Barbara Mawn

Conducting interdisciplinary research to promote healthy and safe employment in health care: promises and pitfalls.

Due to the complexity of human health, emphasis is increasingly being placed on the need for and conduct of multidisciplinary and/or interdisciplinary health research. Yet many academic and research organizations—and the discipline-specific associations and journals—may not yet be prepared to adopt changes necessary to optimally support interdisciplinary work. This article presents an ongoing interdisciplinary research projects efforts to investigate mechanisms and pathways that lead to occupational health disparities among healthcare workers. It describes the promises and pitfalls encountered during the research, and outlines effective strategies that emerged as a result. Lessons learned include: conflict resolution regarding theoretical and methodological differences; establishing a sense of intellectual ownership of the research, as well as guidelines for multiple authorship; and development and utilization of protocols, communication systems, and tools. This experience suggests a need for the establishment of supportive structures and processes to promote successful interdisciplinary research.

The context of unintended pregnancy among married women in the USA

Background and methodology Unintended pregnancy is a concern in the USA due to its association with adverse physical, mental, social and economic outcomes. Few studies have examined this issue among married women from a social and contextual perspective. This study targeted married women to examine factors associated with unintended pregnancy using the ecological model of health promotion that focuses attention on both individual and social environmental factors. Data from the National Survey of Family Growth (NSFG) were merged with NSFG contextual files to examine the major predictive factors. Results Multilevel logistic regression modelling revealed that married women of lower socioeconomic status, higher parity, who lived in communities with a high rate of marital dissolution had a higher probability of an unintended pregnancy. Women reported that their husbands were likely to concur with the unintended designation of the pregnancy. Discussion and conclusions This study utilised a unique perspective to examine contextual factors related to unintended pregnancy among married women. The results support the need to focus on the couple as a unit for prevention efforts. Social policies to enhance access to family planning services are necessary to improve outcomes and prevent unintended pregnancies.

Integrating women's perspectives on prenatal human immunodeficiency virus screening : Toward a socially just policy

The purpose of this study was to include the voices of laywomen at risk for or living with human immunodeficiency virus (HIV) in the ongoing debate on prenatal and newborn HIV screening. A phenomenological approach based on Moustakass heuristic model was used in order to explore womens lived experience. The investigator interviewed 33 women, half of whom were HIV-positive, using an open-ended, loosely structured interview guide. Two major domains were identified related to the womens views and experiences of HIV testing: the importance of a womans awareness of her HIV status for both her own and her childs sake, and the need to maintain voluntary choice. Common themes emerging from the stories included paradoxical dimensions of living with the virus, such as fear of death, worry about health, concern over the pandemic itself, and loneliness, interspersed with faith and hope. Implications for health care providers include an enhanced understanding of the impact of the diagnosis, improvement in counseling techniques, and the importance of the establishment of trust.

Cancer Risk Management Decision Making for BRCA+ Women

Women with pathogenic BRCA genetic mutations face high risks for cancer development. Estimates vary among mutation carriers, with lifetime risks ranging from 41% to 90% for breast cancer and 8% to 62% for ovarian cancer. Cancer risk management options for BRCA mutation positive (BRCA+) women have life-altering implications. This qualitative, phenomenological study explored the experience of cancer risk management decision making for women who are unaffected carriers of a BRCA mutation (previvors). Fifteen previvors recruited from Facing Our Risk of Cancer Empowered (FORCE), an online informational and support group, were interviewed. Findings consisted of four major themes: the early previvor experience, intense emotional upheaval; the decisional journey, navigating a personal plan for survival; lack of knowledge and experience among health care providers; and support is essential. Findings highlight the different decisional perspectives of previvors based on age and individual factors and the need for increased competence among health care providers.

Exploring the Palliative Care Needs of People Living in Thailand With End-Stage Renal Disease: A Pilot Study

This article describes the results of a pilot study that was undertaken as a needs assessment for the development of a home-based palliative care model for people living with end-stage renal disease (ESRD) in Thailand. Using the theory of uncertainty in illness as a guide, this mixed-methods study explored the palliative care needs of individuals with ESRD in Bangkok, Thailand. The study included 30 participants with ESRD, 39 family members, four community leaders, and four healthcare providers. The participants completed the revised Edmonton Symptom Assessment Scale, which provided descriptive data on nine symptoms commonly experienced among palliative care patients. In addition, focus group and in-person interviews were conducted with study participants. Four major themes emerged from the qualitative interviews that were congruent with the uncertainty in illness constructs: tremendous suffering, economic consequences, inadequate community support, and concern for the future. The participants suggested improvements in palliative home care from their unique cultural and spiritual perspectives. These findings will facilitate the development of a future intervention study that will examine the impact of a palliative care program for Thai persons living with ESRD.

