Low-Income Cancer Survivors' Use of Health-Promoting Behaviors.

This cross-sectional correlation study examined use of health-promoting (HP) behaviors and self-efficacy for engaging in HP behaviors. Participants reported higher HP behavior scores for health responsibility, interpersonal relationships, and spiritual growth, and lower scores for physical activity/exercise, nutrition, and stress management. Low physical activity, stress management, and nutrition scores suggest nurses can implement strategies that encourage use of these HP behaviors and enhance self-efficacy.

Health Status and Self-care Outcomes After an Education-Support Intervention for People With Chronic Heart Failure.

BACKGROUND: The rising cost of hospitalizations for heart failure (HF) care mandates intervention models to address education for self-care success. The effectiveness of memory enhancement strategies to improve self-care and learning needs further examination. OBJECTIVE: The objective of this study was to examine the effects of an education-support intervention delivered in the home setting, using strategies to improve health status and self-care in adults/older adults with class I to III HF. Our secondary purpose was to explore participants' subjective perceptions of the intervention. METHODS: This study used a randomized, 2-group design. Fifty people were enrolled for 9 months and tested at 4 time points-baseline; after a 3-month education-support intervention; at 6 months, after 3 months of telephone/e-mail support; and 9 months, after a 3-month period of no contact. Advanced practice registered nurses delivered the intervention. Memory enhancement methods were built into the teaching materials and delivery of the intervention. We measured the intervention's effectiveness on health status outcomes (functional status, self-efficacy, quality of life, emotional state/depressive symptoms, and metamemory) and self-care outcomes (knowledge/knowledge retention, self-care ability). Subjects evaluated the usefulness of the intervention at the end of the study. RESULTS: The mean age of the sample was 62.4 years, with a slight majority of female participants. Participants were well educated and had other concomitant diseases, including diabetes (48%) and an unexpected degree of obesity. The intervention group showed significant improvements in functional status, self-efficacy, and quality of life (Kansas City Cardiomyopathy Questionnaire); metamemory Change and Capacity subscales (Metamemory in Adulthood Questionnaire); self-care knowledge (HF Knowledge Test); and self-care (Self-care in Heart Failure Index). Participants in both groups improved in depressive scores (Geriatric Depression Scale). CONCLUSIONS: An in-home intervention delivered by advanced practice registered nurses was successful in several health status and self-care outcomes, including functional status, self-efficacy, quality of life, metamemory, self-care status, and HF knowledge.

Health promotion for cancer survivors: adaptation and implementation of an intervention.

Randomized control trial of a health promotion intervention was implemented for low-income cancer survivors. The majority of participants were female, older, divorced, educated, and unemployed or on disability leave. Findings indicate the health promotion intervention improved cancer survivors' self-efficacy and increased their use of health-promoting behaviors.

Health-promoting behaviors of low-income cancer survivors.

PURPOSE/OBJECTIVES: The purpose of this study was to explore the health-promoting (HP) behaviors of low-income cancer survivors before and after their diagnosis of cancer. DESIGN: This qualitative study used a purposive sampling strategy to identify low-income, ethnically diverse cancer survivors. SETTING: Participants were recruited from an urban outpatient cancer clinic serving only low-income clients. SAMPLE: Thirteen, ethnically diverse low-income cancer survivors participated in 60- to 90-minute interviews discussing their experience with HP behaviors before and after their diagnosis with cancer, their cancer experience, and their perspectives on being a cancer survivor. METHODS: Conventional content analysis of transcripts and field notes by 2 coders identified words, context, frequency, emphasis, and consistency of participants' comments. Statements were further examined to identify patterns and main themes and to interpret the meaning of what was said. FINDINGS: Participants described their use of various HP behaviors primarily walking, maintaining a positive mental attitude, and changing their diet. Participants discussed their perspectives on having a diagnosis of cancer as well as the meaning of being a cancer survivor. They described spiritual growth through prayer, renewing their faith, maintaining a hopeful outlook, and expressing thankfulness toward God. Participants expressed interested in learning about effective physical exercises, healthy eating, and stress management strategies. CONCLUSIONS: Results suggest that low-income cancer survivors engage in various HP behaviors and want to learn more behaviors to use after cancer treatment. IMPLICATIONS FOR PRACTICE: Findings provide useful information for clinical nurse specialists when providing information about HP behaviors for use during and after cancer treatment as well as the meaning of cancer survivor for low-income cancer survivors.

