Random assignment and patient choice in a study of alternative pain relief for sickle cell disease.

This article presents two case examples in which women with sickle cell disease, when invited to participate in a nursing experiment, requested assignment to the experimental group. This experience stimulated the authors to explore the ethics of random assignment relative to equipoise, informed consent, patient choices, study validity, the clinician-patient relationship, patient support networks, and other issues. There is a need for in-depth discussion about random assignment and its implications within the nursing research and advanced practice communities.

Energy as a central factor in the self-assessment of health.

This article explores the role of energy in conceptualization of health, based on self-reported health ratings in 310 women (master's-prepared nurses) ages 50 to 70 years. The health self-assessment instrument consists of 1 global and 10 specific items. The item energy level emerged as central--loading on both the psychosocial health and physiologic health factors and accounting for 48% of variance of Global Health Self-Assessment. These findings build on the World Health Organization definition of health as a synthesis of psychosocial and physiologic well-being; energy level is key to an integrated view of health.

Tensions between career and interpersonal commitments as a risk factor for cardiovascular disease among women.

For professional women, the tension between the career world and the world of interpersonal commitments to spouses, children and friends is thought to be particularly stressful, and a potential risk factor for cardiovascular disease. The Career-Life Balance Inventory (CLBI) was created to survey a wide variety of these tensions among a group of 202 professional women. In a discriminant analysis, two scales from the CLBI (Career-Sacrifices and Interpersonal Sacrifices) appeared to play an important role in distinguishing those women experiencing serious cardiovascular disease. This model for the discrimination of cardiovascular disease was significant to the .01 level. This result suggests the need for more refined study of the tensions between career and interpersonal commitments, as these may relate to risk for cardiovascular disease.

Perceptions of life-pattern disintegrity as a link in the relationship between stress and illness.

The weak but significant association between stressful events and illness suggests the importance of understanding the specific conditions under which stress is likely to result in illness. The research was undertaken to determine whether a perception of disintegrity--a perception that life has not gone as it should have--may be such a link. Ninety-one master's-prepared nurses between the ages of 55 and 70 completed a measure of the extent to which they had experienced stress in balancing a career with other life involvements. They also assessed the extent of integrity-disintegrity in their life pattern and recorded the illnesses that had occurred during their middle years. In a path analysis, once the indirect path through disintegrity was considered, the direct path between stress and illness was so minimal that it was considered eliminated. This result suggests that unless stress leads to feelings of disintegrity, it is not likely to lead to illness.

Validity and utility of anthropometric measurements: a survey of cancer outpatients.

The use of anthropometric data to assess nutritional status in patient populations is controversial; this study explores relationships among such measures in cancer outpatients in order to evaluate their validity and usefulness. Eighty-eight subjects agreed to participate fully. They were interviewed, and arm measurements were taken. Correlations between percentage of ideal weight, weight change, arm muscle area, and arm fat area tended to be moderately positive in both men (N = 31) and women (N = 57). Percentage of ideal weight had the highest average correlation with other variables. In women who were not above usual weight and in men, factor analysis yielded two-factor solutions, with one factor dominated by arm muscle area and the other factor dominated by arm fat area. This indicates that muscle and fat area estimates supplement weight data and provide distinct information. Even though anthropometric measures lack the precision attained by biochemical analysis of blood and urine samples, they are useful for a variety of clinical and research purposes, and they are inexpensive, noninvasive, and easily obtained. Nutrition leaders should further study the reliability and validity of anthropometric approaches, develop guidelines for their most appropriate use, and communicate the results of their efforts in interdisciplinary forums.

Sexuality and relationship changes in married females following the commencement of bisexual activity.

Some of the changes in sexual behavior and relationships with spouses and other females following the commencement of bisexual activity by women after the age of 30 were studied by conducting in-depth personal interviews with 50 women. Each participant, at the time of her first sexual activity with another female: (a) was married; (b) was at least 30; (c) was, with her spouse, engaging in consensual swinging activities; (d) was enjoying sex with males; and (e) had no history, prior to age 30, of sexual attraction to females. Generally, the subjects revealed high levels of participation in, and enjoyment of, sexual activity with other females, in addition to high levels of enjoyable heterosexual activity. Their generally happy and stable marriages tended somewhat to improve, as did their overall sex lives, and they saw their relationships with other females as significantly improved. Significant changes in sexual fantasies occurred. In all cases, sexual orientation became bisexual, but overall preference for male sex partners did not change.

An evolutionary-based model of health and viability.

A model of health and viability, as influenced by a wide variety of psychosocial variables, is presented. This model is based on the principle that illness and death sometimes serve an evolutionary function by maximizing natural selection prospects of other group members. Thus, evolutionary viability within the social context (personal contribution to one's social network) is a crucial health factor; life events, life style determiners, control perceptions, and viability emotions are other important concepts within the model. This model points to the possibility that the full scope of clinical practice may require assisting patients in regaining a sense of viability; nursing may be particularly relevant to this need because of the opportunity for intense interpersonal contact with patients.

Relaxation: its effect on the nutritional status and performance status of clients with cancer.

Relaxation was used to promote normal food consumption patterns among persons with cancer. As part of a larger study, 22 persons with cancer were randomly assigned to receive instruction and reinforcement in a relaxation technique to be used preprandially. The relaxation procedure included four components: (a) deep abdominal breathing, (b) tensing and relaxing of various body parts, (c) relaxation by autosuggestion, and (d) voluntary image control. Twelve clients complied with relaxation instructions in part, and 10 did not. Among compliers, 75% experienced desirable weight change over a six-week period. Performance status, measured by the Karnofsky scale, improved for 33% and worsened for 17% over eight weeks. Research has shown relaxation to be an effective measure in relation to pain, hypertension, and other conditions. These preliminary results now suggest that relaxation may also be effective in treating the eating problems of the person with cancer, leading to improvement in weight and performance status.

Group-self identification and physical handicap: implication for patient support groups.

Relationships between attitudes toward self and attitudes toward handicapped persons based on semantic differentials and social distance measures for one nonhandicapped and five handicapped subsamples (N = 142) are presented. Among persons characterized by amputation, spinal cord injury, or stroke, over one third of the variation in evaluation of self was accounted for by evaluation of persons with handicaps like one's own. Among persons characterized by arthritis or emotional disturbance and among the nonhandicapped, evaluation of self was most closely related to evaluation for the average person. These results indicate strong group identification on the part of persons with more visible handicaps and a tendency toward dissociation on the part of those with less visible handicaps. The finding of high levels of identification within three of the five conditions studied suggests that group techniques may be beneficial in dealing with stigma and quality-of-life issues; the finding of dissociation among persons with other conditions suggests that such techniques should be employed with caution.

Faculty and student perceptions of effective classroom teaching in nursing.

The purpose of this three-stage study was to identify and validate constructs which students use in differentiating among teachers. In stage I, six theoretical constructs thought to be involved in teaching effectiveness were identified; these were revised through a faculty content validity study. In stage II, a known-groups validity study, all items and constructs were found to be used by students in differentiating between good and poor teachers. In stage III, students' ratings of current teachers were collected and factor analyzed. Two factors, individualized prescriptive approach and systematic theoretical presentation, were identified. An analogy was drawn between these factors and elements of nursing process. The category structure which had been derived through the faculty content validity study was not supported.