Gale A. Spencer

Dating violence: a comparison of rural, suburban, and urban teens

This study analyzed rural, suburban, and urban differences in teen dating violence using the 1996 Teen Assessment Project data. Teens in rural school districts were more likely to be victims of dating violence than their suburban and urban counterparts; males reported being slapped, hit, or kicked more frequently than females. The findings of this study indicate that students in rural school districts are at greater risk for participating in dating violence than suburban and urban students, with rural female students at greatest risk.

Integrative Research Review of Risk Behaviors Among Adolescents in Rural, Suburban, and Urban Areas

PURPOSE The purpose of this integrative review was to describe the state of the science regarding adolescent risk behaviors, with particular emphasis on comparisons among rural, urban, and suburban populations. METHOD The review was done at two levels, moving from the major national survey studies which included data collected in the late 1980s up to 1993, to more focused topical areas including studies with data collection and publication between 1990 and 1996 within each identified category of adolescent health issues. A total of 137 published works across several disciplines were reviewed. Suggestions for clinical practice were drawn from the significant research findings. In addition, risk behaviors were compared to national baseline data and objectives. RESULTS The level of research in this topic area was primarily descriptive. Currently, only a small portion of the national objectives for decreasing adolescent risk behaviors have been met. Successful intervention programs, although few in number, usually included not only topical education but also adolescent interaction with peers and support systems to raise awareness and change behaviors. CONCLUSIONS The risk behaviors for the adolescent population as a whole have been well described. Education alone is not sufficient to change behaviors. Objective outcomes must be identified and health care providers need to use research findings in their practice with adolescents. It is time to intervene with developmentally and culturally appropriate strategies. There was a large gap in the literature regarding risk behaviors and protective factors for rural adolescents. The few studies that included subjects from rural settings indicated that the view that rural adolescents are engaged in fewer or less severe risk behaviors is misleading.

Functional health status among rural and urban older adults in Taiwan: the effect of personal control and social control

AIM To assess the relationship between perceived social control/personal control and functional health status among older adults in rural and urban Taiwan. BACKGROUND The ageing of the population is poised to emerge as a preeminent worldwide phenomenon. It is assumed that even though older adults experience many decades of autonomy and independence, the potential for illness or bodily decline will induce a serious reduction in the level of perceived control in older adult populations. METHOD This is a descriptive correlational study using a secondary data base, Social Environment and Biomarkers of Aging Study. Social Environment and Biomarkers of Aging Study is a nationally representative study of health outcomes in the Taiwanese population. RESULTS Both perceived levels of social control and personal control had a statistically significant relationship with functional health status. Functional health status was significantly higher for urban older adults than their rural counterparts. CONCLUSIONS Personal control and social control were both found to be predictors of functional health status. Major findings are supported by previous studies. RELEVANCE TO CLINICAL PRACTICE Nurses should create programs and plan activities to assist older adults to enhance their perceptions of social control or personal control in order to improve the health status of older adults and minimize associated health care costs.

Magnet nurse administrator attitudes and opportunities: toward improving lesbian, gay, bisexual, or transgender-specific healthcare.

OBJECTIVE: This study explored Magnet® hospital chief nursing officers’ (CNOs’) attitudes toward gays and lesbians and the impact that these attitudes have on providing advocacy for lesbian, gay, bisexual, or transgender (LGBT) patients and staff. BACKGROUND: Homonegativity encompasses both heterosexism and homophobia and has profound effects on the health of LGBT populations. Little has been reported about the attitudes of CNOs toward LGBT populations and how these might impact advocacy for LGBT healthcare. METHODS: Surveys were electronically mailed to 343 Magnet CNOs. The Modern Homonegativity Scale was used to assess attitudes, and additional statements were developed to assess the comfort level of the respondent in advocating for LGBT populations. RESULTS: Attitudes among CNOs toward LGBT populations and comfort with advocating for LGBT populations were positively correlated. Those demonstrating less homonegative attitudes were more likely to feel comfortable advocating for LGBT patients and staff. CONCLUSIONS: Recognizing and addressing bias among nurse leaders through education are important to ensure equitable healthcare for patients and employees.

Barriers to Asthma Management as Identified by School Nurses

Asthma rates are increasing in children. School nurses have opportunities to care for children with asthma but need to overcome barriers impacting their ability to manage asthma in the school setting. This study (a) assessed barriers present in the school setting, (b) determined the impact of barriers on performance of asthma management behaviors, and (c) determined the impact of barriers on importance ratings of asthma management behaviors, asthma self-efficacy, and asthma attitudes (N = 537). Results revealed 72% of the nurses reported at least one barrier. As numbers of barriers increased, performance of asthma management behaviors decreased. Significant relationships were found between specific asthma management behaviors and specific barriers. No significant relationships were found between barriers and asthma self-efficacy, asthma attitude, or importance ratings of asthma management behaviors. Removing barriers may allow the nurse to perform at greatest effectiveness, enhancing the positive outcomes that result from appropriate asthma management.

