Needs assessment of caregivers of people with HIV/AIDS.

This descriptive study assessed 34 caregivers of people with HIV/AIDS to learn their perceived needs, concerns, and use of services. Results indicated the most common health problems of the care recipient were fatigue and weight loss; care recipients needed help with climbing stairs, walking, and bathing; caregivers helped with the household chores, transportation, and companionship; caregivers were concerned about coping with loss and responsibilities; caregivers had help from family, case manager, and neighbor; caregivers wanted help such as a companion and counseling. Discussion relates to the implications of the study for health care professionals.

Validity of a verbally administered numeric rating scale to measure cancer pain intensity.

The ability to quantify pain intensity is essential when caring for individuals in pain in order to monitor patient progress and analgesic effectiveness. Three scales are commonly employed: the simple descriptor scale (SDS), the visual analog scale (VAS), and the numeric (pain intensity) rating scale (NRS). Patients with English as a second language may not be able to complete the SDS without translation, and visually, cognitively, or physically impaired patients may have difficulty using the VAS. The NRS has been found to be a simple and valid alternative in some disease states; however, the validity of this scale administered verbally, without visual cues, to oncology patients has not yet been established. The present study examined validity of a verbally administered 0-10 NRS using convergence methods. The correlation between the VAS and the NRS was strong and statistically significant (r = 0.847, p < 0.001), supporting the validity of the verbally administered NRS. Although all subjects were able to complete the NRS and SDS without apparent difficulty, 11 subjects (20%) were unable to complete the VAS. The mean opioid intake was significantly higher for the group that was unable to complete the VAS (mean 170.8 mg, median 120.0 mg, SD = 135.8) compared to the group that had no difficulty with the scale (mean 65.6 mg, 33.0 mg, SD = 99.7) (Mann-Whitney test, p = 0.0065). The verbally administered 0-10 NRS provides a useful alternative to the VAS, particularly as more contact with patients is established via telephone and patients within the hospital are more acutely ill.

The effect of drug therapy on the perceived symptom and ADL experiences of narcoleptics.

Medications for the treatment of narcolepsy consist of central nervous system (CNS) stimulants to control the somnolent symptoms and tricyclic antidepressants to control the rapid-eye-movement (REM) sleep related symptoms. Anecdotal information suggested that many narcoleptics perceive their symptoms, particularly their sleepiness, to be poorly controlled despite taking medication. This study was a secondary analysis which examined if drug therapy made a difference in the perceived symptom experience and ability to perform daily living activities (ADLs) as reported by narcoleptics. No significant association was found between CNS stimulant or tricyclic antidepressant drug therapy and the subjective ratings of narcoleptic symptoms, nor with the perceived ability to perform ADLs. While this study did not examine symptom ratings on and off drug therapy, these findings do suggest that narcoleptics may have to utilize behavioral strategies with their medication regimens to effectively cope with narcolepsy's adverse effects on daily life.

Microbial resistance to drug therapy: a review.

Microbial resistance to the antimicrobials in standard use is becoming more prevalent. A historical perspective frames further discussion. Bacterial resistance is most common, but resistance has been identified in fungi, viruses, and parasites. Resistance is a complex phenomenon that involves the microorganism, the environment, and the patient-separately and interactively. Resistance may be a characteristic of the microbe before exposure to a given drug or may arise as a consequence of therapy. Mechanisms of resistance to antibiotics are discussed. Antibiotic resistance is considered in both hospital and community settings, as ecosystems that are separate yet blending, and the major organisms demonstrating significant resistance problems are presented. A review of existing guidelines, strategies, and plans for addressing resistance and some recommendations conclude this review.

Adherence to therapy in tuberculosis.

Tuberculosis (TB) is a leading cause of morbidity and mortality worldwide. In the United States, TB has undergone a resurgence and the appearance of multidrug-resistant TB has caused new concerns. A critical part of TB treatment is adherence to the prescribed therapy for a considerable time period. Treatment "failure" is often due to nonadherence. Many factors influence adherence to therapy in TB. This chapter reviews research in the area of adherence to the TB treatment plan in the United States and worldwide. It discusses adherence as an outcome related to treatment regimens such as directly observed therapy, patient characteristics, life and family circumstances, motivation, education, incentives, and combination strategies. Themes across studies are compared and suggestions for successful future studies are identified.

Sleep in men and women infected with human immunodeficiency virus.

Little is known about sleep problems in persons with human immunodeficiency virus (HIV) infection. The article reports a study that assessed quantitative and qualitative aspects of sleep in a group of men and women with HIV infection and examined sleep parameters in regard to the degree of immune function. The convenience sample of 50 persons was drawn from an HIV clinic in a large midwestern metropolitan area. Subjects identified a variety of problems with their sleep that were not significantly related to their immune status. The findings of this study indicate that nurses should perform a sleep history and assessment on all persons with HIV infection to identify those in need of intervention.

