Cynthia S. Darling-Fisher

Measuring Eriksonian Development in the Adult: The Modified Erikson Psychosocial Stage Inventory

To measure psychosocial attributes that arise from progression through Erik Eriksons eight stages of development, a new inventory was developed by modifying the Erikson Psychosocial Stage Inventory by Rosenthal, Gurney, and Moore, which assesses Eriksons first six stages of life cycle development. New scales were created to measure the last two stages. To conduct an empirically based revision and evaluate its psychometric qualities, the modified version and potential items for the two new scales were administered to a convenience sample of 168 men and women whose ages ranged from 19 to 86 yr. Alpha reliability coefficients for this 80-item instrument were trust .82, autonomy .84, initiative .78, industry .88, identity .83, intimacy .78, generativity .75, ego integrity .80, and .97 for the entire scale. The construct validity was indicated by positive correlations between chronological age and the attributes associated with adulthood, an increase in mean generativity and ego integrity levels with age, and an association between the strength of attributes and participation in regular exercise. Reliability and validity of this modified inventory were supported.

Fatherhood reconsidered: A critical review

The purpose of this critical review is to examine the three central foci around which the research on North American fatherhood has been concentrated. These foci include socialization theories relating to fathers role enactment, development theories relating to the growth and development of fathers and children; and descriptions of actual paternal conduct. Since past decades have been marked by an unprecedented paradigm shift in expectations for fathers, a commentary on cultural images of fatherhood examining the empirical research on participatory and absent fathers is included. A research approach based on the social construction of gender, including avenues for future theory development, research, and social policy is proposed.

Identifying Relationships Between High-Risk Sexual Behaviors and Screening Positive for Chlamydia and Gonorrhea in School-Wide Screening Events

BACKGROUND This article describes a school-wide sexually transmitted infection (STI) screening to identify adolescent high-risk sexual behaviors, STI history/incidence, and presence of chlamydia and gonorrhea, and examines relationships between high-risk behaviors and screening positive for chlamydia and gonorrhea in an alternative high school setting. METHODS School-wide chlamydia and gonorrhea education and screening was provided to 869 adolescents; 226 males and 282 females 14-20 years (mean age = 17.07) consented to urine screening. Relationships were examined between screening positive, history of STIs, and high-risk sexual behaviors. RESULTS A majority (69%) of the adolescents consented to screening: 17.76% (92) had a history of STI; 8.83% (46) tested positive at screening. More females than males tested positive (p = .001). Significant relationships existed between history of STIs and ≥ 4 sexual partners (p = .0022), no condom use (p = .06), and sexual intercourse in last 3 months (p = .03). CONCLUSIONS School-Based Health Center (SBHC) screening was well accepted by students and staff. Sexually transmitted infection history was correlated with all identified high-risk sexual behaviors supporting the need for in-depth assessment, counseling, and testing of adolescents wherever they present for care. This study also provides an example of the role SBHCs can play in the national strategy to control chlamydia and gonorrhea in adolescents.

Implementation and outcomes of group medical appointments in an outpatient specialty care clinic

Purpose: To describe the outcomes of a nurse practitioner (NP)‐facilitated group medical appointment (GMA) intervention for chronic obstructive pulmonary disease (COPD) clients in a pulmonary practice in the Midwest. Data sources: Medical records from a convenience sample of six established pulmonary patients in a Midwest specialty clinic who received care in a group format were retrospectively audited. Outcome measures included examination of changes in the utilization of healthcare services, exercise tolerance, and use of nonpharmacological and pharmacological interventions pre‐ and postparticipation in the GMA program. Conclusions: NP‐facilitated GMAs are feasible and can help improve health outcomes. Results showed a significant increase in exercise tolerance measured by 6‐min walk distance. Anecdotally, patient and provider response to the GMA was very positive. Implications for practice: The GMA format is an innovative solution for the management of chronic disease patients that is comprehensive, time efficient, reimbursable, and well suited to NP practice. GMAs can be implemented in most practice settings.

Promoting father-friendly healthcare

Fathers are taking a more active role in their children’s lives and healthcare; consequently, healthcare providers need to be more aware of and attentive to fathers in clinical encounters. The literature on healthcare provider inclusion of fathers is sparse. The focus has been mainly on exhortations to include fathers, or has documented treatment of fathers as invisible in healthcare settings. While not overtly hostile to fathers, healthcare providers occasionally marginalize or ignore them. The purpose of this article is to help healthcare providers: (1) become aware of and assess their interactions with fathers and (2) be more intentional in their interactions with them. To that end, this article includes a self-assessment of one’s practice, including the following components: introductions, body language, eye contact, obtaining/giving information, and beliefs about the role of fathers. Intentional interactions for developing more father-friendly healthcare are discussed including both small and large changes, guided by the PLISSIT model. Finally, best practices, challenges, issues, and resources related to father inclusion in healthcare are described. The major issue for providers is to no longer question whether to include fathers, but how.