Using the Health Belief Model to Understand School Nurse Asthma Management

Ten million children in the United States have asthma. Since children are in school about 6 hr a day, school nurses are positioned to intervene and influence asthma outcomes. A descriptive correlational study was designed to investigate performance of school nurses’ asthma management behaviors in relationship to asthma knowledge, asthma attitude, asthma self-efficacy, and rating of importance of asthma management behaviors. Results indicated that asthma attitude, asthma self-efficacy, and rating of importance of asthma management behaviors were associated with performance of asthma management behaviors. The higher the rating of importance of asthma management behaviors, the more likely school nurses were to perform the behaviors (p < .05). Higher levels of asthma self-efficacy were associated with performance of asthma management behaviors, indicating the importance of strengthening school nurses’ asthma self-efficacy in asthma management. By understanding factors influencing performance of asthma management behaviors by school nurses, interventions can be implemented to increase asthma management behaviors, leading to improved outcomes for students with asthma.

Family Recognition of Delirium in Post-acute Care: Implications for the Rehabilitation Team

Delirium is a common, serious, and potentially life-threatening syndrome affecting older adults. Older adults experiencing delirium have poorer outcomes, higher mortality, and higher health care costs. The purpose of this article is to describe the symptoms of delirium being observed in older adults admitted for rehabilitation to a rehabilitation hospital or skilled nursing center. The Confusion Assessment Method and the Confusion Assessment Method-Family Assessment Method were used to identify delirium and document family observations. The article discusses implications for the rehabilitation team.

Informal caregivers and detection of delirium in postacute care: a correlational study of the confusion assessment method (CAM), confusion assessment method-family assessment method (CAM-FAM) and DSM-IV criteria.

OBJECTIVES Delirium is a common, serious and potentially life-threatening syndrome affecting older adults. This syndrome continues to be under-recognised and under treated by healthcare professionals across all care settings. Older adults who develop delirium have poorer outcomes, higher mortality and higher care costs. The purposes of this study were to correlate the confusion assessment method-family assessment method and confusion assessment method in the detection of delirium in postacute care, to correlate the confusion assessment method-family assessment method and diagnostic and statistical manual of mental disorders text revision criteria in detection of delirium in postacute care, to determine the prevalence of delirium in postacute care elders and to describe the relationship of level of cognitive impairment and delirium in the postacute care setting. Implications for Practice Delirium is disturbing for patients and caregivers. Frequently . family members want to provide information about their loved one. The use of the CAM-FAM and CAM can give a more definitive determination of baseline status. Frequent observations using both instruments may lead to better recognition of delirium and implementation of interventions to prevent lasting sequelae. METHODS Descriptive studies determined the strengths of relationship between the confusion assessment method, confusion assessment method-family assessment method, Mini-Cog and diagnostic and statistical manual of mental disorders text revision criteria in detection of delirium in the postacute care setting. RESULTS Prevalence of delirium in this study was 35%. The confusion assessment method-family assessment method highly correlates with the confusion assessment method and diagnostic and statistical manual of mental disorders text revision criteria for detecting delirium in older adults in the postacute care setting. Persons with cognitive impairment are more likely to develop delirium. Family members recognise symptoms of delirium when asked. DISCUSSION The confusion assessment method-family assessment method is a valid tool for detection of delirium. IMPLICATIONS FOR PRACTICE Delirium is disturbing for patients and caregivers. Frequently. family members want to provide information about their loved one. The use of the CAM-FAM and CAM can give a more definitive determination of baseline status. Frequent observations using both instruments may lead to better recognition of delirium and implementation of interventions to prevent lasting sequelae.

C-Reactive Protein (hsCRP), Diet, and Physical Activity in Rural Women

Purpose: The purpose of this study was to evaluate the effect of dietary fruit and vegetable intake and physical activity (PA) levels on inflammatory marker high sensitivity C-reactive protein (hsCRP) among rural women 35-65 years of age. Sample: Rural, non-smoking women (N = 99) in two states. Method: Cohort analysis from a primary study with randomized-controlled trial (RCT). Results: The dependent variable was calculated as: (a) the log-transformed (log) hsCRP difference , post minus pre values and (b) post log hsCRP. There was no difference between the intervention groups on log difference hsCRP (t (97) = -.88, p = .38); however, those women in the experimental group had half the level of log hsCRP. There was a significant difference in log hsCRP difference by activity level (F (2, 90) = 3.67, p = .03) indicating higher activity reduced hsCRP. Those women with a moderate activity level in the experimental group had the lowest hsCRP levels. The log hsCRP difference was not significantly different when evaluated for those who increased or did not increase their fruit and vegetable intake (p = .35). When analyzed by body mass level there was a significant difference in log hsCRP difference (F = 2.96, 7, 47, p = .001). A multiple regression with three variables accounted for 12% of the variance in log hsCRP. C onclusion: Cardiovascular health of rural women is an area of great concern but limited research. The results of this study indicate increased levels of PA and fruit and vegetable intake by rural women are associated with decreased levels of hsCRP and thus with improved cardiovascular health. This study can contribute to the body of knowledge concerning the role of diet and physical activity on cardiovascular health in rural female populations. Key Words: Rural, C-reactive protein, Diet, Physical Activity, Female Cardiovascular Disease, CVD