Clinical depression and HIV risk-related sexual behaviors among African-American adolescent females: unmasking the numbers.

Clinically depressed and nondepressed African-American adolescent females aged 13-19 years (N=131) were interviewed and surveyed to determine the relationship between depression and HIV risk-related sexual behaviors. Narratives indicate that the psychopathology of depression may create situations where the target population could become exposed to HIV. Specifically, depressed participants described feelings of loneliness, isolation, and wanting somebody to "comfort them" as aspects of depression that affect the decisions they make about sex and relationships. In essence, sex was viewed as a stress reliever, an anti-depressant and a way to increase self-esteem. They shared that even if they did not feel like having sex, they might just "git it over wit" so their partners would stop asking. Some also discussed financial and emotional stability offered by older, more sexually experienced partners. These age-discordant relationships often translated into trusting that their partners knew what was best for their sexual relationships (i.e., having unprotected sex). Sixty-nine percent (n=88) of the sample reported engaging in sexual activity. Given their mean age (16 ± 1.9 years) participants had been sexually active for 2 ± 1.8 years. The adolescents reported an average of 2 ± 1.8 sexual partners within the past three months. Depressed participants reported a higher frequency of having ever had sex (78% vs. 59%, χ(2)=5.236, p=0.022), and had a higher mean number of sexual partners (2 vs. 1, t=-2.023, p= 0.048) and sexual encounters under the influence of drugs and alcohol (8 vs. 2, t=-3.078, p=0.005) in the past three months. The results of this study can guide the modification and/or development of tailored HIV/sexually transmitted infection (STI) prevention programs. The findings provide explicit, psychologically and culturally relevant information regarding the interaction between depression, self-medicating behaviors and risk for HIV/STIs among clinically depressed African-American adolescent females.

Redefining treatment: how biological mothers manage their children's treatment for perinatally acquired HIV.

Current medical thinking supports early initiation of aggressive approaches to the management of perinatally acquired HIV infection. Biological mothers, however, may not endorse this way of managing their child's condition. For this study, grounded theory methods were used to conduct secondary analysis of eight semi-structured in-depth interviews with parents of children with perinatally acquired HIV. Biological mothers' perspectives on their children's treatment for perinatally acquired HIV infection, the strategies they used to manage their children's treatment and sociocultural influences on mothers' beliefs and actions are explored and described. Creation of a framework that may be useful for future research and recommendations for clinical practice are offered.

Effects of home visits to vulnerable young families.

PURPOSE: Nurses' home visits to new parents have been replaced in many high-need communities by nonprofessional visits without clear evidence of effectiveness. Previous reviews of home visiting research have combined nurse and non-nurse interventions and have pooled studies from the US, where home visiting is mainly limited to low-income families, with those from nations where home visiting is a universal service. This integrative review was focused on nurse-delivered interventions in the US and Canada to identify the nursing-specific models with the greatest effect in this cultural context. Evaluation of support for social ecology theory was a secondary aim. DESIGN: The sample consisted of 20 experimental and quasi-experimental studies of home nursing interventions for families of newborn infants who were vulnerable because of poverty, social risks, or prematurity. METHODS: Each report was examined systematically using specific rules of inference and a scoring system for methodological quality. Intervention effects on five outcome domains were described. FINDINGS: Maternal outcomes, maternal-infant interaction, and parenting were more often influenced than was child development, except in preterm infants. Well-child health care did not improve. Effective programs generally began in pregnancy, included frequent visits for more than a year, had well-educated nurses, and were focused on building a trusting relationship and coaching maternal-infant interaction. Social ecology theory was partially supported. CONCLUSIONS: Future nurse home-visiting research should test a combination of these effective components. Nurses can use this information to seek funding of nurse-delivered interventions for vulnerable families.

Journey towards recovery following physical trauma.

Journey towards recovery following physical trauma Convalescence and recovery following illness are of central importance to nursing. These themes have been explored increasingly in the literature. The focus, however, has been primarily on the process of integrating chronic illness into one's life. Recovery from physical injury is rarely addressed. A body of work focusing on physical trauma demonstrates that recovery is often not complete after injuries that have not been viewed as disabling. To illuminate understanding of recovery following physical trauma, the purpose of our 1997 study was to describe more thoroughly the nature of recovery. A total of 63 adults, in a convenience sample, who survived serious physical trauma, were interviewed 2.5 years after injury using an open-ended semistructured interview guide. Three themes were identified: event, fallout, and moving-on. These themes provided the organizing structure for exploring the journey to recovery. This journey, as disclosed by the seriously injured, does not necessarily correspond with the views of most trauma clinicians. Traumatic events create a line of demarcation, separating lives into before and after. The event becomes the starting point of a journey to resume one's life. The event itself is more than the trauma; it is the perceptual and contextual experience that needs to be incorporated into a person's essence. Fallout from the injury is multifaceted and includes physical, psychological, social, and spiritual dimensions. Moving-on in this journey is nonlinear as survivors recognize their lives are forever different. The survivors' accounts suggest that nurses should carefully consider the question, 'What is successful recovery?'

