Nurses self-performing and teaching others breast self-examination: implications for advanced practice nurses.

Although there is evidence to suggest that breast self-examination (BSE) aids in the early detection of breast cancer, the underuse of this prevention behavior continues to exist. The purpose of this study was to explore the personal behaviors and professional practices of nurses in the use of BSE and to discuss implications for the advanced practice nurse (APN). The sample (N = 300) consisted of nurses and student nurses. While almost all nurses had performed BSE at least once, fewer than half did this monthly. The majority believed it was the nurse's role to teach BSE, but almost three fourths of the sample taught it only occasionally or rarely. Not thinking of it and not knowing when or how to teach were reasons identified for not teaching. The roles of the APN as an educator, leader, consultant, direct care provider, and researcher are examined in light of these findings to promote nurses' performing and teaching BSE.

Social support and postpartum African American women.

The birth of the first child is a major transitional period for the new mother and her family. Social support that women receive seems to buffer the changes experienced during the postpartum period. However, very little is written about the social support of postpartum African American women. The purpose of this pilot study was to investigate the difference between social support expected prenatally, and that actually received postpartally in African American primiparous women. Data were collected utilizing a modified version of the Postpartum Social Support Questionnaire. Findings revealed no significant differences in the social support expected, and what was actually received postpartally. This sample was somewhat unique in that the women were educated with at least a high school education, with a mean age of 25, and possessed health insurance (access to health care). Future research utilizing the tool with larger samples should be conducted to further validate the reliability and validity of the tool.

Nurse/parent role perceptions in care of neonatal intensive care unit infants: implications for the advanced practice nurse.

This study compared parent and nurse perceptions of the nurse's roles regarding responsibilities toward infants in the neonatal intensive care unit (NICU). It also examined the attitudes of nurses and parents regarding the extent to which parents should participate in the care of their infants in the NICU, as well as the role of the advanced practice nurse (APN). The convenience sample of 25 parents of infants in the NICU and 35 nurses who cared for the infants was surveyed regarding perceptions of nurses and parents about nurse responsibilities and parent roles in the NICU. Results suggest parents and nurses have different perceptions about role expectations and that nurses perceive themselves to lack comfort and knowledge in providing support to parents. The findings support a role of the APN as fostering a nursing NICU philosophy to facilitate role transition for parents of infants in the NICU.

Health beliefs, health locus of control, and women's mammography behavior.

Research has shown that routine mammography screening can significantly reduce mortality from breast cancer. The use of mammography screening, however, remains well below national goals. In an effort to understand the factors that influence women's mammography behaviors, this study explored the relation between health beliefs, locus of control, and women's mammography practice. Survey instruments used were Champion's health belief scales and the Multidimensional Health Locus of Control (MHLC) scales. The study used a convenience sample of 25 African Americans and 72 white women ages 35 to 84. Findings showed that women who participated in mammography screening were significantly more likely to perceive greater benefits, greater health motivation, and fewer barriers to screening than those who did not participate. These same three variables were similarly associated with greater frequency of receiving mammograms. It also was found that perceived benefits and health motivation were significantly correlated with shorter duration of time since the last mammogram. No support was found for perceived susceptibility, perceived seriousness, and health locus of control as predictors of women's mammography behavior. Implications for nursing research in further examining the MHLC and the Health Belief Model construct of susceptibility as they relate to mammography behavior are identified. Practice implications for nurses are suggested.

Meeting the needs of rural families during critical illness: the APN's role.

Family needs during critical illness have been a major focus of nursing research, yet the unique needs of families living in rural America still need to be investigated. This study sought to identify the needs of families in rural southern Appalachia and compare these findings to those from a study that identified the needs of families in a large metropolitan medical center. We found 13 needs to be significantly different between the rural and urban samples and suggest strategies that rural and urban critical care nurses and advanced practices nurses can use to care for families of critically ill patients from rural areas.

Rural and urban adolescents' perceptions of mental health.

