Dana N. Rutledge

Exploration of factors affecting mammography behaviors.

Of an estimated pool of 1,700 potential participants, only 382 (22%) eligible women participated in a low-cost breast cancer screening program offered to university and medical center employees. Because most women were still available and data were needed to understand why the opportunity to participate was refused by so many, a survey was done to determine factors related to mammography behavior. Three distinct groups of women were identified according to health beliefs, mammography behaviors, and modifying factors. Women who participated in the mammogram program were predominantly well-educated working women who were aware of mammography and its relationship to the breast cancer trajectory; they were affected by cost and convenience issues. One group of women did not participate in the program offered because they had had a recent mammogram; these women were at high risk for breast cancer and perceived mammography to be beneficial. The women who did not participate for other reasons were in nonprofessional jobs, had lower levels of education, and tended not to participate in the health care system as readily as women in the other groups; they perceived themselves less susceptible to breast cancer, valued mammography less, and knew less about breast cancer.

Self-assessed physical function levels of women with fibromyalgia: a national survey.

OBJECTIVE We sought to determine the self-reported physical function level of women with fibromyalgia (FM). METHODS We performed a secondary analysis using data from an Internet-based survey posted on the National Fibromyalgia Association website. Data used for this study included women (n = 1,735) aged 31-78 years who reported being diagnosed with FM. RESULTS More than 25% of women reported having difficulty taking care of personal needs and bathing, and >60% reported difficulty doing light household tasks, going up/down 1 flight of stairs, walking (1/2) mile, and lifting or carrying 10 lbs. More than 90% of women reported having difficulty doing heavy household tasks, lifting or carrying 25 lbs, and doing strenuous activities. Women with lower functional ability reported higher levels of fatigue, pain, spasticity, depression, restless legs, balance problems, dizziness, fear of falling, and bladder problems. CONCLUSIONS The average woman in this sample reported having less functional ability related to activities of daily living and instrumental activities of daily living than the average community-dwelling woman in her 80s. Several symptoms/conditions were found to be associated with functional limitation in women with FM. Targeting these-singly or in clusters-may potentially be important in terms of future interventions.

Factors Related to Women??s Practice of Breast Self-Examination

Factors related to womens practice of breast self-examination (BSE) were studied in a sample of upper-middle-class women attending meetings of voluntary womens groups. Factors found to relate directly to frequency of BSE practice were high perceived benefits of BSE, low perceived barriers to BSE, and high self-concept. Correlations with perceived susceptibility/seriousness of breast cancer, age, perceived level of social support, and social network properties were not significant. A multiple regression analysis was done with BSE frequency as criterion variable; perceived threat (susceptibility/seriousness) and perceived benefits minus perceived barriers were entered hierarchically; age, self-concept, and total social support were entered as a group. Perceived benefits minus barriers was the only significant predictor variable, R2 = .27. These findings underline the importance of assessing detective behaviors such as BSE as potentially different from preventive behaviors.

Leveraging nurse-related dashboard benchmarks to expedite performance improvement and document excellence

Using nursing quality benchmarks in operational dashboards and translating those data to drive performance excellence is a strategic imperative. Since access to unit-level, hospital-generated nurse-related benchmarks is an emerging arena, the authors provide an overview of aggregated trends and benchmarks gleaned from the California Nursing Outcome Coalition acute care database for 2 established nurse-related quality indicators—patient falls incidence and hospital-acquired pressure ulcer prevalence. Integrating these acute care benchmarks into clinical dashboards can be invaluable to clinicians, administrators, and policy makers who share a common commitment to expediting evidence-based improvement in patient care safety, outcomes, and excellence.

Secondary Traumatic Stress in Oncology Staff

As empathetic caregivers, oncology staff may be prone to secondary traumatic stress (STS). Secondary traumatic stress results from exposure to persons who have experienced trauma and from giving care to such persons. The presence of STS among oncology staff has not been documented. This correlational descriptive study examined STS among oncology staff at a 500-bed Magnet-designated community hospital by determining the presence of individual symptoms and frequency with which diagnostic criteria for STS are met. Also determined were associations between STS demographic characteristics and specific stress-reduction activities. In this study, 43 staff members from an inpatient oncology unit completed mailed surveys. The Secondary Traumatic Stress Scale assessed the frequency of intrusion, avoidance, and arousal symptoms associated with STS; also assessed were use/helpfulness of stress-reduction activities. In this first study to document the prevalence of STS among oncology staff, prevalence ranged from 16% (Brides method) to 37% (cutoff-score method). Most common symptoms were difficulty sleeping, intrusive thoughts about patients, and irritability. Least common were avoidance of people, places, and things and disturbing dreams about patients. Current use of massage was significantly predictive of not having STS. Ethnicity of staff member was related to having STS. Further research is warranted evaluating STS prevalence in different groups of oncology staff along with the effect of STS on burnout and job retention.