Creating a positive work environment: implementation of the nurse-friendly hospital criteria.

The nursing shortage is negatively affecting the quality, effectiveness, and timeliness of patient care, which warrants a transformation of the nursing work environment. The Nurse-Friendly (NF) Hospital Project assisted 30 rural or small hospitals implement 12 NF criteria into hospital policies to create a positive work environment. The NF criteria represent organizational attributes necessary for ensuring quality patient care, positive work environment, professional development, and nurse satisfaction. The authors discuss nurses' perception of presence of NF criteria before and after they were incorporated at each hospital and the implementation outcomes.

Nurse-Friendly Hospital Project: enhancing nurse retention and quality of care.

The present shortage of nurses in the United States is expected to continue. Nurse shortage, the nature of the work environment, and employers' expectations and attitudes, among other factors, influence both nurse retention and quality of patient care. The Nurse-Friendly Hospital Project was designed to improve nurses' work environment in rural and small hospitals in Texas. Findings demonstrate improvements in nurse retention, nurse staffing, and quality of care.

Effects of spirituality in breast cancer survivors.

PURPOSE/OBJECTIVES: To examine the effects of spirituality (meaning in life and prayer) on a sense of well-being among women who have had breast cancer. DESIGN: Descriptive, correlational, cross-sectional. SETTING: Rural and urban communities in central Texas. SAMPLE: Convenience sample of 84 women, 34-80 years of age diagnosed less than one year previously (36%), within the previous one to five years (38%), and more than five years previously (26%). METHODS: The study approach consisted of completing a questionnaire assessing personal and cancer characteristics, aspects of spirituality (meaning in life and prayer), and physical and psychological responses to breast cancer. MAIN RESEARCH VARIABLES: Meaning in life, prayer, and physical and psychological responses to breast cancer. FINDINGS: Meaning in life was positively related to psychological responses and negatively related to physical responses. Prayer was positively related to psychological well-being. Women with higher prayer scale scores reported lower education levels, less income to meet their needs, and closer relationships with God. Meaning in life mediated the impact of breast cancer on physical and psychological well-being. CONCLUSIONS: Strong relationships exist among spirituality and personal and cancer characteristics. Meaning in life mediated the effects of breast cancer on well-being in breast cancer survivors. IMPLICATIONS FOR NURSING: The findings support healthcare providers encouraging women diagnosed with breast cancer to explore their spirituality as an effective resource for dealing with the physical and psychological responses to cancer.

The effects of spirituality on well-being of people with lung cancer.

PURPOSE/OBJECTIVES: To examine the effects of spirituality on the sense of well-being of people with lung cancer. DESIGN: Descriptive, correlational study. SETTING: Urban and rural oncology and radiation centers. SAMPLE: 60 adults ranging from 33-83 years of age. Most participants had non-small cell lung cancer and were female, Caucasian, and older than 50. METHODS: Participants completed a questionnaire composed of six survey instruments: Life Attitude Profile-Revised, Adapted Prayer Scale, Index of Well-Being, Symptom Distress Scale, a background information sheet, and a cancer characteristics questionnaire. Correlations among study concepts were examined, and multiple regression analysis was used to determine the effects of spirituality. MAIN RESEARCH VARIABLES: Meaning in life, prayer activities and experiences, symptom distress, and psychological well-being. FINDINGS: Higher meaning in life scores were associated with higher psychological well-being and lower symptom distress scores. Higher prayer scores were associated with higher psychological well-being scores. Regression analysis indicated that meaning in life mediated the relationship between functional status and physical responses to lung cancer and explained 9% of the variance in symptom distress. Prayer mediated the relationship between current physical health and psychological responses and explained 10% of the variance in psychological well-being. CONCLUSIONS: Aspects of spirituality, meaning in life, and prayer have positive effects on psychological and physical responses in this group of people with lung cancer. IMPLICATIONS FOR NURSING: This research provides knowledge about spirituality and sense of well-being to guide the care of people with lung cancer.