This study investigated rural and urban adolescents' perceptions of mental health. A questionnaire containing nine vignettes (involving child abuse and adult and adolescent mental health issues) was devised based on a tool developed by Flaskerud (1980). Analysis of responses to the questionnaire indicated that there was general agreement among the students about unhealthy behaviors. However, there were some significant differences related to rural/urban setting, gender, and ethnic background. The findings provide insight into rural and urban students' perceptions of problematic behaviors, who should intervene, and how. It is recommended that health care providers assist adolescents in expanding their range of coping behaviors, especially in regard to alcohol abuse and violence.

Nursing assessment of adult females who are alcohol dependent and victims of sexual abuse.

Women who develop alcohol dependence pose a serious health threat to themselves, their families, and their communities. One of the factors theorized to be a major influence in the development of maladaptive behaviors relative to alcohol use in women is childhood sexual abuse. This paper uses King's theory of dynamic interacting systems to examine relationships between the personal, family, and community variables that may influence women who have been victims of childhood sexual abuse and develop alcohol dependence. Guidelines for a research-based nursing assessment are suggested.

Health-promoting behaviors of African-American rural women.

A primary role of nurse practitioners is to promote health. This study describes the practice of health-promoting behaviors of 75 African-American women in rural northwest Florida. The convenience sample completed the 94 Health-Promoting Lifestyle Profile (HPLP), which measures six aspects of health behavior, including exercise, nutrition, and stress management. Demographic factors were also examined in relation to participation in health-promoting behaviors. Findings showed women scoring the highest in interpersonal support and the lowest in exercise and nutrition on the HPLP subscales. Also, women with higher education and an income above $10,000 a year practiced more health-promoting behaviors. Those with less education, a lower income, and more family members practiced fewer health-promoting behaviors. Older women tended to exercise less and reported less interpersonal support. Nurse practitioners can encourage health promotion among African-American women. They can utilize strategies that maximize women's perceived benefits and self-efficacy while minimizing perceived barriers to health-promoting behaviors. Churches, worksites, and schools are suggested as accessible settings for providing programs and services to this population.

Employer attitudes toward breastfeeding in the workplace.

A descriptive, exploratory study of 69 male and female employers was done in a small rural community to determine their attitudes toward breastfeeding or expressing milk in the workplace. Business variables, such as experience working with women who have breastfed and knowledge of other businesses who have employed breastfeeding women, appeared to be better predictors of a positive level of support toward breastfeeding in the workplace than personal attributes, such as age, education level, and personal history with a spouse or friend who breastfed. The health care provider needs to become instrumental in promoting breastfeeding in the workplace by focusing on the positive effects on the business and providing employers with successful examples of workplace breastfeeding programs.

The relationship of social support to women's obtaining mammography screening.

This study examined the relationship between social support and obtaining mammography screening. Fifty women, half of whom had undergone mammography, were matched for age and ethnicity and interviewed related to perception of their social support networks. Results revealed a significant difference in the levels of social support and mammography screening. Women who had undergone mammography perceived a higher level of social support than those who had not. Parse's Theory of Human Becoming was used as a framework to discuss nursing implications of the findings.

Families as a source of AIDS information for school age children.

The acquired immune deficiency syndrome (AIDS) pandemic, which has taken an increasingly devastating toll worldwide over the past 10 years, has highlighted the need for carefully designed, massive public education campaigns focused on prevention. Research has shown that education will be most effective if it occurs before the onset of behavior that must be prevented. Because most elementary students have not yet begun to engage in behavior that places them at risk for human immunodeficiency virus infection, they are among those individuals most likely to benefit from educational efforts designed to teach preventive strategies. The family is the primary socializer in health beliefs, attitudes, and practices. This study examines the nature of communication about AIDS among school age children and their families. The findings underscore a critical deficiency in frequency of parent-child interactions about AIDS. The role of the CNS/nurse practitioner in developing educational strategies for children and their families is discussed.

A group for "wandering" institutionalized clients with primary degenerative dementia.

The authors implemented a group in a state psychiatric institution for women with primary degeneration dementia. The group provided scheduled opportunity in a nonrestrictive environment for structured movement and sensory stimulation. Over a period of nine sessions, small but significant changes were noted in the members' behavior. This type of therapy can benefit such limited clients by enhancing the quality of their life in the institution.

Attitudes, practices, and role of nurses in the use of mammography.