Symptom description and management in narcolepsy.

Narcolepsy is a neurologic condition that is chronic and lifelong. The study reported describes the experience of living with the most prevalent symptoms of narcolepsy and the management strategies employed for those symptoms by persons with narcolepsy. Descriptions of living with excessive daytime sleepiness, sleep attacks, and cataplexy are given. Nonpharmacologic strategies for symptom management were described by 63.2% of the study participants for cataplexy, 54.5% for sleep attacks, and 35.5% for excessive daytime sleepiness. Specific management and coping strategies are provided.

Family experiences when a child is HIV-positive: reports of natural and foster parents.

The purpose of this exploratory study was to examine issues reported by natural and foster parents when caring for a child 3 years of age or younger with vertically transmitted HIV-disease. Issues common to both groups, and specific to the natural and foster parents were explored. The issues discussed by the natural mothers included guilt, their relationship with their infected child, and the effects of their HIV infection on their family. Issues discussed by foster mothers included their decision to foster a HIV-positive child, characteristics of their HIV- positive foster children, fears of transmission, and the effect of the HIV-positive foster child(ren) on their natural family. Issues common to both sets of mothers include disclosure, support, preparation for the HIV-positive child's death, and life in general. The experiences of these families are important to describe in order for pediatric nurses to give accurate, sensitive, and culturally appropriate care.

The development of an instrument to measure the effects of a parent's chronic illness on parenting tasks.

An instrument was developed to assess the impact of chronic illness on the performance of parenting tasks (e.g., lifting, feeding, transporting, etc.). Little research on the affect of illness in general on the performance of parenting tasks is in the literature. Mothers with narcolepsy (n = 20) were used as the sample for this pilot study along with a comparison of mothers without a chronic illness (n = 20). Mothers were matched by the age and sex of the oldest child. The age groups of childhood and adolescence from the Parenting Tasks Index (PTI) were used in this study. Good reliability and validity were found in the use of this instrument. Over 50% of the mothers with narcolepsy indicated many parenting tasks (e.g., assigning the child chores, disciplining, and performing household chores) that posed moderate to severe difficulty for them. Pediatric nurses will find this instrument useful in planning individualized interventions related to identified difficult parenting tasks and in furthering research in this area.

Equal team partners? The roles of principal investigators, co-principal investigators and co-investigators on federally supported research grants.

A survey of 188 NLN-accredited graduate nursing programs was done to determine how the research roles of principal investigator (PI), co-principal investigator (Co-PI) and co-investigator (Co-I) are supported and to examine the similarities and differences in benefits for PIs, Co-PIs and Co-Is. Most schools did not provide salary supplementation in addition to the usual salary for any investigators. For other benefits, the PI was more likely than was the Co-PI or Co-I to receive direct access to indirect cost recovery dollars, the use of extra research assistants, and the reduction of teaching time commensurate with the time supported by their grant. If the team approach is truly valued, should not all investigators be rewarded in a like manner?

Research on families and pediatric human immunodeficiency virus disease: a review and needed directions.

Human immunodeficiency virus (HIV) disease in children has important and longlasting effects on families. Although aspects of other childhood illnesses can be applied to the study of pediatric HIV disease, the total constellation of symptoms and effects makes HIV disease unique. Further, the majority of families affected by HIV disease are minority and disadvantaged. There is little in the research literature about normal family functioning under these conditions. Many older studies of childhood illness were based on negative assumptions and did not address concepts such as resiliency. Family theories, approaches, and common themes are briefly discussed. The few studies addressing families and pediatric HIV disease are reviewed and recommendations are made for future research directions.

Foster care of HIV-positive children in the United States.

A national study regarding the foster care of children identified as human immunodeficiency virus-positive (HIV-positive) was conducted in 1991. A survey form was sent to the administrators of the State agency responsible for foster care in each State, the District of Columbia, and U.S. Territories for a total sample size of 55. After followup, all 55 responded for a response rate of 100 percent. The number of children in foster care was ascertained for the current year and cumulatively. In 1991, 1,149 HIV-positive children were reported to be in foster care. Most States (49) had a general foster care policy and 21 had specific policies regarding care of a foster child who is HIV-positive. Measures and criteria used for recruitment were examined. In regard to recruitment policies, only seven States mandated recruitment of families specifically for children with HIV and acquired immunodeficiency syndrome. The major topics covered in training for HIV foster families included confidentiality, behavioral management, working with natural families, emotional factors, separation and loss, and others. Other issues discussed are foster parent training, supplemental services, later adoption possibilities, payments, and the expressed fears and doubts of foster parents caring for HIV-positive children. It is recommended that a national conference address the issues.