The Impact of Nursing Interventions Overview of Effective Interventions, Outcomes, Measures, and Priorities for Future Research

The purpose of this article is to present findings from a review of published systematic/integrative reviews and meta-analyses on nursing interventions and patient outcomes in acute care settings. A literature search was conducted for the period 1999-2005, producing 4,000 systematic/integrative reviews and 500 meta-analyses covering seven topics selected by the authors: elder care, caregivers, developmental care of neonates and infants, symptom management, pressure ulcer prevention/treatment, incontinence, and staffing. The association between nursing care interventions/processes and patient outcomes in acute care settings was found to be limited in the articles reviewed. The strongest evidence was for the use of patient risk-assessment tools and interventions implemented by nurses to prevent patient harm. We observed significant variation in methods to measure the effect of independent variables (nursing interventions) on patient outcomes. Results indicate the need for more research measuring the effect of specific nursing interventions that may impact acute care patient outcomes.

Cognitive Performance in Women Aged 50 Years and Older With and Without Fibromyalgia

OBJECTIVES Persons with fibromyalgia (FM) report having cognitive dysfunction. Neuropsychological performance was compared across a variety of domains in 43 women with FM (Mage = 63 years) and in 44 women without FM (Mage = 65 years). METHOD Measures included explicit memory (Consortium to Establish a Registry for Alzheimers Disease [CERAD] immediate/delayed recall, delayed recognition), aspects of executive function including interference/inhibition (Stroop Color/Word test), working memory (Digit Span Forward/Backward), set-shifting/complex sequencing (Trails B), monitoring (verbal fluency: naming animals), processing speed (Trails A, Digit Symbol Substitution Coding), and problem solving (Everyday Problems Test). RESULTS Women with FM performed more poorly than controls on executive function (Stroop Color/Word) and one processing speed measure (Digit Symbol Substitution Coding). DISCUSSION Results partly support altered cognitive function in FM. Mixed findings across cognitive domains among individuals with or without FM is consistent with the literature and suggest that factors beyond those typically controlled for (e.g., heterogeneity in FM) may be influencing findings. Future research is warranted.

Do fall predictors in middle aged and older adults predict fall status in persons 50+ with fibromyalgia? An exploratory study.

We explored potential predictors of fall status in 70 community-dwelling persons > or =50 years of age with fibromyalgia (FM). Over 40% of the sample reported one or more falls in the year prior to the study. A logistic regression model using 10 variables known to predict falls in middle aged and older persons predicted 45% of the variance in fall status. Three variables offered significant independent contributions to the overall model predicting fall status: perception of postural instability, balance performance, and executive function processing speed. The results support prior work in both nonclinical and clinical populations of middle aged and older adults indicating that falls are associated with multiple risk factors. Prospective designs with larger samples are needed to (a) validate and extend these findings, and (b) identify risk factors related to fall status that are unique to persons with FM.

Effects of Topical Essential Oil on Exercise Volume After a 12-Week Exercise Program for Women with Fibromyalgia: A Pilot Study

OBJECTIVES We determined--in women with fibromyalgia (FM)--effects of essential oils used with a 12-week exercise program on exercise volume, pain, physical performance, and physical function. DESIGN This was a randomized clinical trial comparing 024 essential oil with sham oil combined with exercise. SETTINGS SETTINGS included community sites in southern California. SUBJECTS The study included 20 women randomized to 024 oil, 23 to sham oil. INTERVENTIONS Women were trained in oil application before exercise, at bedtime on exercise days; the 12-week program included weekly group sessions with trained leaders guided by a prerecorded regimen (allowing choice of program level) plus 2 days of home exercise with the recorded regimen. OUTCOME MEASURES Primary: Exercise volume (number of days exercised multiplied by exercise level--intensity and duration). Secondary: Pain (Brief Pain Inventory), measures of physical performance (30-second chair stands, 6-minute walk, multidimensional balance), and self-reported physical function (Composite Physical Function scale). RESULTS The average participant was 54 years old, had some college education, was married, Caucasian, and minimally/mildly depressed. There was no significant difference in exercise volume between women using 024 as compared with those using sham oil after 12 weeks (depression as covariate). There were no significant group nor pre- to postexercise changes in pain intensity or interference. There were greater positive changes in 30-second chair stands, 6-minute walk distance, and multidimensional balance scores in the 024 group than in the sham group, but these were not significant. The counterirritant 024 oil was not different from the sham oil in its effect on exercise volume (frequency, exercise level--intensity and duration) for women with FM. It is unknown whether 024 actually decreases local pain when used with exercise. CONCLUSIONS Increases in physical function found, while not significant, may be attributable to the exercise regimen or to the interaction of the oils and exercise regimen.

Impact of Employment and Caregiving Roles on the Well-Being of People with Fibromyalgia Syndrome

Objective This study examined the associations between social roles [namely, employment and caregiving] and health status, quality of life, physical functioning, and depression in individuals 50+ years of age with and without fibromyalgia syndrome [FMS]. Methods Seventy people with FMS [93 percent female, mean age 60 years] and 76 people without FMS [67 percent female, mean age 68 years] completed questionnaires and assessments, including the Composite Physical Function scale and Beck Depression Inventory-II. Results Although the FMS group had significantly poorer outcomes overall, roles predicted better outcomes among the FMS group when compared with the non-FMS group. Specifically, linear regressions revealed that, for the FMS group, increased roles were positively associated with better health status, quality of life, and physical functioning, as well as fewer depression symptoms. For the non-FMS group, number of roles was positively linked with depression and not significantly associated with any of the other outcomes. Conclusion Results suggest that fulfilling multiple roles may enhance the overall well-being of individuals with FMS.