Reliability and Validity of the Modified Erikson Psychosocial Stage Inventory in Diverse Samples

The Modified Erikson Psychosocial Stage Inventory (MEPSI) is a relatively simple survey measure designed to assess the strength of psychosocial attributes that arise from progression through Eriksons eight stages of development. The purpose of this study was to employ secondary analysis to evaluate the internal-consistency reliability and construct validity of the MEPSl acrossfour diverse samples: healthy young adults, hemophilic men, healthy older adults, and older adults with chronic obstructive pulmonary disease. Special attention was given to the performance of the measure across gender, with exploratory analyses examining possible age cohort and health status effects. Internal-consistency estimates for the aggregate measure were high, whereas subscale reliability levels varied across age groups. Construct validity was supported across samples. Gender, cohort, and health effects offered interesting psychometric and theoretical insights and direction for further research. Findings indicated that the MEPSI might be a useful instrumentfor operationalizing and testing Eriksonian developmental theory in adults.

Improving Sexual Risk Communication With Adolescents Using Event History Calendars

This study was conducted to explore the effects of an event history calendar (EHC) approach on adolescent sexual risk communication and sexual activity. Adolescent school-linked health clinic patients (n = 30) who reported sexual activity self-administered the EHC that was used by nurse practitioners (NPs; n = 2) during a clinic visit. Immediately pre- and post-visit, and at 1 and 3 months, adolescents reported sexual risk behaviors and perceptions about EHC communication on questionnaires and by interview. NPs reported their perceptions of EHCs by questionnaire after the visit and poststudy interview. The EHC approach facilitated communication and adolescent awareness of their risk behaviors. Scores increased on Amount of Communication, t(29) = 8.174, p < .001; Satisfaction with Communication, t(29) = 3.112, p = .004; Client Involvement in Decision Making, t(29) = 3.901, p = .001, and Client Satisfaction with Interpersonal Style, t(29) = 3.763, p = .001. Adolescents reported decreased sexual intercourse at 1 month, p = .031. School nurses could use the EHC approach to facilitate adolescent communication and tailoring of interventions.

Patient-Centered Communication and Health Assessment With Youth

Background:Patient-centered communication is fundamental to individualizing healthcare, but there has been limited evaluation of provider communication with youth. Objectives:The aim was to compare communication outcomes after use of an event history calendar (EHC) and Guidelines for Adolescent Preventive Services (GAPS) to structure interactions during a clinic visit. Patient and provider descriptions of EHC and GAPS communication experiences were also obtained. Methods:This is a secondary analysis of data obtained during a randomized controlled trial. A sequential explanatory mixed-methods approach was used. A split-plot design with one between factor (EHC, GAPS) and one within factor (pretest, posttest) was used for the quantitative portion. Qualitative data were collected from open-ended questions, audiotaped visits, and exit interviews. Providers (n = 9) at three clinics were assigned at random and trained to implement either the EHC or GAPS protocol. Male and female youth (n = 186) were randomly assigned to the EHC or GAPS intervention. Before their clinic visit, youth completed assessments of past communication experiences with healthcare providers (pretest); communication during the current visit was assessed immediately after the visit (posttest). Results:Communication outcomes from pretest to posttest improved for youth in both the EHC and GAPS groups. Post hoc subgroup analysis suggested that men and Arab Americans derived more benefit from the EHC intervention in some aspects of communication. Qualitatively, the EHC group identified improved outcomes in validating patient perspective, being viewed in context, reaching a shared understanding of needs and preferences, and being helped to share power in the healthcare interaction. Discussion:EHC and GAPS provided effective frameworks for structuring communication during a clinic visit. Compared with GAPS, the integrated time-linked assessment captured by the EHC enhanced patient-centered communication in select groups.

Patient-Centered Participatory Research in Three Health Clinics Benefits, Challenges, and Lessons Learned

Research informed by individuals’ lived experiences is a critical component of participatory research and nursing interventions for health promotion. Yet, few examples of participatory research in primary care settings with adolescents and young adults exist, especially with respect to their sexual health and health-risk behaviors. Therefore, we implemented a validated patient-centered clinical assessment tool to improve the quality of communication between youth patients and providers, sexual risk assessment, and youths’ health-risk perception to promote sexual health and reduce health-risk behaviors among adolescents and young adults in three community health clinic settings, consistent with national recommendations as best practices in adolescent health care. We describe guiding principles, benefits, challenges, and lessons learned from our experience. Improving clinical translation of participatory research requires consideration of the needs and desires of key stakeholders (e.g., providers, patients, and researchers) while retaining flexibility to successfully navigate imperfect, real-world conditions.

What are we missing? Risk behaviors among Arab-American adolescents and emerging adults

BACKGROUND AND PURPOSE Research on Arab-Americans as a distinct ethnic group is limited, especially when considering the health of Arab-American youth. This study describes health risk (substance use, violence); health promotive behaviors (hope, spirituality); and sexual activity (oral, vaginal, anal sex) of Arab-American adolescents and emerging adults (aged 15-23) within their life context, as well as the association between these behaviors. METHODS A secondary analysis of data on a subset of Arab-American participants obtained from a randomized-control trial was utilized to conduct mixed methods analyses. Qualitative analyses completed on the open-ended questions used the constant comparative method for a subsample (n = 24) of participants. Descriptive quantitative analyses of survey data utilized bivariate analyses and stepwise logistic regression to explore the relation between risk behaviors and sexual activity among the full sample (n = 57). CONCLUSIONS Qualitative analyses revealed two groups of participants: (a) multiple risk behaviors and negative life-events, and (b) minimal risk behaviors and positive life-events. Quantitative analyses indicated older youth, smokers, and those with higher hope pathways were more likely to report vaginal sex. IMPLICATIONS FOR PRACTICE The unique cultural and social contexts of Arab-American youth provide a framework for recommendations for the prevention of risk behaviors.