Adaptation to High-Risk Childbearing: Extension of a Preliminary Situation-Specific Theory with Focus on Psychological State and Functional Status / Adaptación a la maternidad de alto riesgo: ampliación de una teoría preliminar de situación específica con enfoque en la condición psicológica y el estado funcional / Adaptação à maternidade de alto risco: ampliação de uma teoria preliminar de situação específica com foco na condição psicológica e no estado funcional

Introduction: Little is known about expectant and new parents' psychological experiences of high-risk childbearing. Objective: The paper is a report analyses of data from a Roy Adaptation Model-guided pilot study of women's and their male partners' adaptation to high-risk childbearing and thereby extends a preliminary situation-specific theory of adaptation to high-risk childbearing. Materials and methods: A previous paper was a comprehensive report of the results of the pilot study except for psychological state, measured by the Multiple Affect Adjective Checklist-Revised. The additional data analyses reported in this paper are for effect sizes of correlations between the Multiple Affect Adjective Checklist-Revised subscales and maternal and paternal functional status inventories. Results: Correlations of small (r = 0.1), medium (r = 0.3), and large (r = 0.5) effect sizes were found for the measures of psychological state and functional status for both women and their male partners except for psychological state positive affect and maternal functional status during the postpartum, and psychological state anxiety and paternal functional status during the postpartum. Conclusions: Overall, no substantial differences were found in psychological state and functional status for women and their male partners during pregnancy and the postpartum. The findings of this secondary data analysis constitute an extension of the preliminary situation-specific theory reported in a previously published paper.

Introducción: poco se conoce sobre las experiencias psicológicas de los futuros y nuevos padres en la maternidad de alto riesgo. Objetivo: dar a conocer unos análisis de datos adicionales a partir de un estudio piloto guiado por el modelo de adaptación de Roy sobre la adaptación de las mujeres y sus parejas masculinas a la maternidad de alto riesgo y, por lo tanto, ampliar una teoría preliminar de situación específica de la adaptación a la maternidad de alto riesgo. Materiales y métodos: el artículo previo fue un informe completo de los resultados del estudio piloto, excepto por la condición psicológica, que se midió mediante la lista de verificación de adjetivos de afecto múltiple revisada. Los análisis de datos adicionales suministrados en este documento corresponden a los tamaños del efecto de las correlaciones entre las subescalas de la lista de verificación de adjetivos de afecto múltiple revisadas y los inventarios de estado funcional materno y paterno. Resultados: se encontraron correlaciones de tamaños de efecto pequeños (r = 0,1), medianos (r = 0,3) y grandes (r = 0,5) para las medidas de condición psicológica y estado funcional tanto para las mujeres como para sus parejas masculinas, excepto para el afecto positivo de la condición psicológica y el estado funcional materno durante el posparto y la condición psicológica de ansiedad y el estado funcional paterno durante el posparto. Conclusiones: en general, no se encontraron diferencias sustanciales en la condición psicológica y el estado funcional de las mujeres y sus parejas masculinas durante el embarazo y el posparto. Los hallazgos de este análisis de datos secundarios constituyen una extensión de la teoría preliminar de situación específica presentada en un artículo publicado con anterioridad.

Introdução: pouco se sabe sobre as experiências psicológicas dos futuros e novos pais na maternidade de alto risco. Objetivo: apresentar as análises de dados adicionais a partir de um estudo-piloto orientado pelo modelo de adaptação de Roy sobre a adaptação das mulheres e seus companheiros à maternidade de alto risco e, portanto, ampliar uma teoria preliminar de situação específica da adaptação à maternidade de alto risco. Materiais e método: tendo em vista que se trata de uma extensão de um artigo publicado anteriormente, o qual foi um relatório completo dos resultados do estudo-piloto, exceto pela condição psicológica, que foi medida mediante a checklist de adjetivos de afeto múltipla revisada, as análises de dados adicionais fornecidas neste documento correspondem aos tamanhos do efeito das correlações entre as subescalas da checklist de adjetivos de afeto múltipla revisada e os inventários de estado funcional materno e paterno. Resultados: foram constatadas correlações de tamanhos de efeito pequenos r = 0,1), médios (r = 0,3) e grandes (r = 0,5) para as medidas de condição psicológica e estado funcional tanto para as mulheres quanto para seus companheiros, exceto para o afeto positivo da condição psicológica e o estado funcional materno durante o pós-parto, e a condição psicológica de ansiedade e o estado funcional paterno durante o pós-parto. Conclusões: em geral, não foram encontradas diferenças substanciais na condição psicológica e no estado funcional das mulheres e seus companheiros durante a gestação e o pós-parto.

