Cheryl K. Nordstrom

Effects of nurse-managed telemonitoring on blood pressure at 12-month follow-up among Urban African Americans

Background: Nearly one in three adults in the United States has hypertension. Hypertension is one of the largest risk factors for cardiovascular diseases, and it is growing in prevalence, especially among African Americans. Objectives: To test the hypothesis that individuals who participate in usual care (UC) plus blood pressure (BP) telemonitoring (TM) will have a greater reduction in BP from baseline to 12-month follow-up than would individuals who receive UC only. Methods: A two-group, experimental, longitudinal design with block stratified randomization for antihypertensive medication use was used. African Americans with hypertension were recruited through free BP screenings offered in the community. Data were collected through a structured interview and brief physical exam. Cross tabs, repeated measures analysis of variance, and independent t tests were used to analyze the studys hypothesis. Results: The TM intervention group had a greater reduction in systolic BP (13.0 mm Hg) than the enhanced UC group (7.5 mm Hg; t = −2.09, p = .04) from baseline to the 12-month follow-up. Although the TM intervention group had a greater reduction in diastolic BP (6.3 mm Hg) compared with the enhanced UC group (4.1 mm Hg), the differences were not statistically significant (t = −1.56, p = .12). Discussion: Telemonitoring of BP resulted in clinically and statistically significant reductions in systolic BP over a 12-month period; if maintained over a longer period of time, the reductions could improve care and outcomes significantly for African Americans with hypertension.

Using the Teach-Back Method to Increase Maternal Immunization Literacy Among Low-Income Pregnant Women in Jamaica: A Pilot Study

The purpose of this pilot study was to assess maternal health literacy of pregnant women in Jamaica and evaluate their ability to communicate the benefits, risks, and safety of the Bacillus Calmette-Guerin (BCG) and Hepatitis B (hep B) vaccines after using the teach back method. REALM scores were moderately, positively correlated with identification of the BCG vaccine risks (r = .43, p = .01) and with hep B vaccine benefits (r = .34, p = .05) and risks (r = .42, p = .01). Women who gave incorrect responses about the benefits or risks of the vaccines had lower REALM scores than women who gave completely correct or partially correct responses.

Comparison of Bodily Pain: Persons With and Without Venous Ulcers in an Indigent Care Clinic

PURPOSE The purpose of this study was to examine bodily pain and its relationship with functional status, perception of control, coping, and depression for patients with and without venous ulcers who were receiving care in an urban, primary care clinic for low-income adults. METHODS We used an exploratory, cross-sectional design. Participants (N = 301) completed demographic, pain severity and pain interference with function, depression, control, and coping questionnaires. Seventy patients (23.3%) had venous ulcers and 231 (76.7%) did not. RESULTS Participants were generally male (53%, n = 159), mostly African American (92%, n = 277), and ranged in age from 22 to 74 years (M = 49.5, SD = 8.5). Persons with and without venous ulcers did not differ significantly based on gender, race, number of pain sites (n = 3.3), or self-rated health. Those with leg ulcers were significantly older, had more health problems, and were more likely to have pain-related disability. The pain descriptors used by patients with venous ulcers were sharp (89%), nagging (87%), tiring (87%), and throbbing (87%). Patients with leg ulcers reported significantly lower average pain (M = 6.0) than those without leg ulcers (M = 6.6) and greater 24-hour pain relief from treatments or medications (55% vs 44%). Patients with venous ulcers reported greater control over their pain and greater coping with pain. The 2 groups did not differ significantly on depression, life control, or purpose in life scores. CONCLUSIONS Compared to patients without venous ulcers, those patients with venous ulcers rated their pain lower and reported higher coping and control over pain, which may be reflected in better subjective pain management despite having more pain sites and disability related to pain. Pain management for indigent patients with and without venous ulcers remains a concern and needs further study.