Qualitative research interviews with children and their families.

Regulations about conducting research with children, development of the field of qualitative research, and sophistication of our knowledge about children has prompted increased recognition of children as research subjects are described. Guidelines for how to prepare and conduct qualitative interviews with children and their families are summarized in Table 1. While gathering research data from children and their families presents many challenges, qualitative interview methods are a potentially rich source of data.

Discontinuing treatment in children with chronic, critical illnesses.

Decisions about optimal treatment for critically ill children are qualitatively different from those related to adults. Technological advances over the past several decades have resulted in myriad treatment options that leave many children chronically, critically ill. These children are often technology dependent. With new technologies and new patient populations comes the responsibility to understand how, when, and why these technologies are applied and when technology should not be used or should be withdrawn. Much has been written about ethical decision making in the care of chronically, critically ill adults and newborns. In this article, relevant factors about the care of children older than neonates are described: standards, decision makers, age of the child, and pain management. A case study is used as a mechanism to explore these issues. Dimensions of futility, discontinuing aggressive treatment, and a consideration of benefits and burdens are integrated throughout the discussion to inform nurse practitioner practice.

Home care considerations for chronic and vulnerable populations.

Conducting a predischarge home assessment can provide important information to the hospital care team for discharge planning and postdischarge care. In addition, a predischarge home visit assists the family in preparing for the infant or child's care needs. This report describes an Environmental Assessment Guide initially developed and subsequently used in two nursing research studies. Anecdotal information from advanced practice nurse care records is provided to illustrate issues relating to predischarge assessment.

The individual, the family, and genetic testing.

Genetics plays a role in every disease, yet few health care providers understand basic genetic principles or the science underlying the genetic testing process. An understanding of the science behind genetic advances is necessary, and it is equally important for health professionals to have an understanding of the complex nature of genetic testing for individuals and their families. Much of the debate about the psychological effects of genetic testing has occurred in the absence of empirical data on diseases for which predictive testing has only recently emerged. This article will review selected literature on genetic testing and its implications for the individual and the family. The responses of families and individuals to the diagnosis of a genetic disease will be reviewed, and Huntington disease will be used as the paradigm for examining issues related to genetic testing for adult-onset cancers. Literature addressing the response to genetic susceptibility for adult-onset cancers and the implications of testing children also will be explored. Finally, identification of emerging issues relevant to genetic screening will provide a framework for identifying needed nursing research in genetic testing for adult-onset cancer risk.

Clarifying the concept of normalization.

PURPOSE: To refine and develop the concept of normalization. While firsthand accounts, clinical observation, and numerous studies suggest that parents of children with chronic conditions often strive to lead a normal family life, the distinguishing characteristics of normalization need to be understood before evaluating the feasibility and consequences. Conceptualizing these efforts as normalization, researchers have identified cognitive and behavioral strategies used by parents to normalize family life. SOURCES: A total of 33 articles representing 14 studies were selected through computer-assisted searches of the topic from 1966-1997, hand searches of nursing journals from 1970-1997, and analysis of reference lists. Key words in the searches included: adaptation, psychological; chronic disease; disabled persons; family; child; adolescence; parent-child relations; models, psychological; and nursing theory. Articles (N = 19) that applied and expanded the concept comprised the sample used in the analysis. A normalization construct was used. METHODS: Attributes for normalization were inductively derived based on the most recent methods for refining and developing concepts, with special attention to how family and illness affect manifestations of normalization. FINDINGS: The attributes identified in 1986 remained relevant, but required revision and expansion to reflect a contemporary understanding of normalization. Unique manifestations of normalization were identified within certain illness and family contexts. CONCLUSIONS: Knowledge synthesized from previous studies can enhance how normalization is used in future qualitative and quantitative research and in theory development. Findings indicate the need for researchers to build on the current state of knowledge and continue to further develop the concept. Understanding the findings can also sensitize clinicians to the complex process of normalizing when a child has a chronic condition.

Issues to consider when choosing and using large national databases for research of families.

Secondary analysis of large national databases offers promise for research of families. In this article, issues that the secondary analyst must consider when choosing a database for research of families are described. Potential advantages and limitations of databases are discussed. Strategies to minimize potential limitations are highlighted.

Conceptual and pragmatic considerations in conducting a secondary analysis. An example from research of families.

In this article, the authors discuss conceptual and pragmatic considerations for conducting research of families using large secondary data sets. Conceptual considerations include establishing consistency among the theory, variables, and available data, and determining reliability and validity of the data in the context of the theory. Pragmatic considerations include the use of resources such as management of the data among several authors, criteria and methods for selection of a subsample, and, recoding of the data to examine dyadic difference scores. The Family Special Interest Group of the Eastern Nursing Research Society initiated this research as part of a project to analyze families using large national data sets. The purpose of the secondary analysis was to identify family beliefs about healt-promoting behaviors. Combining parent and teen data to create relational level data resulted in new information that had not been identified in the original survey.

