Knowledge, attitudes, and self-efficacy and compliance with medical regimen, number of emergency department visits, and hospitalizations in adults with asthma.

PURPOSE: The purpose of this study was to examine the relationship between knowledge, attitudes, and self-efficacy and compliance with prescribed medical regimen, number of emergency department (ED) visits, and hospitalizations in adults with asthma. METHOD: The sample consisted of 29 adults with a diagnosis of asthma. The relationship among knowledge, attitudes, self-efficacy, and compliance with medical regimen was explored through use of a survey design. The Knowledge, Attitude, and Self-Efficacy Asthma Questionnaire and the Asthma Management Questionnaire that measured compliance were mailed to subjects' homes. Once completed, questionnaires were returned, and demographic data and number of ED visits and hospitalizations were obtained through a retrospective chart review. RESULTS: There was a significant correlation between knowledge and attitudes and knowledge and self-efficacy. The more positive persons' attitudes toward their asthma, the higher their knowledge and self-efficacy scores. There were significant correlations between select demographic variables and knowledge, attitude, and self-efficacy. Women scored higher on attitudes, persons with a college education scored higher on knowledge and attitudes, and persons with mild asthma scored highest on the self-efficacy scale. Compliance with use of peak-flow meters correlated with higher scores on the attitude and self-efficacy scales. The higher total compliance score group had significantly higher self-efficacy scores. In addition, higher self-efficacy scores correlated with lower numbers of hospitalizations. CONCLUSION: Attitudes and self-efficacy rather than knowledge had the most significant impact on compliance and number of ED visits and hospitalizations. The Knowledge, Attitude, and Self-Efficacy Asthma Questionnaire provides a means for nurses to assess patients' knowledge, attitudes, and self-efficacy regarding their asthma. Patients with low scores could be channeled into programs that would help them improve their ability to manage their asthma.

The effects of education alone and in combination with pulmonary rehabilitation on self-efficacy in patients with COPD.

This study compared the effects on self-efficacy of participation by patients with chronic obstructive pulmonary disease (COPD) in a pulmonary rehabilitation program that combined education and supervised exercise training with the results demonstrated by participation in a program that provided education alone. Thirty-seven patients participated in the pulmonary rehabilitation program, and 22 patients participated in the education-only program. Self-efficacy, as it effects managing or avoiding breathing difficulty, was measured before and after the programs. Patients' self-efficacy scores significantly improved after the pulmonary rehabilitation program and remained significantly improved 6 months later. Education alone was also effective in significantly improving self-efficacy scores, but patients' scores 6 months later were not significantly better than preprogram scores. This study indicates that a rehabilitation program that combines education and exercise training is more effective in improving long-term self-efficacy in patients with COPD.

Pulmonary rehabilitation: is it cost effective?

The purpose of the study was to evaluate number of hospitalizations, length of stay, exercise routine, and patient satisfaction following attendance at a pulmonary rehabilitative program. A retrospective chart review and survey conducted on 72 subjects with chronic obstructive pulmonary disease showed a significant decrease in number of hospitalizations and length of stay following attendance at the program. In addition, 72% of the subjects continued to carry out an exercise routine and 99% indicated that the rehabilitation program had met their expectations. This study suggests that the pulmonary rehabilitative program was cost-effective.

The effect of a pulmonary rehabilitation program on self-efficacy, perception of dyspnea, and physical endurance.