The Effect of Low Literacy on the Self-Care Behaviors of Men Receiving Radiation Therapy

Using Orem’s theory as the framework, two purposes guided the study: (a) to test the effectiveness of an audio-visual education program and behavioral contracting to promote self-care behaviors in managing radiation side effects and (b) to determine the extent to which low literacy affects self-care abilities. Seventy men diagnosed with prostate cancer participated in this experimental study. The nursing interventions of education and behavioral contracting significantly increased the self-care behaviors of men in managing radiation side effects. An increase in self-care behaviors was especially shown in men with low-literacy skills.

What parameters affect left ventricular diastolic flow propagation velocity? In vitro studies using color M-mode Doppler echocardiography.

BackgroundInsufficient data describe the relationship of hemodynamic parameters to left ventricular (LV) diastolic flow propagation velocity (Vp) measured using color M-mode Doppler echocardiography.MethodsAn in vitro LV model used to simulate LV diastolic inflow with Vp measured under conditions of varying: 1) Stroke volume, 2) heart rate (HR), 3) LV volume, 4) LV compliance, and 5) transmitral flow (TMF) waveforms (Type 1: constant low diastasis flow and Type 2: no diastasis flow).ResultsUnivariate analysis revealed excellent correlations of Vp with stroke volume (r = 0.98), LV compliance (r = 0.94), and HR with Type 1 TMF (r = 0.97). However, with Type 2 TMF, HR was not associated with Vp. LV volume was not related to Vp under low compliance, but inversely related to Vp under high compliance conditions (r = -0.56).ConclusionThese in vitro findings may help elucidate the relationship of hemodynamic parameters to early diastolic LV filling.

Web citations in the nursing literature: how accurate are they?

One problem with using Web citations is whether those documents will be available over time. We examined 573 Web citations in articles published in nursing journals and checked their availability (either by direct link or by searching the main site). There was a mean of 3.1 Web citations per article. Most Web citations were to documents that related to clinical practice, for example, clinical guidelines and explanations of clinical conditions and treatments. Of the 573 Web citations, 414 (72.3%) were still available; of those, 229 (55.3%) were able to be accessed by direct link and the other 185 (44.7%) by searching the main Web site. However, 159 (27.7%) of the references were not available, not even by searching the Internet using key terms from the citation. Considering that more than a fourth of the Web citations in this study were no longer available, authors need to be cautious about using the Web as a primary source of information for their publications.

The impact of coronary artery disease risk factors on intravascular ultrasound-derived morphologic indices of human coronaries.

Objective: The relationship of intravascular ultrasound (IVUS)‐derived measurements of atherosclerotic plaque to various coronary artery disease (CAD) risk factors is not well known. The purpose of this study was to examine the relationship of percent coronary luminal stenosis by IVUS to other IVUS measures of CAD, as well as the relationship of common IVUS measures of CAD to traditional CAD risk factors. We hypothesized that one or more IVUS measures of CAD might relate more strongly to CAD risk factors than does percent luminal coronary stenosis. Methods: The records of 897 consecutive patients (57% men, mean age 62 years) who underwent IVUS investigation of their coronary arteries from 1996 through 2001 were retrospectively reviewed. IVUS was performed using a 20‐MHz probe (Jomed, Rancho Cordoba, CA) and a manual pull‐back technique to image the coronary arteries. Coronary artery remodeling ratio—i.e., the ratio of coronary lesion external elastic membrane cross‐sectional area (EEM CSA) to proximal reference artery EEM CSA; plaque burden—i.e., plaque plus media CSA divided by EEM CSA; calcium arc; and percent stenosis of luminal cross‐sectional area were measured by a single reader. Results: Percent area stenosis, the most commonly used IVUS parameter, did not correlate with the other three IVUS‐derived parameters, nor was it related to any of the CAD risk factors considered. In contrast, remodeling ratio was directly correlated with plaque burden (r = 0.22, P < 0.001), but inversely related to calcium arc (r =−0.13, P = 0.01). IVUS plaque burden was significantly correlated with male gender (P < 0.0001) and diabetes mellitus (DM) (P = 0.003). In multivariate analyses including age, gender, and CAD risk factors, plaque burden was significantly associated with age, male gender, and DM, but not with chronic renal failure, hypertension, or hypercholesterolemia. The multivariate model also revealed that the calcium arc was significantly associated with male gender and age. These IVUS findings provide anatomic documentation that the traditional CAD risk factors relate more strongly to plaque burden than to percent coronary arterial luminal narrowing.