Adaptation to High-Risk Childbearing: A Preliminary Situation-Specific Theory / Adaptación a la maternidad de alto riesgo: una teoría preliminar específica de la situación / Adaptação à maternidade de alto risco: uma teoria preliminar específica da situação

ABSTRACT The purpose of this paper is to present a discussion of a preliminary situation-specific theory of adaptation to high-risk childbearing for expectant and new mothers and fathers. Roy's Adaptation Model guided the design and conduct of the pilot study of correlates of maternal and paternal functional status from which the theory was derived. The conceptual-theoretical-empirical structure for the study is displayed in a diagram. The concepts of the theory-functional status, physical symptoms, physical energy, psychological symptoms, and relationship quality--are identified and defined, and their linkages are identified. Implications for testing and potential use of the theory in nursing practice are discussed.

RESUMEN El propósito de este artículo es presentar una discusión sobre una teoría preliminar específica, de la situación de la adaptación a la maternidad de alto riesgo, para las futuras madres y los nuevos padres. El modelo de adaptación de Roy sirvió de guía para el diseño y la realización del estudio piloto de correlatos del estado funcional materno y paterno del cual se derivó la teoría. La estructura conceptual-teórico-empírica para el estudio se muestra en un diagrama. Se identifican y definen los conceptos de la teoría: estado funcional, síntomas físicos, energía física, síntomas psicológicos y calidad de la relación, y se identifican sus vínculos. Se discuten las implicaciones para las pruebas y el uso potencial de la teoría en la práctica de enfermería.

RESUMO O objetivo deste artigo é apresentar uma discussão de uma teoria preliminar específica da situação de adaptação à maternidade de alto risco para as futuras mães e os novos pais. O modelo de adaptação de Roy serviu como um guia para desenho e implementação do estudo piloto de correlatos do estado funcional materno e paterno do qual a teoria foi derivada. A estrutura conceitual-teórico-empírica para o estudo é mostrada em um diagrama. Os conceitos da teoria são identificados e definidos: estado funcional, sintomas físicos, energia física, sintomas psicológicos e qualidade da relação, e seus elos são identificados. As implicações para o teste e o uso potencial da teoria na prática de enfermagem são discutidas.

Predictors of the intensity of symptoms in a cluster in patients with breast cancer.

PURPOSE: To examine the influence of selected demographic and clinical variables on the intensity of symptoms in two previously identified symptom clusters (psychoneurological and upper gastrointestinal) across the treatment trajectory for breast cancer. DESIGN: A secondary analysis was conducted with a sample of 282 female breast-cancer patients who were receiving chemotherapy or radiation therapy in two American cancer centers. Data were collected three times across the treatment trajectory: baseline (before chemotherapy or radiation treatment) and two follow-up times after treatment initiation. METHOD: Multiple regression analyses were done at each time point to examine the influence of selected demographic and clinical variables on the intensity of symptoms in each cluster. FINDINGS: Baseline physical performance status was a consistent predictor of symptom intensity in the psychoneurological cluster across time whereas age and treatment modality were consistent predictors of symptom intensity in the upper gastrointestinal cluster. Poor physical performance at baseline predicted more intense psychoneurological symptoms. Younger women and women undergoing chemotherapy experienced more intense gastrointestinal symptoms. In addition, at the second follow-up treatment modality also influenced intensity of symptoms in the psychoneurological cluster and race and baseline physical performance status also influenced the intensity of symptoms in the upper gastrointestinal cluster. CONCLUSIONS: Clinicians can anticipate that younger patients, patients with poor baseline physical performance status, and patients who receive chemotherapy will have more intense treatment-related gastrointestinal and psychoneurological symptoms during adjuvant breast cancer therapy. Further research is needed to determine whether collective management for symptoms in a cluster may be beneficial. CLINICAL RELEVANCE: Clinicians can use findings from the present study to identify patients who need greater attention to symptom assessment and management, including anticipatory counseling of patients and families.

Treatment-related symptom clusters in breast cancer: a secondary analysis.