OBJECTIVE: To determine the effect of attendance at an outpatient pulmonary rehabilitation (OPR) program on changes in self-efficacy, perception of dyspnea, and exercise endurance in patients with chronic obstructive pulmonary disease (COPD). DESIGN: Single-group, pretest and posttest design. SETTING: A moderate sized, urban private hospital in western New York. PATIENTS: Sixty patients with a diagnosis of COPD. Their ages ranged from 35 to 82 years (mean +/- SD = 65 +/- 0.75 years). OUTCOME MEASURES: Scores on the COPD Self-Efficacy Scale (CSES) and the Dyspnea Scale and distance walked (feet) on the 12-minute walking-distance test (12 MD). INTERVENTION: The OPR consisted of an educational component and exercise training. Methods to increase self-efficacy were integrated into the rehabilitation program. Preprogram and postprogram measurements were obtained on the CSES, the Dyspnea Scale, and the 12 MD. RESULTS: Paired t tests were used to examine the differences in mean scores between preprogram and postprogram results on the CSES, the Dyspnea Scale, and the 12 MD. There was a significant difference between preprogram and postprogram scores on the CSES (p < 0.01), the Dyspnea Scale (p = 0.01), and the 12 MD (p = 0.04). Pearson product moment correlations showed a significant negative correlation between scores on the CSES and scores on the Dyspnea Scale (r = -0.5566, p = 0.01) and a positive correlation between scores on the CSES and the 12 MD (r = 0.4293, p = 0.05). These results indicated that higher self-efficacy scores on the CSES were correlated with lowered perception of dyspnea and greater distances walked in 12 minutes. CONCLUSIONS: An OPR can improve self-efficacy or confidence in participants' ability to manage or avoid breathing difficulty. Improvement in self-efficacy also may be a factor in decreased perception of dyspnea and increased exercise endurance. Methods to increase self-efficacy expectations with education and exercise training provide an approach to assist persons with COPD to manage their breathing difficulty more effectively. Further studies using a randomized experimental, control design are needed to provide more conclusive direction with regard to effective methods in pulmonary rehabilitation.

Using self-efficacy theory to educate patients with chronic obstructive pulmonary disease.

The predominant debilitating symptom in patients with chronic obstructive pulmonary disease (COPD) is shortness of breath. Self-efficacy theory has been used in a case study approach to begin examining the expectations of a patient with COPD who attended a pulmonary education program. Mr. M. was selected for the case study because his condition typifies many of the problems encountered by patients with COPD. Mr. M.'s self-confidence in managing his breathing difficulty was measured by using the COPD Self-Efficacy Scale (CSES) before an educational program began and again 1 month and 6 months after the program. The CSES measures patients' confidence in their ability to manage or avoid breathing difficulty in a variety of situations. Mr. M.'s scores on the CSES improved in most areas. Incorporating programs to increase patients' self-efficacy may have implications for rehabilitation nurses who help patients with COPD manage their breathing difficulty.

The role of self-efficacy in assisting patients with chronic obstructive pulmonary disease to manage breathing difficulty.

The purpose of this study was to examine changes in self-efficacy after attending a pulmonary rehabilitation program. Twenty-nine subjects with chronic obstructive pulmonary disease (COPD) were enrolled in the program, which was designed to increase patients' confidence in their own ability to manage or avoid breathing difficulty in certain situations. Results showed a significant improvement (p < .05) in scores on the COPD Self-Efficacy Scale between preprogram and postprogram attendance. These findings were still evident at 6 months following program attendance. Incorporation of self-efficacy theory should be considered in the rehabilitation of individuals with COPD.

Is a case study approach effective in altering the attitudes of student nurses toward AIDS?

The effect of a case study approach on attitudes of sophomore nursing students toward caring for patients with AIDS was examined. Pre- and post-program attitudes of 36 students were measured using an AIDS questionnaire. No significant differences were found between pre- and post-program scores on the questionnaire. An examination of change scores for individual items on the questionnaire indicated that the case study approach may have been helpful in making the students more aware of the multifaceted problems facing patients with AIDS.

Nursing administrators' perceptions of critical care CNSs.

