Christine Savage

Factors influencing diabetes self‐management in Chinese people with type 2 diabetes

Patients with diabetes must incorporate a complicated regimen of self-management into their daily lives (e.g., taking medication, diet, exercise). Diabetes self-management (DSM) is the cornerstone for controlling diabetes and preventing diabetic complications. The purpose of this study was to test a model describing the effects of individual and environmental factors on DSM in a sample of patients with diabetes in Beijing, China. Survey data were gathered from a convenience sample of 201 Chinese adults with type 2 diabetes during outpatient visits. Data were analyzed using structural equation modeling. Model fit indices indicated a good fit to the data. In the final model, belief in treatment effectiveness and diabetes self-efficacy were proximate factors affecting DSM. Knowledge, social support, and provider-patient communication affected self-management indirectly via beliefs and self-efficacy. The findings provide a theoretical basis to direct the development of interventions for improving DSM in Chinese individuals with diabetes.

The Culture of Pregnancy and Infant Care in African American Women: An Ethnographic Study

In Hamilton County, Ohio, the infant mortality rate for African American infants in 2002 was 18.1 per 1,000 live births compared with 14.4 for the United States. It is essential to engage community residents and leaders in identifying the underlying cultural factors contributing to this disparity. The purpose of the study was to explore the cultural contexts of prenatal and infant care practices among African American women of childbearing age living in an urban community located in Hamilton County, Ohio. This was an ethnographic community-based participatory research study. Seven participants were recruited for the study. Family support from mothers and sisters in obtaining needed resources related to pregnancy and child care emerged as the central theme. A strong family-based social network was core to the culture of pregnancy and infant care for these women. Nurses should consider developing family-centered interventions to reduce disparity in infant health.

Adaptation and testing of instruments to measure diabetes self-management in people with type 2 diabetes in mainland China.

Purpose: The purpose of this study was to test the psychometric properties of instruments used to measure diabetes self-management (DSM) that were modified and translated into Chinese. Method: A convenience sample of 30 people with type 2 diabetes in Beijing, China, completed a questionnaire consisting of six instruments that had been translated and modified for use with a Chinese population. The reliability and validity were examined. Results: The Cronbachs alpha for the six instruments varied from .62 to .87. Factors analysis was performed, with variances explained by factors ranging from 61.6% to 97.9%. Conclusions: The findings of the psychometric testing of the modified and translated instruments support the use of these tools to assess DSM and its influencing factors in Chinese people with type 2 diabetes.

Current Screening Instruments Related to Alcohol Consumption in Pregnancy and a Proposed Alternative Method

Because alcohol is a known teratogenic substance that negatively affects the fetus, screening for alcohol use is included in maternal child texts for nurses. They present no standard screening approach, however. In the general literature, a multitude of screening instruments exist for the purpose of detecting maternal alcohol dependence but few allow the nurse to detect fetal alcohol exposure in the absence of maternal alcohol dependence. After a comparative analysis of existing screening instruments, we concluded that the Timeline Followback method has the most utility as a screening instrument to detect fetal exposure to alcohol. The purpose of this article is to present a critical review of current screening instruments related to alcohol consumption in pregnant women and to propose the use of the Timeline Followback method as the preferred approach.

The Influence of Secondhand Smoke Exposure on Birth Outcomes in Jordan

This study investigates how secondhand smoke (SHS) exposure influences neonatal birth weight in Jordan, a country with high smoking prevalence. The findings revealed that as the average number of SHS exposure hours per week increased in the second trimester, the neonatal birth weight decreased while holding all covariates constant. Women who reported a higher average number of SHS exposure hours per week from work in the second trimester, home in the third trimester, and outside in the third trimester were at greater risk for having a low birth weight neonate than women who reported a lower average number of SHS exposure hours.

Health care needs of homeless adults at a nurse-managed clinic.

Up to 55% of the homeless population report health problems. They often use the emergency department (ED) to obtain care when the health needs are not urgent. Nurse-managed clinics have the potential to reduce nonurgent ED use and improve the health of the homeless. The purpose of this study was to establish baseline health data on homeless persons prior to attending a nurse-managed clinic.1 This study was a cross-sectional, retrospective health survey of homeless clients at a nurse-managed clinic. A total of 110 participants completed a baseline health survey. Of these, 61% reported that prior to coming to the clinic, they used the ED as a source of health care. The most frequent medical diagnoses reported were substance use disorders, depression, back pain, hypertension, and asthma. Providing care for chronic conditions at a nurse-managed clinic has the potential to improve health and reduce use of the ED.