This study investigated treatment-related symptom clusters and the influence of selected demographic/clinical variables on symptom clustering in breast cancer patients across a treatment trajectory. A secondary analysis of 282 breast cancer patients receiving chemotherapy or radiotherapy was done to determine the clustering of oncologic treatment-related symptoms at selected time points of treatment. Two distinct clusters were identified: a psychoneurological cluster and an upper gastrointestinal cluster. The clustering of symptoms was generally stable across the treatment trajectory. The clustering, however, was weaker when the time lapse after the completion of treatment became longer. Demographic and clinical variables did not significantly influence symptom clustering. Psychoneurological symptoms had a tendency to occur together across the treatment trajectory, as did upper gastrointestinal symptoms. Effective symptom assessment/management strategies need to take into account this co-occurrence of symptoms. The findings from this study underscore the need for further investigation of the common biological basis of symptoms to attain more effective management of multiple symptoms.

Development and testing of the Blueprint for Integration of Cultural Competence in the Curriculum Questionnaire.

The 31-item Blueprint for Integration of Cultural Competence in the Curriculum Questionnaire (BICCCQ) was developed to measure student reports of components of content on cultural competence taught in undergraduate and graduate nursing programs. BICCCQ items were derived from the Tool for Assessing Cultural Competence Training, which was developed to measure faculty report of components of content on cultural competence in medical school curricula. Additional items were added by a task force of members of a nursing faculty. Five factors were found by principal components factor analysis with varimax rotation: Attitudes and Skills, Knowledge of Basics, Cultural Communication, Knowledge of Theory, and Knowledge of Key Concepts, which accounted for 62.64% of the variance and included all 31 items. Mean scores for freshmen, seniors, and master's students were statistically significantly different for each factor, with freshmen scoring lower than the other two groups. Internal consistency using Cronbach's alpha ranged from .73 to .94 across factors and was .96 overall. The BICCCQ has satisfactory preliminary construct validity and internal consistency reliability. Further testing in other schools to cross-validate the stability of our findings is recommended.

Promoting research partnerships to reduce health disparities among vulnerable populations: sharing expertise between majority institutions and historically black universities.

This chapter focuses on promoting cultural competence in research and the care of vulnerable populations by establishing inter-university nursing partnership centers for health disparities research between historically Black universities and minority-serving institutions and research-intensive majority institutions. The Hampton-Penn Center to Reduce Health Disparities (HPC), an inter-university collaborative center funded through the National Institutes of Health (NIH) National Institute of Nursing Research (NINR) P20 funding mechanism, is discussed as the exemplar. The mission of the Hampton-Penn Center is to promote culturally competent research on health promotion and disease prevention and the examination of how culture, race and ethnicity and their interactions with the health care system and the larger society influence health outcomes and the occurrence of health disparities. The history, goals, and conceptual model underlying this collaborative effort between the University of Pennsylvania and Hampton University Schools of Nursing are described as are the accomplishments and lessons learned to date. Based upon the Hampton-Penn experience, recommendations for similar collaborations to reduce health disparities among vulnerable populations are made in three major areas: (a) increasing the study of the multi-system level factors that contribute to health disparities among vulnerable populations, (b) promoting the development of culturally competent research on health disparities, and (c) promoting the recruitment and training of health researchers who are themselves members of vulnerable populations.

Development of the Comprehensive Inventory of Functioning-Cancer.

The Comprehensive Inventory of Functioning-Cancer (CIF-CA) was developed to measure actual and desired functional status in women with cancer. CIF-CA items were taken from the Inventory of Functional Status-Cancer, which measures only actual performance of usual activities. Six CIF-CA subscales measure the extent to which women perform usual personal care, family care, household, social, community, and occupational activities following diagnosis of cancer (actual functional status) and the level at which they wish to perform those activities (desired functional status). Reliability and construct validity estimates were obtained using a sample of 190 women with breast, lung, or colon cancer. Internal consistency reliability using average correlations for subscale item to subscale total scores ranged from 0.68 to 0.93 for actual functional status and from 0.61 to 0.85 for desired functional status. Internal consistency reliability coefficients for subscale to total CIF-CA scores ranged from 0.46 to 0.86 for actual functional status and from 0.62 to 0.83 for desired functional status. Initial construct validity coefficients, using subscale to subscale scores, ranged from 0.10 to 0.61 for actual functional status and from 0.33 to 0.62 for desired functional status. The data support continued development of the CIF-CA.

Using a focus group to determine car seat use among mothers of children aged 3 to 7 years.