HIV Screening: Beliefs and Intentions of the Homeless

&NA; HIV screening is the first step in identifying HIV infection; however, the HIV screening rates remain low. Homeless people in the United States are at risk for HIV infection, yet their acceptance of HIV screening remains poorly understood. The purpose of this study was to investigate beliefs and intentions of the homeless toward HIV screening. Using a survey design, this study applied the Theory of Planned Behavior to investigate attitudes, social norms, and perceived behavioral control and their relationship to intention to screen for HIV. Homeless people (N = 323) from 12 different shelters participated in this study. The final path analysis explained 60% of homeless peoples intentions to screen for HIV. Significant predictors included: attitude toward HIV screening, prior screening, age, and subjective norms. Implications include health provider recommendations for screening and increasing awareness of HIV risk behaviors for this vulnerable population.

Health Disparities Among Health Care Workers

In this article we describe the process of an interdisciplinary case study that examined the social contexts of occupational and general health disparities among health care workers in two sets of New England hospitals and nursing homes. A political economy of the work environment framework guided the study, which incorporated dimensions related to market dynamics, technology, and political and economic power. The purpose of this article is to relate the challenges encountered in occupational health care settings and how these could have impacted the study results. An innovative data collection matrix that guided small-group analysis provided a firm foundation from which to make design modifications to address these challenges. Implications for policy and research include the use of a political and economic framework from which to frame future studies, and the need to maintain rigor while allowing flexibility in design to adapt to challenges in the field.

The Changing Horizons of U.S. Families Living With Pediatric HIV

Although HIV is considered a chronic pediatric illness that is on the wane in the United States, challenges remain for those affected. The purpose of this longitudinal qualitative study was to examine the phenomenon of raising an HIV-positive child in the United States from the parental perspective. This study incorporated a longitudinal, phenomenological approach. The purposive sample included parents and guardians from 10 families from the northeast region of the United States with children diagnosed with asymptomatic HIV infection at the study onset. The researcher conducted in-depth interviews with the parents over a 7-year period. The common themes identified included: balancing normalcy with uncertainty, facing the multifaceted dilemmas associated with disclosure, and addressing the evolving medication and treatment challenges. The findings of this study can enhance the understanding of nurses and other health care professionals to improve policies, standards of care, and interventions for children and families living with pediatric HIV infection.

Immunization update: a community-based nursing education program.

BACKGROUND Nurses play key roles as advocates, educators, and researchers to eliminate barriers to access as well as educate the public on the importance of vaccines for children in the United States. METHOD Fifty-four nurses attending a community-based immunization program completed a pretest questionnaire which included identification of related practice behaviors and general knowledge questions. Twenty-four responded to a similar posttest survey 6 months later. The investigators compared knowledge pretest and posttest scores with a t test. Behavioral changes were compared between the pretest and posttest group by analyzing the percentage of change between the time period. RESULTS The mean score in the knowledge section increased significantly from a pretest mean of 52% to 75% during the posttest period (p < 005). Behavior change was not statistically significant because of the low number of posttest responses indicating actual immunization practices in the clinical setting. The investigators analyzed trends in practice by comparing percentages of responses. CONCLUSION These findings suggest that a multifaceted, community-based nursing continuing education program including both local, ethnic community perspectives and information related to the latest standards of practice can impact knowledge levels and some practice behaviors.

Exploring Transition to Self-Management Within the Culture of Sickle Cell Disease

Purpose: The aim of this study was to explore the meaning of transition to self-management in sickle cell disease. Design/Method: Twelve audio-recorded semistructured interviews were conducted with a sample of 21- to 25-year-olds recruited from a comprehensive sickle cell center in the northeast region of the United States. Data were analyzed using an existential framework according to van Manen’s phenomenological method. Findings: The meaning of transition to self-management was found in lived time, space, body, and human relationship. The emerging themes highlighted in this article include: Best Mother Ever, Growing up in the Hospital, I’m Not Trying that Again, Doing it on My Own, Living Day-by-Day, and Not a Kid any Longer. The themes reflected meaning and insight into this unique experience. Conclusion/Practice Implications: Study results emphasize the culturally constructed meaning of transition to sickle cell disease self-management and need to integrate transcultural perspectives into nursing practice to support this emerging phenomenon.