The prevalence of pain and its association with psychosocial factors for indigent adults enrolled in a primary care clinic.

Objectives:Pain is a symptom reported in 50% to 70% of primary care visits and negatively impacts both physical and psychological functioning. People at risk of receiving inadequate management of pain include the indigent and people of color. The purpose of this exploratory, descriptive, cross-sectional study was to describe the prevalence of pain and its relation to functional status, depressive symptoms, perception of control over pain and coping in an urban, primary care clinic for indigent adults. Methods:Individuals (N=301) attending a primary care clinic for indigent adults were surveyed. Patients were 22 to 64 years of age, experienced pain during the past 2 weeks, and were able to understand and respond in English. Results:Ninety-two percent of the sample was African American and the average worst pain score was 8.4/10. The majority of patients had depression symptoms (77%), with pain most affecting patients’ function with sleep, ability to work, and walking. Patients reporting higher pain scores had significantly lower perception of control over pain and reduced control over life in general. Higher reported pain levels were also significantly correlated with higher catastrophizing, depressive symptoms, and interference with function scores. Discussion:Pain levels were reported as high and affected psychological and physical functioning. This study was unique in the high percentage of African American participants and being conducted in a primary care clinic for indigent adults. Greater understanding of this population’s pain will assist clinicians to assess pain comprehensively, provide education, and make treatment decisions for these patients.

Psychometric Properties and Construct Validity of the Knowledge Information Profile–Coumadin

Background: Oral anticoagulation therapy using Coumadin (warfarin) requires significant patient involvement. Limited validated instruments exist to test patient knowledge of Coumadin, and low health literacy may impede patient self-management. Objective: This article reports the psychometric testing of the Knowledge Information Profile–Coumadin (KIP-C20) to determine (a) minimum number of items and dimensions, (b) reliability, and (c) construct validity. Methods: Participants (N = 192) were recruited from outpatient pharmacist-directed anticoagulation clinics associated with an urban teaching hospital in the Midwest United States. Instruments were the Animal Naming test (AN), Rapid Estimate of Adult Literacy in Medicine (REALM), and KIP-C20. Multidimensional item response theory modeling and exploratory factor analyses were used to determine the best fitting model. Results: The final instrument, renamed KIP-C14, with 3 factors and 14 items, had a good fit to data (M2 = 96.49, P < .0001; root mean square error of approximation = .04), and all factor loadings were .3 or larger. Internal consistency reliability was .65; test–retest correlation was .67. The KIP-C14 correlated positively, as expected, with years of Coumadin treatment. Subscales were differentially correlated with sociodemographic variables. Conclusions: The KIP-C14 had nearly identical, slightly higher reliability than the KIP-C20. Still, reliability was lower than expected, indicating a promising clinical assessment scale in need of further refinement.

Wound-Psychosocial and Quality of Life Aspects: 3401

a static air mattress overlay and static air seat cushion on all patients admitted to our surgical hospital unit would decrease the incidence of hospital-acquired pressure ulcers. We used crosssectional data collection using the National Database of Nursing Quality Indicators (NDNQI). The target population was inpatients located on the surgical unit of our hospital and excluded any patient that was not on a static air mattress overlay during their entire inpatient hospital stay. The study compared a one-day snapshot survey of patients with standard ulcer prevention strategies before usage of static air mattress and seat cushion and a oneday snapshot survey after usage of a static air mattress overlay and static air seat cushion, education for the patient, families and nursing staff. We discovered that the percentage of our surgical patients with hospital-acquired pressure ulcers (HPU) for the quarter prior to the research study was 18.18%. The percentage of our surgical patients during the research study was 4.76%. The patients that developed a HPU during our study had been previously excluded from the research study because they were not on a mattress overlay during their entire inpatient stay. We concluded that the use of a static air mattress overlay and static air seat cushion, when used on all patients admitted to our surgical unit along with education for the patient, families and staff resulted in positive patient outcomes as demonstrated by the significant reduction in hospital-acquired pressure ulcers.