Improving health status of homeless patients at a nurse-managed clinic in the Midwest USA

Homeless adults have a higher rate of morbidity and mortality than their housed counterparts. Improving the health of homeless adults is a complex problem because of the overlay of individual risk factors, social issues and lack of economic resources. Due to the increased morbidity and mortality rate in homeless adults, it is imperative to develop interventions with demonstrated efficacy that result in improved health outcomes. The purpose of this pre-post pilot study was to compare pre- and post-test scores on specific health outcomes in a group of homeless adults receiving a nurse intervention when utilising a nurse-managed clinic located in the urban core of a Midwestern city in the USA. Between September of 2004 and January 2006, 43 homeless adults completed a health survey at baseline and 2 months later that included measures of health-related quality of life (HRQOL), substance use and health resource use. There was a significant improvement on the post-test scores including substance use, perceived quality and availability of health care, and on two domains of HRQOL: mental health and vitality. This study provides evidence that a nursing intervention can result in improved health outcomes for adult homeless persons.

Measurement of maternal alcohol consumption in a pregnant population.

Alcohol is a known teratogenic substance that operates under a dose‐response mechanism. Before we conducted a larger study that examines the use of alcohol both before pregnancy and during pregnancy, it was important to pilot our method for measuring a pregnant mothers alcohol use that would allow us to capture the number of drinks consumed per day while addressing recall bias. The purpose of this study was 1) to pilot the Time Line Followback (TLFB) method developed by Sobell and Sobell (1992, Measuring Alcohol Use. Totowa, NJ: Humana Press) as a method for examining alcohol use during pregnancy and 2) to determine if the use of a study protocol that included biological markers of alcohol use would affect our ability to recruit subjects. Using a descriptive design, we tested our protocol for collecting alcohol use data with 10 mothers receiving prenatal care. We measured alcohol use using the TLFB method (Sobell and Sobell, 1992, Measuring Alcohol Use. Totowa, NJ: Humana Press, 1996). We also collected collected biological blood markers for heavy alcohol use. Of the 10 maternal subjects we recruited, 5 mothers (50%) reported alcohol use during pregnancy. We successfully recruited 10 out of 11 mothers approached and had a 100% retention rate for the second interview. The TLFB method is viable for measuring fetal alcohol exposure over the pregnancy, and the collection of blood samples did not impact our ability to recruit or retain mothers.

A study of the level of knowledge about diabetes management of low-income persons with diabetes

Diabetes education has proven to be an effective intervention for the management of diabetes. Persons with lower education levels, the majority of whom have low incomes, receive less diabetes self-management education (DSME) than their peers. This study compared the diabetes knowledge level of low-income adults who did not have a high school diploma or general equivalency diploma with those who did. We conducted a survey among residents of 4 low-income neighborhoods in Cincinnati, Ohio, using a cross-sectional descriptive design. Surveys included information related to diabetes self-management and level of education. The only questions for which there was a significant difference between the 2 groups were those pertaining to the causes and treatment of hypoglycemia. Survey results were used to validate the need for a DSME program for low-income adults in Cincinnati, Ohio. A DSME program was developed specifically for persons with low literacy.

Public health and nursing: a natural partnership.

The health of individuals occurs within the context of their environment and the other individuals they interact with in the communities they live in, work in and visit. Promoting the health of the public requires multiple strategies aimed at improving the environment, the health knowledge of groups and individuals, maintaining adequate food and water, and reducing the spread of disease. Many disciplines are needed to meet these goals, but the largest segment of the professional health work force required to meet these needs is nursing. Historically, nursing leaders in public health such as Florence Nightingale and Lillian Wald made significant inroads related to serious health issues because they were nurses. Today across the globe, nurses provide the key components of public health interventions including well baby care, health education, screening and immunization clinics, disaster management and emergency preparedness. With the growing nursing shortage in acute care settings, the brain drain of nurses from certain areas of the world, the shrinking public dollars for preventive health care, the nursing workforce needed to continue to provide these essential health care services is threatened. It is essential to put the spot light on nursing’s role in public health with the hopes of attracting more public funds and more nurses to provide these essential services.