PURPOSE: This study built on prior research and examined the beliefs, behaviors, barriers and motivating factors for use of child car seats with children aged 3 to 7 years. STUDY DESIGN AND METHODS: Two focus groups of eight mothers each were conducted using a structured interview guide. One group consisted of African American and Latina women, the other of White women. RESULTS: All of the mothers believed that properly restraining their children while riding in a car protected the children from injury. Most also reported that they have used car seats for their children. African American and Latina mothers, however, reported more inconsistent use of the seats, particularly with older children of this age group. They were also more likely to report greater resistance by their children to use car seats. CLINICAL IMPLICATIONS: In this small study, there were ethnic disparities in differences in use of child car seats for children aged 3 to 7; this subject requires more research. In the meantime, public health programs on child car seats are needed and should take into account differing beliefs and behaviors of various cultural groups.

Women's perceptions of the effectiveness of telephone support and education on their adjustment to breast cancer.

PURPOSE/OBJECTIVES: Social support is believed to be important in helping women adjust to breast cancer. Reports have suggested limited positive effects of social support on well-being, mood disturbances, and relationships with significant others for women who receive telephone support. Women's perceptions of the role of social support in recovery, however, has had limited study. The purpose of this study was to describe women's perceptions of their emotional and interpersonal adaptations to breast cancer after their involvement in a randomized clinical trial in which one group received educational materials and telephone support from oncology nurses and another group received educational materials only. RESEARCH APPROACH: Content analysis was used to discover women's perceptions of their emotional and interpersonal adaptation to breast cancer following their participation in a study in which one group received educational materials and telephone support from oncology nurses and another group received educational materials only. SETTING: All participants were interviewed by telephone in their homes. PARTICIPANTS: 77 of 106 women with breast cancer from a randomized clinical trial were interviewed about their expectations of their adaptations and the effectiveness of the experimental and social support intervention delivered by telephone. METHODOLOGIC APPROACH: Telephone interviews were recorded on audiotape and transcribed for analysis. Structured interviews were completed by a non-nurse interviewer. Frequency counts were obtained from the responses to items and comments were clustered for themes. MAIN RESEARCH VARIABLES: Emotional and interpersonal adaptations to breast cancer, educational materials, and telephone support from oncology nurses. FINDINGS: Fifty-four percent of the women who received the telephone support interventions reported improvement in attitude, whereas 43% of the interviewed women in the control group reported improvement. Only three participants, all in the control group, reported worsened emotional status. The percentage of those reporting improved or unchanged physical status was about equal in each group. The majority of participants in both groups indicated that their levels of involvement in activities remained the same or increased. Forty-six percent of participants in the intervention group reported improved relationships with their spouses compared to 38% in the control group. Women from both groups indicated that the diagnosis of cancer had caused them to review their lives and make changes in their relationships and activities. CONCLUSIONS: Participants who received telephone support for one year, in addition to educational materials, reported improvement in their attitudes toward their breast cancer and better relationships with their significant others. INTERPRETATION: The women's perceptions are consistent with quantitative results from the clinical trial. This article reports additional evidence that telephone support is an effective alternative to support groups and may be appropriate for those with limited access to such groups because of geography, work demands, or family situations.

Symptom clusters: concept analysis and clinical implications for cancer nursing.

The purpose of this article is to analyze the concept of symptom clusters and to discuss its application to cancer nursing to promote communication and enhance scientific knowledge. Rodgers' evolutionary method of concept analysis served as the framework for reviewing literature from psychology/psychiatry, general medicine, and nursing. Attributes of symptom clusters were relationships of symptoms and relationships of clusters, concurrence, underlying dimensions, stability, and common etiology. The major antecedent was the presence of 2 or more symptoms. Consequences were poorer physical health status, interference with activities of daily living, emotional distress, and increased financial burden. A symptom cluster is defined as consisting of 2 or more symptoms that are related to each other and that occur together. Symptom clusters are composed of stable groups of symptoms, are relatively independent of other clusters, and may reveal specific underlying dimensions of symptoms. Relationships among symptoms within a cluster should be stronger than relationships among symptoms across different clusters. Symptoms in a cluster may or may not share the same etiology. Symptom should be broadened to include both subjective (self-reported) symptoms and objective (observed) signs. Implications for researchers include the need to use a clear definition, determine the optimal methods of identifying etiology and nature of symptom clusters in various populations, assess the clinical utility of symptom clusters, and test interventions. Implications for practitioners include the need to comprehensively assess symptoms over the entire cancer trajectory, select interventions that target single and multiple symptoms, and evaluate outcomes that include quality of life and economic variables.

The effect of telephone social support and education on adaptation to breast cancer during the year following diagnosis.