Parent-teen worry about the teen contracting AIDS.

A secondary data analysis of the National Commission on Children: 1990 Survey of Parents and Children was conducted with a subsample of 457 parent-teen pairs who responded to the "worry about AIDS" question. The teen's worry about contracting AIDS was associated with race, parent's education, the amount of discipline from the parent for engaging in sex, the teen's desire to talk to the parent about the problem of sex, the teen's rating of the neighborhood as a safe place to grow up, whether the parent listened to the teen's telephone interview, and the parent's response to whether his or her teen had a history of sexually transmitted disease. Of the parent-teen pairs in the subsample, 46% (N = 210) agreed in their responses about worry. Agreement was more frequent among the parent-teen pairs when compared to randomly constructed surrogate pairs. Dyadic analysis supported a family system view of perceived susceptibility.

Nutritional assessment for children who are HIV-infected.

Pathophysiologic, psychosocial, and economic considerations are important in nutritional assessment of infants and children who are HIV-infected. Nutritional assessment guidelines vary based on the child's circumstances. Specific assessment guidelines are proposed for (a) ongoing ambulatory care; (b) when growth decelerates or its below the fifth percentile; (c) acute illness; and (d) home and community care. The guidelines are based on data collected from a sample of 16 children who were HIV-infected and their families during a pilot study of transitional nursing care using advanced practice nurses. The guidelines were inductively derived from patient care records and from a review of the literature.

Mothers with multiple sclerosis and their children: effects of fatigue and exacerbations on maternal support.

BACKGROUND: Mothers with multiple sclerosis (MS) often face fatigue and episodic exacerbations during their child-rearing years. These problems affect their support of their children, including physical affection. Children, depending on their age and gender, may or may not understand the changes. OBJECTIVES: To increase knowledge about mothers with MS concerning the relationship of fatigue and functional status to the perception of physical affection with their children, their perceptions of physical affection with their children in relation to exacerbation of their symptoms and the age and gender of their children, and the children's perceptions of their mothers' physical affection in relation to the children's age and gender and exacerbations in their mothers' symptoms. METHOD: Thirty-five mothers with relapsing-remitting MS and a child of each mother were studied, using interviews and questionnaires. RESULTS: Functional status and fatigue were not significant predictors of physical affection during an exacerbation. When the mothers' symptoms were stable, perceptions of mothers and children with respect to maternal physical affection were similar. Significant changes were reported in both the mothers' perceptions of their physical affection and the children's perceptions of their mothers' physical affection during exacerbations. There was a significant difference between the perceptions of the mothers and children regarding the magnitude of that change. Mothers significantly underestimated changes in their physical affection. CONCLUSIONS: Physical affection was selected as an important aspect of family functioning that could be affected by characteristics of illness, including exacerbations, fatigue, and functional status. However, fatigue and functional status did not explain the perception of physical affection during an exacerbation.

Preparing advanced practice nurses for clinical decision making in specialty practice.

Dramatic changes in the delivery of healthcare have placed an increased emphasis on developing critical thinking skills and clinical decision making abilities of nurses on both the undergraduate and graduate levels. The authors discuss teaching-learning strategies that promote clinical decision making skills of advanced practice nurses. Particular attention is paid to advanced practice nurses who are being prepared to work within specialty practice settings. An algorithm to guide educators to teach clinical decision making is presented.

Chronic sorrow: A content analysis of parental differences.

Sixty-eight mothers and 64 fathers of children with a neural tube defect responded to a questionnaire about chronic sorrow. Mothers reported a mood state change in very intense category from more pessimistic at time of diagnosis to more optimistic at current time. Fathers, although indicating a mood change in the very intense category to more optimistic, also had more pessimistic responses. Parental similarities and differences were also reported in both times and events that triggered the sorrow response. Categories across times and events were primarily related to health care, school/development concerns and social significance. Clinical and research implications of these findings are discussed.

The determinants of successful self-catheterization programs in children with myelomeningoceles.

Myelomeningocele is a birth defect that results in lifelong consequences for the child and family. One of the abnormalities that results from the defect is a neurogenic bladder. Most children with myelomeningoceles will require a clean intermittent catheterization (CIC) program for continence. Yet, many children do not have success with these programs. The purpose of this report is to identify in the literature components of a successful self-catheterization program. The importance of proper urinary management in children with myelomeningoceles will be discussed. Physiological, developmental, and motivational qualities that are present in successful self-catheterization programs will be identified. The importance of knowing when the child is ready to learn, how to know when the child is ready to learn, and different styles of teaching self-catheterization will be discussed. Finally, nursing implications for children on CIC programs will be described.