Prostate cancer treatment ascertained from several sources: analysis of disagreement and error.

BACKGROUND: Treatment data for prostate cancer can be obtained from a variety of sources. Each of these sources has its own strengths and weaknesses and is subject to error. MATERIALS AND METHODS: In a population-based cohort of 319 prostate cancer patients, data on treatment were obtained from five sources: two patient interviews at 6 and 12 months after diagnosis, primary caregiver interviews, physician questionnaires, and medical records. Inter-reporting agreement and accuracy of reporting (compared with medical records) were assessed. Multivariate analyses examined patient, caregiver, and physician characteristics as determinants of reporting error. RESULTS: The agreement among different reporting methods was generally good to excellent for prostatectomy and brachytherapy (kappa range 0.70-0.90) and fair to good (kappa range 0.35-0.75) for external beam radiation and hormonal treatment. Compared with medical records, the interview- and questionnaire-based data collection methods were more accurate for prostatectomy and brachytherapy than for external beam radiation and hormonal therapy. Using medical records as the 'gold standard', patient and caregiver interviews at 6 months after the diagnosis had higher sensitivity and specificity than other reporting sources. CONCLUSION: Interviews of prostate cancer patients and caregivers are useful alternatives to medical record abstraction, particularly if carried out during, or soon after, treatment.

A social cognitive-based model for condom use among college students.

BACKGROUND: Social cognitive theory has been used extensively to explain health behaviors. Although the influence of one construct in this model-self-efficacy-has been well established, the role of other social cognitive constructs has not received as much attention in human immunodeficiency virus (HIV) prevention research. More complete understanding of how social cognitive constructs operate together to explain condom use behaviors would be useful in developing HIV and sexually transmitted disease (STD) prevention programs for college students. OBJECTIVE: The primary aim of this study was to test a social cognitive-based model of condom use behaviors among college students. METHODS: Data were collected from a sample of college students attending six different colleges and universities. Participants were 18 to 25 years of age, single, and sexually active. For the sample of 1,380 participants, the mean age was 20.6 years (SD = 1.76). Most participants reported having had vaginal intercourse (95.8%) and oral sex (86.5%); 16% reported anal sex. FINDINGS: Self-efficacy was related directly to condom use behaviors and indirectly through its effect on outcome expectancies. As predicted, self-efficacy was related to anxiety, but anxiety was not related to condom use. Substance use during sexual encounters was related to outcome expectancies but not to condom use as predicted. CONCLUSIONS: Overall, the findings lend support to a condom use model based on social cognitive theory and provide implications for HIV interventions. Interventions that focus on self-efficacy are more likely to reduce anxiety related to condom use, increase positive perceptions about condoms, and increase the likelihood of adopting condom use behaviors.

The effects of ethnicity and perceived power on women's sexual behavior.

PIP: This study examined differences in sexual attitudes and behavior among women who described themselves as dominant in their relationship with a male partner, sharing equal dominance with a male partner, or being dominated by a male partner. Data from 615 White and African American college women (aged 18-25) in the US were analyzed. Results indicate that women who perceive their partner as dominant in their relationship may have more difficulty with the interpersonal aspects of safer sex behavior than women who see themselves as equal or dominant. These women had significantly lower levels of confidence in their abilities to negotiate sex and discuss the use of condoms successfully. They also expressed greater fear of the negative consequences of engaging in these interpersonal behaviors. Examinations in the context of racial differences showed that African American women had higher rates of personal empowerment and safer sex behavior than White women. However, perceived dominance did not appear to affect African American and White women differently. Thus, HIV prevention programs targeting women should incorporate discussions on the effects of power in relationships on women's sexual behavior, sexual assertiveness, and communication skills training.^ieng

Identifying the social contexts of effective sex refusal.