Suggestions for clinical nursing research: symptom management in AIDS patients.

Clinical nurse researchers are challenged to formulate and test effective interventions to alleviate the symptoms associated with HIV/AIDS. Although many symptom-management studies have been conducted on specific populations, such as oncology patients, few related nursing studies of persons infected with HIV have been done. The authors offer suggestions for studying symptom management approaches for persons with AIDS. The suggestions represent the funding priorities identified by the National Institute of Nursing Research.

The influence of the AIDS epidemic on the master's-prepared oncology nurse.

More than 139,000 cases of the acquired immunodeficiency syndrome (AIDS) have been reported to the Centers for Disease Control. Many of these individuals will develop malignancies, such as Kaposi's sarcoma and malignant lymphoma. Because of the neoplastic complications of AIDS and the terminal nature of this disease, some centers employ oncology clinical nurse specialists to coordinate the care of patients. This study was designed to determine the extent to which master's-prepared oncology nurses care for patients with AIDS in the United States, the type of care these nurses provide, their sources of AIDS-related information, and the risks they perceive in caring for patients with AIDS. This information will guide educators to develop graduate curricula and continuing education programs that include useful information on the care of patients with AIDS. These results will also direct administrators to consider extra stressors imposed on the master's-prepared oncology nurse who also cares for those with AIDS.

The pharmacologic treatment of HIV infection and AIDS in adults.

Despite the still bleak picture of HIV infection and AIDS, there has been progress in pharmacologic therapeutic approaches. These comprise both direct and indirect approaches. Direct approaches include treatment aimed at the HIV whereas indirect approaches include boosting the immune system and treating or preventing opportunistic infections and neoplasms. Many new drugs are undergoing trials for evaluation of efficacy.

Immunologic impairment, infection, and AIDS in the aging patient.

Consideration of immunologic consequences of aging coupled with the potential for infectious disease and the relatively new recognition of HIV infection will continue to present challenges to nurses in acute care settings. Knowledge of these issues can provide the basis for effective approaches to the problems.

Compound narcolepsy: sleep pattern and involution.

A review of studies of sleep in three-month-old infants, narcoleptics, and normal adults indicates that the sleep pattern in compound narcolepsy is in many ways involuted. Similarities in sleep onsets, REM-specific movement, REM dissociation, ambiguous sleep, nocturnal arousals, diurnal sleep-wake cycles, and relatively limited quiet-awake time are discussed as part of a global inability to inhibit state changes common to both infants and compound narcoleptics. The analogy with infant sleep patterns and results of studies of brain function in narcoleptics suggest that forebrain inhibitory processes are more important in narcoleptic symptomology than is brainstem dysfunction. Puberty and old age are critical periods for the development or exacerbation of the involuted sleep pattern. Closer study of the early development of narcoleptics and of lability of state changes in narcolepsy may aid in diagnosis and prognosis for susceptible individuals.

Compound narcolepsy: development of biochemical imbalance.

In a review of existing literature, compound narcolepsy is shown to involve not only problems of sleep regulation, but also autonomic, hormonal, emotional, and possibly motor and cognitive dysfunctions, strongly implicating the hypothalamus, limbic system, and possibly the striatum and cortex in the disorder. Neurochemical studies and the pattern of narcoleptic symptoms support the idea of a dynamic imbalance between dopamine and acetylcholine in the etiology of the disorder. What is known about the natural history of compound narcolepsy suggests a developmental course beginning with fluctuations in dopamine release, followed by supersensitivity of dopamine autoreceptors, and later followed by a pattern of intrinsic oscillations and reciprocal "overshoots" in release of dopamine and acetylcholine to account for the typical sequence of appearance of narcoleptic symptoms.

Narcolepsy: a review of a common, life-long sleep disorder.

Narcolepsy is a severe debilitating chronic life-long sleep disorder that can be ameliorated but not cured. In the United States, its prevalence is at least 1 in 1000 making it more common than multiple sclerosis or Parkinson's disease. Its symptoms lead to severe lifestyle consequences, with profound impact on the affected persons, their interpersonal relationships, job, school experiences, and family life. Despite this, little has appeared in the nursing literature about the disorder. The most characteristic symptoms include uncontrollable excess daytime sleepiness, cataplexy (bilateral voluntary muscle weakness), sleep paralysis, hypnagogic hallucinations and disturbed night-time sleep. Characteristics of normal sleep are reviewed and compared with disturbances seen in narcolepsy. The aetiology, assessment, diagnosis, pharmacologic therapy, non-pharmacologic therapy and psychosocial issues are discussed along with needed research directions.