This research examined the mammography behavior of 145 nurses as well as their patient teaching practices about mammography. A subsample of 100 were identified as compliant or noncompliant with mammogram screening guidelines. Nurses who complied and those who did not comply were not significantly different on variables of age, licensure, education level, or clinical practice setting. Nor was a positive family history associated with compliance. In patient teaching about mammography, only 25% of nurses reported teaching. The vast majority of nurses, 75%, rarely or only occasionally did the patient teaching. Reasons cited for not teaching included not thinking about it and feeling unqualified to do this teaching. However, all nurses thought it was important for educating nurses about the need to teach women about mammography screening. The health belief model was applied as a framework for further research exploring nurses educating women about mammography.

The relation between self-esteem, sexual activity, and pregnancy.

This study examined self-esteem in relation to sexual behaviors which often result in teen pregnancy. A sample of 141 male and 172 female adolescents of racial diversity was surveyed to elicit levels of self-esteem, sexual activity, pregnancy and fatherhood status. The Coopersmith Self-Esteem Inventory was used as well to elicit qualitative data about self-esteem, demographics, and sexual activity. Analysis revealed no differences in the self-esteem of males vs. females. Further, sexual activity or virginity was not related to self-esteem in either males or females. Pregnant teens did not have different levels of self-esteem from the nonpregnant. However, males who had fathered a child had lower self-esteem than did nonfathers. The findings support a multifocused approach to sex education for pregnancy prevention and also emphasize a need to include males in both pregnancy prevention efforts as well as in further research on teen pregnancy.

PIP: The interactions among self-esteem, premarital sexual activity, and pregnancy were investigated in a racially mixed sample of male and female adolescents. Included were 287 high school students and 16 pregnant females recruited from a local physician's practice. Subjects ranged in age from 13-19 years; 55% were female and 40% were Black. The mean level of self-esteem (assessed by means of the Coopersmith Self-Esteem Inventory) was 17.776 out of a maximum possible score of 25.0; there were no significant differences in scores in relation to race or gender. Contrary to one of the study's hypotheses, the self-esteem scores of both sexually active males and females were not significantly lower than those of their non-sexually active counterparts. Interestingly, female virgins had slighter higher self-esteem scores than non-virgins, while male virgins had somewhat lower mean scores than non-virgin males, but neither finding was significant. Also unsupported was the hypothesis that pregnant teenagers would have higher self-esteem scores than their nonpregnant peers. On the other hand, adolescent males who had fathered a child had significantly lower self-esteem levels than non-fathers. Finally, multiple regression analysis indicated that adolescent self-esteem could not be predicted by the independent variables of sexually active, virgin, gender, age, and pregnancy/fatherhood. The failure of this study to confirm the significance of self-esteem as a significant factor may stem, in part, from characteristics of the sample. Students were drawn from university-affiliated high schools that emphasized parental involvement and teacher influence--factors that are known to enhance self-esteem. In addition, the pregnant subjects were in their final trimester, and thus had time to develop a positive adaptation to pregnancy. Pregnancy prevention programs should be based on a comprehensive assessment of factors that influence the targeted adolescents on the individual, peer group, family, and community levels.

Helping the medicine go down. Nurses' and patients' perceptions about medication compliance.

The issue of medication compliance is a multidimensional phenomenon that rests not only with the patient, but also with the interactions of caregivers. Study results revealed that nurses and patients generally perceive estimated frequency of medication compliance to be similar, although increased length of time as a psychiatric nurse was associated with nurses perceiving patients as being less compliant. Reasons given by patients and nurses for medication noncompliance differed. Patients' responses were characterized by being more concrete and varied in nature than those of the nurse.

Vulvovaginal candidiasis: a study of immediate vs. delayed treatment on patient comfort.

Vulvovaginal candidiasis is a miserable infection that affects millions of women each year. The purpose of this article's study was to investigate the effectiveness of an immediate treatment intervention for increasing the comfort level of women with vulvovaginal candidiasis. An experimental study using a sample of 20 women compared the comfort of a control group, which received routine care, to the comfort of the experimental group, which received routine care plus vaginal debridement followed by application of vaginal medication. The experimental group experienced greater relief from their symptoms post-treatment than did the control group. Implications for NP practice are presented.