A factorial survey was conducted to identify social situations that inhibit or promote college students' sex-refusal skills. Respondents evaluated five different situations in which sexual intercourse might occur and ranked each according to how certain the respondent would be to refuse to have sexual intercourse in that context. Regression analysis of the survey data showed that knowing the other person well, being with one's boyfriend or girlfriend, having condoms available, wanting to have sex, and both persons' wanting to have sex reduced the probability of refusal. On the other hand, having no condoms and the presence of drugs in the situation increased the probability the individual would refuse to have sex. In addition, men, individuals with previous sexual experience, and drinkers displayed diminished ability to refuse sex. However, the lack of condoms, when combined with these three respondent characteristics, acted to increase the ability to refuse sex.

A comparison of AIDS-related sexual risk behaviors among African-American college students.

This article compares the sexual practices and risk-taking behaviors of African-American male and female college students (n = 649) attending 4-year institutions in a major southeastern metropolitan area. It is a descriptive study of the kinds of practices that put African-American college students at a high risk of contracting the human immunodeficiency virus (HIV). Overall, the reported practices indicate that the college students studied are exposed to risk by certain sexual behaviors, with males reporting significantly higher frequency of risk behaviors than females. The percentages of male students reporting they engage in an array of risky sexual practices (including sex without condoms and anal intercourse) suggest the invulnerability to HIV apparently perceived by this group. Although the students overall adhere to some HIV-preventive behaviors, they also violate important HIV prevention practices. The findings illuminate the need for designing and conveying messages for African-American college students, and particularly for males, that impress the realities of acquired immunodeficiency syndrome (AIDS) as an indiscriminant disease on this group.

Self-management in persons with epilepsy.

The purpose of this study was to assess the extent to which people with epilepsy use recommended self-management strategies. Questionnaires on epilepsy self-management were mailed to 450 persons with epilepsy as part of a larger study on epilepsy self-management. One hundred ninety five people returned completed questionnaires and met the study criteria. The respondents were on average 35.8 years old and bad experienced seizures for a mean of 18.5 years. In general, the respondents reported compliance with medications but less adherence to other recommended practices such as safety and lifestyle behaviors. The results of this study offer some suggestions for nursing practice including an increased awareness of the teaching needs of persons with epilepsy.

The relationship of illness longevity and relapse with self-perception, cancer stressors, anxiety, and coping strategies in children with cancer.

A descriptive, correlational design was used to investigate the relationship of the longevity of the cancer experience and the presence of a relapse to the child's self-perception, cancer stressors, anxiety, and use of coping strategies. The 44 children included in this study were 6 1/2 to 13 1/2 years of age. Fifteen of the children had experienced a relapse of the disease either on or off therapy. The longevity of the cancer treatment and the presence of a relapse were negatively associated with the child's self-perception. Trait anxiety was positively associated with duration of the cancer experience and with the presence of a relapse. Longevity of the cancer experience and the presence of a relapse may be factors that signal the need for interventions designed to enhance the child's self-perception throughout treatment. Because children in this study who reported lower self-perception and higher trait anxiety levels also reported experiencing more cancer stressors, nursing efforts to develop innovative strategies designed to enhance patients' feelings of self-worth and decrease their anxiety may prove to be important contributions to the care of children receiving treatment for cancer.

Focus groups: an interview method for nursing research.

Focus groups present an ideal way for nurse researchers to collect preliminary information about an area of research interest. The information obtained can lead to greater understanding of phenomena or can be used to develop more extensive quantitative studies. Following the recommendations for conducting a focus group as described in this article and focus group manuals can lead to a worthwhile and enjoyable experience for all involved.

Nausea and fatigue during early pregnancy.

Nausea and fatigue are uncomfortable, sometimes almost debilitating, symptoms of pregnancy. Anecdotally, fatigue seems worse as nausea increases. This descriptive correlational study investigated the relationship between nausea and fatigue during early pregnancy. Fifty-one women who received prenatal care at two obstetrics and gynecology nurse-midwifery practices in a large metropolitan area participated. Each women completed a nausea questionnaire, the Pearson-Byars fatigue feeling checklist, and a demographic data sheet at her first or second prenatal visit. Participants were at less than 17 weeks' gestation; 43 percent were pregnant for the first time, and 48 percent reported nausea at the time they completed the questionnaire. Women with severe nausea had higher levels of fatigue than those with no or mild and moderate nausea. Severity of nausea and level of fatigue were positively correlated, indicating that as nausea increased so did the severity of fatigue.

