Impact of caregiving: listening to the voice of informal caregivers.

Long-term care of the elderly and the disabled rests on a vast network of informal caregivers. This qualitative study examined the effects of caregiving on the health and wellbeing of a small, non-representative sample of urban women caregivers. These 11 informants participated in two interviews. Health was conceptualized in a holistic manner, consistent with the view of the World Health Organization and Health Canada. The caregiving experience, as described in this study, was life changing and consuming. Analysis revealed that the domain of caregiving could be captured by three dominant themes: loss and grieving; adapting and coping; and the short- and long-term impact. The consistency in the findings and policy recommendations of studies of informal caregiving begs the question: when will caregivers finally be heard?

Understanding nursing students' stress: a proposed framework.

A paucity of comprehensive research, as well as inconsistent application of theories/conceptual frameworks, have resulted in a limited knowledge of stress in nursing students. The purpose of this paper is to establish a framework for understanding the stress/coping/adaptation process in the nursing student population. To this end, Pollock's Adaptation Nursing Model (Pollock 1984) is discussed and subsequently recommended as a possible alternative. Utilization of this framework as an organizing construct for the paper facilitates a comprehensive review of recent literature related to stress in undergraduate nursing students. In addition, it is proposed that Pollock's model can provide nurse educators, practitioners, administrators and researchers with a framework for understanding nursing students' stress.

Serum ferritin and heart disease: the effect of moderate exercise on stored iron levels in postmenopausal women.

OBJECTIVE: To determine the effect of a moderate exercise regimen on stored iron as measured by serum ferritin in previously sedentary postmenopausal women. DESIGN: Randomized assignment to one of three groups: a five day/week walking group (five-day group, n = 27); a three day/week walking group (three-day group, n = 27) or a sedentary group (control group, n = 25). SETTING: Community-based intervention. PARTICIPANTS: Women who were postmenopausal, over 50 years old, sedentary, not on hormone replacement therapy, nonsmokers, physically capable of exercising, without clinical signs of cardiovascular, pulmonary or metabolic disease, and not on medication that would affect iron metabolism. In addition, they had neither donated blood nor been transfused within the previous 12 months. All participants were screened volunteers who had responded to media advertisements. Seventy-nine participants met these criteria. Results are reported for 56 subjects (five-day group, n = 17; three-day group, n = 19; control group, n = 20) who completed the study. Their mean age was 61.3 +/- 5.8 years. INTERVENTION: The five-day group and the three-day group walked an average of 279 +/- 20 and 171 +/- 7 mins/week, respectively. Participants were counselled not to change their dietary intake. MAIN RESULTS: Following 24 weeks of walking, mean serum ferritin decreased significantly in the five-day group (P < 0.03), but not in the three-day group (P < 0.09) compared with controls. CONCLUSIONS: The extent of physical activity required to elicit a decrease in stored iron in postmenopausal women was determined. This may be clinically significant because stored iron increases significantly following menopause and excess stored iron have been cited as risk factors for coronary artery disease.

Stress in critical care nurses: actual and perceived.

OBJECTIVE: To describe the stressful work experiences and the perception of stress in female critical care nurses, and to explore possible relationships between these variables. DESIGN: A descriptive, correlational study. SETTING: Two Canadian, university-affiliated, tertiary care hospitals. SUBJECTS: A convenience sample of 96 female nurses, with at least 1 year of critical care experience, currently working in adult intensive care units. INSTRUMENTS: Subjects were administered a demographic instrument, the Critical Care Nursing Stress Scale, and the Perceived Stress Scale. RESULTS: Ranking the stressful work situations revealed that patient care-related stressors ranked the highest overall. Although lack of control appeared to be a common element among those situations ranked as the most stressful, there was considerable diversity in the stressor rankings between the individual units. There were significant correlations between perceived life stress and the perceived severity of work stressors (r = 0.296, p < 0.005), as well as between actual (frequency) and perceived (intensity) stressful work events (r = 0.50, p < 0.001). CONCLUSIONS: This study provides valuable insight into the actual and perceived stressful experiences of critical care nurses, thus contributing to the ongoing effort to reduce burnout in this population. The findings also establish a foundation for further nursing stress research in the context of the Adaptation Nursing Model.

Influence of walking volume on health benefits in women post-menopause.

The health benefits of physical activity are believed to be related more to exercise volume than to intensity. In this 24-wk study, we examined the effect of walking volume on aerobic fitness, serum lipids, and body composition in women post-menopause, a population at risk for coronary artery disease. Of 79 women randomly assigned to groups at the outset, 56 completed the study (mean age 61.3 +/- 5.8). Participants walked at an intensity of 60% peak oxygen uptake (VO2peak) for 60 min, 3 d.wk-1 (N = 19) or 5 d.wk-1 (N = 17), or remained sedentary (N = 20). Walking 3 or 5 d.wk-1 increased VO2peak (ml.kg-1.min-1) by 12% and 14%, respectively (P < 0.01). There were no changes in serum lipids in response to either program. Percent body fat decreased by 1.1% and 1.3% in those walking 3 and 5 d.wk-1, respectively; both changes significantly different from the control group (P < 0.05). Walking 5 d.wk-1 did not result in more health benefits than 3 d.wk-1, possibly due to a greater compensatory decline in activities other than the walking program, or greater discrepancies between actual and reported activity and food intake. Longer-duration programs, or simultaneous changes in diet, may be necessary to alter serum lipids in nonobese, normo-lipidemic women post-menopause.

Challenges to achieving quality care: efficiency, effectiveness and beneficence.

At first glance it would seem strange to suggest that efficiency, effectiveness and beneficence, all positive and desirable goals, could challenge nurses' achievement of quality health care. However, as shown below, attitudes and actions reflecting either the overly zealous pursuit of any of these or an attitude of complacency can compromise or threaten the quality of care.

Lifestyle profiles of hypertensives.

Healthy lifestyles and quality of life are key elements in the health of individuals and the community as a whole. This study examines the relationship of specific lifestyle behaviours to blood pressure in subjects being treated for hypertension. Data were collected over a two-year period and analysis was completed in June, 1989. Discriminant analysis identified that, of the lifestyles selected, predictors of uncontrolled hypertension were a high calcium intake, a high perceived level of stress, and a 'normal' body mass index. Profiles of lifestyle behaviours identified by discriminant analysis found to be important to various age and sex groupings of the subjects are illustrated.

Predicting success in antihypertensive drug therapy: the importance of nondrug variables.

The hypothesis of this study was that specific lifestyle patterns would be predictive of, or increase the risk for, uncontrolled hypertension in drug-treated hypertensive subjects. By means of a previously validated questionnaire, alcohol consumption, smoking, exercise, calcium intake, sodium intake, caffeine intake, body weight pattern and perceived stress level were evaluated in 364 subjects who attended a hypertension clinic in a large urban teaching hospital. The subjects were divided into controlled and uncontrolled categories on the basis of a clinic blood pressure reading. The number of prescribed drugs was not different between the two groups. Stratified analysis identified a high perceived stress level, a high calcium intake, and a lower body mass index as predictive of uncontrolled hypertension. Other variables showed no significant correlation. The conclusion of the study is that traditional risk factors for hypertension may assume less importance in drug-treated hypertensive patients than in untreated hypertensive patients.