Elaine S. Marshall

Adherent and nonadherent medication-taking in elderly hypertensive patients.

Nonadherence to medications is a significant reason why patients fail to control their blood pressure. Little work has been attempted to conceptualize medication-taking behaviors from the patient’s perspective. This study examined factors that influence elderly hypertensive patients’ adherence or nonadherence to prescribed medications. Using a qualitative descriptive research design, 21 hypertensive elderly people were interviewed. Two domains of adherence were identified: purposeful use of the medication for the control of patient’s blood pressure and establishing and maintaining patterns of medicationtaking. Two similar domains also emerged for nonadherence: purposeful and incidental. Adherence behaviors were dependent on the person’s decision to take hypertension medication, access to medications, and ability to initiate treatment and maintain a medication-taking pattern. The timing and location of pills were integral parts of establishing patterns of taking medications. Inadequate access to medications or interruption of a person’s pattern were associated with the incidental missing of medications.

Group Visits in Diabetes Care: A Systematic Review

Purpose This review appraised research evidence on the effectiveness of group visits for persons with diabetes. The group visit approach included both education and medical management of the patient, and this review focuses on the implications for the certified diabetes educator (CDE) as part of the group visit provider team. Methods A search of a comprehensive list of databases produced 395 articles related to group visits, group education, and primary care of patients with diabetes. Results Using specific inclusion criteria, 12 articles were included in the review. Four review articles examined a total of 75 studies, and 8 additional original research articles analyzed outcomes related to group visits in the care of patients with diabetes. Conclusions Current models for diabetes focused group visits that incorporate both group education and a health provider office visit in lieu of the traditional brief office visit failed to demonstrate consistent statistical improvement in A1C, BP, or lipids. There is evidence that group visits may reduce costs, some physiological outcomes may be improved, and patient and clinician satisfaction may be enhanced. The diabetes focused group visit model needs further testing by health care teams in a variety of settings including private primary care and rural practices.

“This Is a Spiritual Experience”: Perspectives of Latter-Day Saint Families Living With a Child With Disabilities

The presence of a child with disabilities elicits a variety of stress demands on the family. Religion is recognized as a powerful personal, family, and cultural variable. However, little is known about the influence of religion in dealing with disability among families within particular religious groups. This descriptive study explored themes of spiritual belief and religious support among families of the Church of Jesus Christ of Latter-Day Saints (LDS, or Mormon) with a child with developmental disabilities. Parents shared perspectives of meaning that emerged from experiences with religion and family beliefs perceived to be unique. The core theme, “This is a Spiritual Experience,” provides the foundation for a descriptive model that depicts aspects of finding meaning and perceived transcendence.

Type 1 diabetes: children and adolescents’ knowledge and questions

AIM This paper is a report of a study conducted to describe what children and adolescents who have type 1 diabetes know and want to know about the disease. BACKGROUND Research indicates that young peoples knowledge of diabetes may minimize their health complications, because with greater knowledge they may engage in more effective management practices and adherence. METHODS In this qualitative study, a purposive sample of 58 children and adolescents with type 1 diabetes were interviewed in 2005 about what they knew and wanted to know about their disease. Through a process of induction, major themes were identified from the data. FINDINGS The six major themes were: (a) Care, including both physical and emotional care, (b) Physiology, (c) Consequences, including both short- and long-term, as well as positive and negative consequences, (d) Cure, (e) Effects on the Family and (f) Experience at Diagnosis. Themes related to the unique challenges associated with type 1 diabetes were also identified. CONCLUSION Nurses, diabetes educators and parents should provide developmentally appropriate information about diabetes care and management, scaffolding on existing knowledge. They should provide child-centred contexts in which children and adolescents can freely ask questions about their condition and problem-solve. Programmes that allow young people to develop coping skills and share experiences could also prove beneficial.

Support, Communication, and Hardiness in Families With Children With Disabilities

The purpose of this study was to examine how support and communication are related to hardiness in families who have young children with disabilities. A sample of 108 parents (54 couples) of preschool-age children with disabilities completed the measures. Among demographic variables, family income was positively correlated with family hardiness. Hierarchical regression analyses revealed perceived family support as a predictor of family hardiness for both parents. Incendiary communication was negatively related to family hardiness for mothers, whereas income was positively associated with fathers’ assessments of hardiness. Results provide family nurses with a foundation for exploring constructs important to help families with children with disabilities.

