aimed to identify factors associated with treatment initiation. The participants were outpatients (n = 198) at Veterans Affairs (VA) healthcare facilities who were referred to a free VA-based behavioral weight loss treatment. Participants were assessed on psychosocial factors potentially relevant to treatment initiation. Subsequent treatment initiation was determined via medical record review. Study participants were 77 % male, 60 % African American, and 54 % initiated treatment. In multivariable analyses, treatment initiation was associated with being single, higher anxiety, and patients' perceptions that referring provider supported their weight autonomy. Endorsement of treatment barriers was not associated with treatment initiation. Treatments offering in-person sessions and mood management components were rated as more preferred. Initiation of behavioral weight loss treatments may increase if patients believe that providers respect their weight control autonomy and if healthcare organizations offer treatments that match patients' preferences.

Education issues surrounding the teaching of spirituality.

This article explores the emerging debate surrounding the teaching of spirituality in nurse education programmes. It is suggested that both historical and traditional approaches to nurse education can be complementary in preparing nurses to meet patients' spiritual needs.

Student discontinuations: is the system failing?

Are nurse educators guilty of hypocrisy? While espousing holism and evidence-based practice, we may be neglecting to support the most distressed and vulnerable in our care--students. Student discontinuation arouses strong emotions, which need to be expressed and resolved. These are often unresolved leaving students and educators frustrated and alienated in 'failure'. Although it cannot be expected that all students will succeed as professionals and academic standards must be maintained, those who fail have a right to expect fairness. With the advent of Subject Quality Review (formally TQA) institutions of higher education may be asked to demonstrate their operational mechanisms for 'managing' the process of student failure. Now would be the best time for departments of nurse education to reflect on experience, review attrition rates and learn from each other in order to establish a model of best practice. Such a review may generate the formulation of national guidelines, safe guarding against the looming threat of litigation.

The debates emerging from the literature surrounding the concept of spirituality as applied to nursing.

This paper explores three debates surrounding the growing concept of spirituality as applied to nursing: 'Spirituality: in pursuit of conceptual and theoretical unity'; 'The demise of spirituality and the rise of secularism within nursing'; and 'Spirituality: a unifying force at the foundation of holistic philosophy'. The debates reveal the complex and diverse nature of spirituality suggesting that there is no single authoritative definition. The debates challenge the nursing profession to develop a definition of spirituality which is broad enough to accommodate the uniqueness of all individuals.

Nurses' perceptions of spirituality and spiritual care.

This research study illustrates nurses' concern about spiritual care and the author demonstrates why this issue needs to be researched more fully to prepare nurses to fulfil this role appropriately.

The spiritual dimension: why the absence within nursing curricula?

This article explores the complex barriers which may have prevented the formal integration of the spiritual dimension within programmes of nurse education in the UK. These barriers have been termed intrinsic (arising from within the educational institutions themselves) and extrinsic (reflecting society's and individuals' values, beliefs and cultural norms). It is argued that these barriers have slowed down curriculum innovation and change, preventing the spiritual dimension from receiving due recognition within programmes of nurse education.

Behavioral assessment of relaxation: the validity of a Behavioral Rating Scale.

Poppen (Behavior Relaxation Training and Assessment, 1988) has developed an observational method of assessing the degree to which individuals show a relaxation response. Although promising, this method, the Behavioral Rating Scale (BRS), has yet to be thoroughly investigated. Subjects in this study were randomly assigned to a progressive relaxation training group or an attention-control group. Following a training period, subjects participated in a laboratory session in which self-report measures of relaxation were obtained, physiological measures were monitored, and behavioral observations were made using the BRS. Results supported the use of the BRS as a valid, observable measure of an individual's relaxation response. Discriminant validity was demonstrated by between-group differences on the BRS and construct validity was shown by significant correlations between changes on the BRS and changes on self-report and physiological measures. It is argued that, though alternative explanations are feasible, this study's results support the use of the BRS as an effective assessment tool when measuring an individual's response to progressive muscle relaxation.

The stress response in headache sufferers: physiological and psychological reactivity.

When examining headache sufferers' reactivity to stress, few studies attend to differing characteristics of the environment. In this study, we evaluated the influence of the clarity/ambiguity and positive/negative valence of an event on subjects' physiological and psychological reactivity. Migraine (n = 30), tension (n = 39), and control (n = 35) subjects participated in a laboratory experience in which they had to practice and then deliver a news story to a videocamera (similar to a newscaster on television). During this experience, they received performance feedback and were instructed to try to use the information to improve their performance. In reality, this feedback was noncontingent, with subjects semirandomly assigned to either a positive, negative, or ambiguous feedback condition. Physiological and psychological measures were collected prior to this experience, during an anticipation or practice period prior to the newscast, and during a recovery period following the delivery of the news story. Results suggested that tension subjects might not attend to information from their environment when assessing, responding, or reevaluating potentially stressful events: relying instead on more global beliefs or attributions. Results also indicated that migraine might be associated with a prolonged cardiovascular response (i.e., delayed recovery) following a stressful experience.

The reflective diary: an aid to practice-based learning.

This article explores the use of reflective learning diaries in conjunction with a modified form of the Benner assessment tool (Benner 1984). The authors describe a practicum, based on the findings of a small action research study for the development and use of reflective diaries during clinical placement. The results suggest that students, preceptors, reflective diaries and assessment tools can be combined to create a positive learning environment.

Sense of coherence: its effects on psychological and physiological processes prior to, during, and after a stressful situation.

This study examined whether Antonovsky's (1987) stress-resistance construct, sense of coherence (SOC), affected individuals' psychological and/or physiological responses to a controlled stressful situation. Subjects were assessed for SOC level and then completed a battery of questionnaires before and after a stressful situation. Physiological responses were monitored during baseline, anticipation, and recovery periods. Analyses examined differences among low, middle, and high SOC groups and revealed group differences in psychological distress, cognitive appraisal, coping processes, and pulse rate. These results provide some support for the validity and utility of Antonovsky's SOC construct by indicating that low SOC subjects show more distress and appraise and cope with stressful situations in ways less likely to resolve or eliminate their distress.

Assessing nicotine dependence: a comparison of the Fagerström Tolerance Questionnaire (FTQ) with the Fagerström Test for Nicotine Dependence (FTND) in a clinical sample.

A recent effort to improve the psychometric properties of the Fagerström Tolerance Questionnaire (FTQ) resulted in the revised Fagerström Test for Nicotine Dependence (FTND). We endeavored to replicate and extend findings suggesting the superiority of the FTND by examining the psychometric properties of both instruments, as well as their relationship to self-report and biochemical variables associated with nicotine dependence in 110 smoking clinic participants. Results verified that the FTND represents a modest improvement over the FTQ, however, the need for continued development of self-report measures of nicotine dependence is noted.