The literature has demonstrated inconsistencies among nursing administrators in their perceptions of the CNS role functions. Nursing administrators from 198 hospitals were surveyed: (a) to determine the current use of the critical care CNS, (b) to identify the importance placed on the critical care CNS role functions (expert clinician, educator, consultant/change agent, researcher, manager), (c) to ascertain perceptions of specific activities related to each role function, and (d) to determine any differences in perception of role functions between administrators who employed critical care CNSs and those who did not. Nursing administrators who employed critical care CNSs ranked the role of expert clinician as most important, followed by educator, consultant/change agent, and researcher. The role of manager was ranked least important. Nursing administrators who did not employ critical care CNSs ranked the roles in the following order of importance: expert clinician, educator, consultant/change agent, manager, and researcher.

Acute/critical care nurses' knowledge of physical restraints--implications for staff development.

The use of physical restraints in acute care facilities has become a routine practice. Although nursing home settings have been federally mandated to reduce reliance on restraints, there has been no indication of a reduction in hospital settings. Staff development educators can provide guidance in the proper use of restraints. A total of 235 acute/critical care nurses from 17 states were asked to complete an 18-item knowledge questionnaire about the proper use and application of restraints. A majority (n = 142; 60.4%) had 13 of the 18 questions correct. The results suggest variability in knowledge about restraints due most likely from lack of information rather than misinformation. One hundred fifty-four nurses (65.6%) stated they were unsure about caring for a restrained patient. The authors describe implications of the study findings for nursing staff development and offer an outline for an inservice program on restraint use.

Restrained patients: an important issue for critical care nursing.

OBJECTIVE: To determine practice and attitudes of acute-critical care nurses toward the use of physical restraints. DESIGN: Survey with a self-administered anonymous questionnaire. SUBJECTS: A self-selected sample of 235 acute-critical care nurses from 17 states who were enrolled in critical care review classes. MEASUREMENTS: Data were gathered by use of a questionnaire developed by the researchers. The questionnaire was designed to elicit information regarding demographic and professional characteristics, nursing practice, and attitudes toward the use of restraints. Nurses responded to the practice items on a three-point Likert Scale as to whether they "always," "sometimes," or "never" carried out the procedure. To obtain information on attitudes, nurses were asked to respond on a three-point Likert Scale as to whether they "agreed," were "undecided," or "disagreed" with the statement. RESULTS: Responses indicated 78% of the sample "always" try alternative nursing measures before restraining the patient. However, when units were believed to be understaffed there was more reliance on restraints. Thirty-eight percent of the sample would "always" rather sedate patients than physically restrain them. The overall score on the attitude component of the questionnaire reflected positive or acceptable attitudes toward the use of restraints. Most (62%) "agreed" that a patient suffers a loss of dignity when placed in restraints. Significant relationships did exist between select demographic and professional characteristics and practice and attitudes regarding the use of restraints. The longer the respondents had worked in critical care the more appropriate (positive) their attitudes toward the use of restraints (r = -.211, p < .01). CONCLUSIONS: In general, nursing practice and attitudes regarding the use of physical restraints indicated that respondents were using restraints in accordance with accepted practice. There is a need for additional research in this area, especially regarding the use of alternative measures to physical restraints.

A longitudinal study of nurses' attitudes toward caring for patients with AIDS in Erie County.

The purpose of this study was to examine nurses' attitudes toward caring for patients with AIDS in a longitudinal context. Results of the 1990 survey were compared with those of a survey conducted in 1986 for the purpose of examining changes in attitudes over time. Findings indicated that there were no significant differences between the 1986 and 1990 scores on the attitude scales. The results of the study indicated that many nurses still have fears and concerns about caring for patients with AIDS.

Asthma and the use of CNS depressants: gender differences.

A retrospective 5-year random sample of 196 charts of patients with asthma was obtained from two hospital-based outpatient clinics. The chart reviews showed that age- and severity-matched males and females with asthma were prescribed antihistamines in similar proportions; however, 16.8% of the females were prescribed a tranquilizer or sedative compared with 8.5% of the males. The females (8.7%) also were prescribed a combination of these drugs, or two tranquilizers; none of the males were prescribed more than one CNS depressant. Results showed that, in this study, females were prescribed CNS depressants three times as often as males.