Metabolic Control, Self-care Behaviors, and Parenting in Adolescents With Type 1 Diabetes A Correlational Study

Purpose The purpose of this pilot study was to explore relationships among metabolic control, self-care behaviors, and parenting in adolescents with type 1 diabetes. Methods Twenty-nine adolescents (mean age, 14.1 years) and their parents participated. Metabolic control was determined by an average of 4 A1C values taken prior to study enrollment; self-care behaviors were measured with a 12-item self-report questionnaire; parenting style was evaluated using the Parenting Practices Report. Results The mean for A1C values was 8.5%; the mean for overall self-care behaviors was 4.93 (5 = usually). Participants rated themselves highest on the self-care behaviors of giving insulin shots when indicated and adjusting insulin when eating a lot. They ranked themselves lowest on eating a low-fat diet and testing urine for ketones. Parents tended to be more authoritative in their approaches to parenting than either authoritarian or permissive. A significant relationship was found between authoritative mothering and adolescent self-care behaviors and metabolic control. Regression analyses controlling for age and length of time with diabetes confirmed the significance of these relationships. Authoritative fathering positively correlated with the self-care behaviors of monitoring blood glucose, taking insulin, and not skipping meals. A relationship was also noted between permissive parenting by mothers/fathers and poorer metabolic outcomes. However, the permissive parenting correlations did not remain significant when controlling for age and length of time with diabetes. Conclusions Clinicians may help prevent declining participation in self-care behaviors and metabolic control in adolescents with type 1 diabetes by working with parents, particularly mothers, and encouraging authoritative parenting.

Parental perceptions of sibling relationships in families rearing a child with a chronic condition.

This study examined sibling relationships in families raising children with autism, Down syndrome, orthopedic conditions, and diabetes. Parents from 108 families independently completed the 28-item Schaefer Sibling Inventory of Behavior. Parents rated siblings as very empathetic, fairly often kind and involved, and rarely avoidant. Mothers rated sibling empathy higher than fathers did and older siblings more avoidant than younger siblings. Fathers rated male siblings kinder than female siblings; they also rated siblings of children with Down syndrome or autism more kind and involved than siblings of children with orthopedic conditions or diabetes. Sibling intervention efforts should consider these findings and be individualized according to the need of each child and family.

Home as place for healing.

Although environment is a core concept in nursing, it has had little theoretical or empirical attention, especially related to healing. This article explores the following aspects of the meaning of healing as they relate to environment as place: (a) healing is grounded in suffering; (b) healing is active and requires presence of the patient and the nurse; and (c) healing is private, spiritual, and profound. Home is explored as a place for healing. The article explores implications for the study of meaning of home, when home is not a place for healing, and future directions for theory and research.

Costs of Treating Depression With Individual Versus Family Therapy

Depression is one of the most common concerns that bring clients to treatment. Although marriage and family therapy has been shown to be an effective treatment, little research exists regarding the cost-effectiveness of related services. In this study, we examined claims data for 164,667 individuals diagnosed with depression to determine (a) differences in the cost of treating depression according to type of therapy and license type, (b) differences in recidivism rates by age, gender, type of therapy, and type of mental health professional, and (c) differences in cost-effectiveness by therapy modality and type of professional. The results showed that services provided by marriage and family therapists resulted in the lowest recidivism rate, and family therapy services were the least expensive.

Children With HIV/AIDS: A Vulnerable Population With Unique Needs for Palliative Care

Children are among the most defenseless of vulnerable populations. Providing palliative care to children with HIV/AIDS presents unique challenges to family, nurses, and the entire healthcare system. Significant issues include the global perspective on the needs of children with HIV/AIDS, family concerns and specific palliative care needs of such children, unique issues of child consent in treatment and research, and future challenges in practice and research as the human immunodeficiency virus continues to evolve. Caring for children with HIV/AIDS and their families presents challenges and specific implications for hospice and palliative nurses.