Nurses' needs for education on cancer and end-of-life care.

BACKGROUND: Changes in cancer and end-of-life care require frequent assessment of educational needs of nurses. METHODS: The Nurse Oncology Education Program surveyed a random sample of Texas registered nurses about their continuing education practices, level of knowledge, and educational needs. RESULTS: The 352 nurses responding to the survey primarily obtained continuing education from workshops, inservice education, and independent studies citing cost, location, content, and length of course as influencing factors. Their cancer educational needs included clinical trials, genetics, complementary therapies, and pain management. Nurses' perceptions of end-of-life needs were for physical needs, "what to expect" concerns, and transition to palliative care. CONCLUSION: These findings provide specific direction for future continuing education programs about cancer and end-of-life issues for nurses.

The Expect Respect Project. Creating a positive elementary school climate.

The Expect Respect Project, a violence prevention program, was developed to reduce the incidence of bullying and sexual harassment by creating a positive school climate in which inappropriate behaviors are not tolerated and staff members respond consistently to incidents. The project implemented an educational intervention for students, parents, and staff members on expecting respect in student relationships and strategies for responding to inappropriate student behaviors. This article describes the educational intervention and evaluation of the project. Findings from the project showed a significant increase in awareness of bullying following the educational intervention. Bullying was reported to have occurred in areas with less adult supervision such as the playground, cafeteria, hallway, and buses. Students thought staff would respond to inappropriate behaviors by telling students to ignore verbal bullying or sexual harassment. In contrast, staff at the elementary schools thought adults would respond to inappropriate behaviors by telling the bully to stop, calling his or her parents, or giving a specific punishment.

Prayer in people with cancer.

The purpose of this study was to adapt an instrument to assess prayer activities, experiences, and attitudes for people with cancer. A cross-sectional correlational research design was used to study 32 adults (24 women and 8 men) at 3 urban oncology and 2 radiation clinics. The prayer scale was adapted for people with cancer by the author, reviewed by measurement and content experts, and tested by administration to 32 people with a variety of cancers. Expert review supported the content validity of the adapted instrument. Instrument subscales had acceptable reliability for internal consistency. The 3 prayer scale subscales were moderately correlated to perceived relationship with God. Results demonstrated that high scores on the frequency of prayer subscale were associated with low levels of education and functional status and high presence of metastasis at diagnosis. Reports of more prayer activity were related to low levels of functional status. Additionally, those reporting low levels of physical health status had more prayer experiences. The prayer scale is a sensitive instrument for assessing prayer activities, experiences, and attitudes of people with cancer. Prayer is a valuable internal resource, which can lessen the effect of cancer.

Maintenance of skin integrity as a clinical indicator of nursing care.

OBJECTIVE: To assess maintenance of skin integrity in hospitalized patients as a clinical indicator of quality nursing care. DESIGN: Descriptive correlational study. SETTING: 17 acute care urban and rural hospitals in Texas. PARTICIPANTS: 723 hospitalized patients from 33 medical-surgical units. MAIN OUTCOME MEASURES: Pressure ulcers since admission and nursing care practices per unit. MAIN RESULTS: Overall prevalence of pressure ulcers since admission (4.7%) was lower than previously reported for acute care settings. Prevalence of pressure ulcers in hospitalized patients (10%) was higher than found in the Texas Nurses Association feasibility study (3.7%). The skin integrity ratio was strongly correlated for several unit variables, including number of beds per unit (r = 0.623) and average daily census per unit (r = 0.909). Benchmarking data across units showed that units with subjects that maintained skin integrity had a lower percentage of patients assessed on admission and performed daily assessments less frequently than did the units with subjects that did not maintain skin integrity. In addition, the units with subjects that maintained skin integrity classified fewer patients as at risk for pressure ulcer development and did not implement a skin care protocol for these patients. CONCLUSION: Patients who developed a pressure ulcer after admission were older and had more risk for pressure ulcers than those who maintained skin integrity. Benchmarking data detected various differences in nursing care. Significant relationships between study variables demonstrate the importance of assessing clinical indicators to monitor nursing care. Outcomes such as skin integrity, pressure ulcer since admission, and nosocomial ratio represent the quality of nursing care.