A time-series perspective on effectiveness of a health teaching program on chronic obstructive pulmonary disease.

The purpose of this research was to study the long-term effects of attendance at "Help Yourself to Better Breathing" classes on knowledge attainment, coping strategies, and anxiety, depression, and hostility in individuals with chronic obstructive pulmonary disease. Data were gathered immediately and six months following completion of the program. The results were then compared to those obtained before program attendance. The data showed a significant difference between the pretest, immediate post-test, and the six-month knowledge scores. Coping scores remained the same, which may indicate that not enough emphasis is placed on the development of these skills. There was a significant lowering of the depression scores at the six-month post-testing, and anxiety and hostility scores were lower, but not significantly so. In addition, some participants after the classes were completed chose to enroll in the Better Breathers Program support group and in a pulmonary rehabilitation program. Overall, this study indicates that beneficial effects are evidenced six months following attendance at "Help Yourself to Better Breathing" classes.

What nursing staff members really know about physical restraints.

Although the use of physical or mechanical restraints is decreasing in long-term care facilities, there always will be some patients who require them. If a restraint is to be employed at all, it needs to be used correctly. A convenience sample of 118 nursing staff members who work in a county nursing home was asked to complete an 18-item knowledge questionnaire regarding restraint usage. Scores ranged from 6 to 17 (potential range 0-18), with a mean score of 13.2 (SD = 2.1). Overall, the staff's knowledge level can be considered good; however, there were some areas of concern. For example, a majority of the respondents (82.2%) believed that it was appropriate to keep a patient restrained lying flat in bed. Implications for administrators and rehabilitation nurse clinicians are identified.

Can a pulmonary health teaching program alter patients' ability to cope with COPD?

Many clinical nurse specialists (CNSs) are involved in providing group teaching programs for individuals with chronic obstructive pulmonary disease (COPD). Although knowledge levels often are enhanced by these programs, what is less well known is whether such programs also can affect the coping methods used by those with this disease. The exploratory study described here was part of a larger research project aimed at determining patients' knowledge, specific psychological parameters (anxiety, hostility, depression), and coping strategies. Thirty people agreed to participate in the study. The Jalowiec Coping Scale (JCS) (Jalowiec & Powers, 1981) was used so that participants could rate each coping method according to the degree of use and to determine whether the methods employed were affective or problem-solving approaches. There was very little change in the pre- and posttest scores on the JCS, indicating that there was little change in coping strategies used. There also were no significant correlations between the JCS scores and the demographic characteristics of age, educational level, and the length of time since diagnosis of COPD. The results of this study seem to indicate that pulmonary rehabilitation programs should place more emphasis on appropriate coping strategies that the COPD patient can incorporate into his or her lifestyle.

The nursing dilemma of restraints.

This study provides a data base for developing intervention strategies aimed at helping staff cope with concerns regarding restraints. Most respondents believe patients should be restrained for safety even if it means loss of dignity, and that a caring manner should be conveyed to restrained patients. A large percentage felt that family members did not have the right to refuse the use of restraints, but that they should have that right if they were patients, suggesting negative attitudes toward restraints, of which they are unaware. Personal and professional characteristics, such as knowledge about restraints, years in geriatrics, and experience with elderly family members, showed no significant relationship to attitudes.

AIDS and homophobia among nurses.

The purpose of this research was to study nurses' attitudes toward homosexuality and caring for homosexual patients. The results reported in this article are a component of a larger study of nurses' knowledge about and attitudes toward caring for patients with AIDS. The sample comprised 581 Registered Nurses residing in Erie County, New York. Data were gathered by mailed questionnaires. Results of the study indicate that issues concerning the care of patients with AIDS may be complicated by the fact that many of these individuals are homosexuals. The results of this research provide data for developing intervention strategies to help nurses cope with their concerns about caring for homosexual patients with AIDS.