Learning needs of persons with epilepsy: a comparison of perceptions of persons with epilepsy, nurses and physicians.

The purpose of this study was to describe and compare patients', nurses' and physicians' perceptions of learning needs of persons with epilepsy. The study is based on adult learning theory which states that learning needs dictate receptivity to information and knowledge of learning needs can help structure teaching sessions. Study participants were recruited from patients attending epilepsy clinics, neuroscience nurses employed at study hospitals or working with neurologists or neurosurgeons and neurologists or neurosurgeons practicing in the state. The sample sizes were: 59 patients, 85 nurses and 38 physicians. Data were analyzed using frequencies, percent and analysis of variance. Data analysis revealed that patients, nurses and physicians similarly ranked major areas of learning needs. However, differences in the ranking of individual learning needs were noted between patients and health care providers. An understanding of the differences and similarities among the groups provides useful information for educational programs for epilepsy patients.

The development and testing of an instrument to measure self-efficacy in individuals with epilepsy.

The purpose of this study was to develop and test an instrument to measure self-efficacy in persons with epilepsy. With Bandura's self-efficacy theory serving as the conceptual basis for instrument development, the study was divided into two phases, an instrument development phase and a reliability and validity assessment phase. In phase one, self-efficacy and epilepsy literature along with discussions with epilepsy patients served as sources for item derivation. A panel of experts reviewed the instrument for content validity. In phase two, testing of the instrument for reliability and validity was done using different groups of epilepsy patients. Reliability coefficients ranged from .81 for test-retest reliability to .93 for internal consistency. A strong positive correlation between self-efficacy and social support (r = .48, p less than .001) and between self-efficacy and self-management (r = .50, p less than .001) provided evidence to support the construct validity of the instrument.

An analysis of trends in neuroscience nursing research: 1960-1988.

This study examined trends in neuroscience nursing research from 1960 to 1988. The review was an extension of a study analyzing trends in cardiovascular nursing from 1960 to 1985. Four questions (similar to those developed by Yarcheski regarding elements essential to development of a scientific base) framed the present analysis of neuroscience nursing research studies. The sampling frame for the study consisted of four journals: Nursing Research, 1960-1988; Western Journal of Nursing Research, 1979-1988; Research in Nursing and Health, 1978-1988; Journal of Neurosurgical Nursing, 1969-1985; and Journal of Neuroscience Nursing, 1986-1988. These journals were canvassed for studies meeting specified criteria as neuroscience nursing research studies. A total of 71 studies meeting the stated criteria were included in the final sample and reviewed in a systematic manner to identify such characteristics as variables measured, type of approach to theory development, type of research design, number and type of subjects, data analysis procedures, interpretation and conclusions of the study. Findings of the study indicate there has been a substantial increase in the number of neuroscience studies conducted and reported by nurses and an increase in the number of principal authors with advanced degrees. The orientation of studies has shifted from chronic care or rehabilitation to acute care research. An absence of studies about prevention of head and spinal cord injury was noted. Although a trend toward the theory-then-research approach was detected, the research-then-theory approach has been and continues to be the primary strategy for the development of a body of scientific knowledge. It is possible that clinical nurses are using research more frequently to solve problems. Finally, the scientific methods employed in this group of studies have become more complex and varied over time.

Group dynamics within long-term continuing education programs.

Nursing educators have responded to the need for continuing education by developing a variety of programs ranging in length from half-day seminars to several months of intensive study. Although books and articles have been written about nurses returning to school for baccalaureate degrees and the ensuing expectations, changes, and needs involved in this process, the literature revealed little information on how students, families, and faculty "live" a long-term continuing education (CE) experience. This article will examine the evolution of students into well-defined groups. The stages of group process, development of norms, assumption of roles within the groups, and factors related to conflicts are discussed. Methods used to reduce conflict and facilitate the movement of the groups to the resolution stage are presented in order to assist instructors involved in long-term CE programs.