PURPOSE/OBJECTIVES: To find the most effective methods of providing social support for women diagnosed with breast cancer by testing the effectiveness of a telephone social support and education intervention to promote emotional and interpersonal adaptation to breast cancer. DESIGN: Multisite, two-group experimental study with repeated measures. SETTING: Arkansas and New Jersey. SAMPLE: The Arkansas sample consisted of 106 women who entered the study two to four weeks postsurgery for nonmetastatic breast cancer and were randomly assigned to an experimental or control group. The comparison group consisted of 91 women from New Jersey who had participated in a previously completed study that used the same interventions and found that telephone support resulted in more positive, statistically significant adaptation to the disease. METHODS: The experimental group received 13 months of telephone social support and education. Both groups received educational materials via a mailed resource kit. The Profile of Mood States; Visual Analogue Scale-Worry; Relationship Change Scale; University of California, Los Angeles, Loneliness Scale-Version 3; and the modified Symptom Distress Scale provided data regarding the variables of interest. Data analysis included descriptive statistics, t tests, and multivariate analysis of variance with repeated measures. MAIN RESEARCH VARIABLES: Mood, worry, relationships with significant others, loneliness, and symptoms. FINDINGS: Data analysis showed no significant differences between groups, and both improved on some of the outcomes. Significant time-by-location interaction effects were found when comparing the Arkansas and New Jersey samples, thereby supporting the need to consider regional differences when developing interventions. CONCLUSIONS: The mailed educational resource kit alone appeared to be as effective as the telephone social support provided by oncology nurses in conjunction with the mailed resource kit. IMPLICATIONS FOR NURSING: Mailed educational resource kits may be the most efficient and cost-effective way to provide educational support to newly diagnosed patients with breast cancer, but their effect may differ according to region.

Methodological issues in the use of published cartoons as data.

When common understanding of a phenomenon is under investigation, mass media representation in general, and cartoon images in particular, are a useful source of data. Sample selection, data collection, and the analysis of constructed images differ from other kinds of data. Cartoonists may intend to stimulate multiple interpretations among readers. Uncovering these interpretations is essential to understanding public discourse of the phenomenon of interest. Semantic validation is used to assess the degree to which the meanings of text relative to their context are accurately represented. Analysis of the image and text of cartoons has the potential to yield important understanding of public discourse surrounding issues of the public's health and well-being.

A longitudinal study of functional status and correlates following coronary artery bypass graft surgery in women.

BACKGROUND: There is limited information available to help women gauge their functional status following coronary artery bypass graft surgery. OBJECTIVE: This article describes changes in functional status and the influence of comorbidity, household composition, fatigue, and surgical pain on functional status in women during the first 6 weeks at home following coronary artery bypass surgery. METHOD: A single-group longitudinal design was used for this research. Women were interviewed in person before hospital discharge and by telephone at 2, 4, and 6 weeks after discharge. Functional status was assessed by (a) the Inventory of Functional Status in the Elderly and subscales of the Sickness Impact Profile; (b) comorbid conditions by simple tally; and (c) fatigue and surgical pain by the Energy/Fatigue and Pain Severity subscales of the MOS Patient Assessment Questionnaire. RESULTS: Women experienced significant gains in functional status over 6 weeks, particularly between 2 and 4 weeks. They engaged most frequently in personal care and low-level household activities during the study period, and most reported improvement in their overall functional status. None of the women were completely recovered or had regained baseline functional status by 6 weeks. The women experienced significant decreases in fatigue and surgical pain, but continued to experience both at 6 weeks. Fatigue and surgical pain were significantly correlated at all time periods. DISCUSSION: Information about recovery following coronary artery bypass graft, and particularly the finding that recovery is incomplete by 6 weeks, should be incorporated into discharge planning and follow-up for this patient population.

Effects of two types of social support and education on adaptation to early-stage breast cancer.

A Roy adaptation model-based support and education intervention for women with early-stage breast cancer was tested in a three-group, three-phase randomized clinical trial of a sample of 125 women. The experimental group received 13 months of combined individual telephone and in-person group support and education, Control Group 1 received 13 months of telephone-only individual support and education, and Control Group 2 received one-time mailed educational information. The experimental group and Control Group 1 reported less mood disturbance at the end of all three phases, less loneliness at the end of Phases II and III, and a higher-quality relationship with a significant other at the end of Phase II than did Control Group 2. No group differences were found for cancer-related worry or well-being. The findings suggest that individual telephone support may provide an effective alternative to in-person support groups. Further study of telephone interventions is recommended using ethnically and economically heterogeneous samples.