Gene Elizabeth Harkless

Self-Efficacy, Stress, and Parental Adaptation: Applications to the Care of Childbearing Families

Successful adaptation to parenthood may require that parents believe they have the ability to succeed at this challenging task Relationships of selficacy, stress, and parental adaptation were assessed during the early transition to parenthood. Mothers exceeded fathers in self-efficacy, confidence, satisfaction, and support. For mothers, stress and self-efficacy were inversely related, and self-efficacy postpartum was positively associated with partner relationship, satisfaction, confidence, and support. Forfathers, self-efficacyand stress were not related, and self-efficacy at 4 months was associated with confidence and life situation. Self-efficacy and stress as predictor variables modestly explained adaptation to parenthood. Gender predicted confidence in parenting, and the interaction of gender and self-efficacy predicted support for parenting. Strategiesforassessingandenhancingparentingself-efficacyand implicationsforfuture research are discussed.

Nursing sensitive quality indicators for nursing home care: International review of literature, policy and practice

OBJECTIVES To review nursing sensitive indicators used for nursing home care across seven nations with similar elder care (USA, Australia, Norway, New Zealand, England, Sweden and Denmark), and to evaluate their validity. DESIGN Systematic search in the literature and other sources to find descriptions of development and validity testing of national quality indicators. DATA SOURCES Papers from scientific databases, relevant websites, additional papers and reports, and personal communication with experts in the field. The material was included if it contributed to the description of each countrys processes in defining nursing sensitive quality indicators for nursing home care, and the main focus was use, developing and/or testing of quality. REVIEW METHODS An overview of each countrys utilization of nursing sensitive quality indicators was obtained. The evidence for the validity in development and testing procedures was analyzed using a set of evaluation criteria. RESULTS All countries, except Sweden, have nationally standardized assessment of the patient before admission to the nursing home. There is large variation in the way these data collection tools were developed and how the data is used. Only the USA has systematically developed quality indicators on the basis of resident assessments. Twenty-three indicators used nationally in USA, thirteen in Australia, four in Norway, three in New Zealand and three in England were selected for review, and were evaluated for their validity as described in the literature. All selected indicators had satisfactory face validity, and for the twenty-three indicators used in the USA there was evidence for reliability testing. None of the quality indicators met all the criteria for validity. Evidence that the quality indicators can demonstrate meaningful differences in care and that the information can be extracted with minimal extra efforts was not found. Thresholds for high or low quality were determined only for the US quality indicators. CONCLUSIONS There are concerns about the validity and reliability of nursing sensitive quality indicators for nursing home care. The indicator development is sparsely documented. It is recommended that the development of quality indicators follows a sound process and that extensive empirical testing of the indicators is done.

Effect of physical training on urinary incontinence: a randomized parallel group trial in nursing homes

Background Residents in nursing homes (NHs) are often frail older persons who have impaired physical activity. Urinary incontinence (UI) is a common complaint for residents in NHs. Reduced functional ability and residence in NHs are documented to be risk factors for UI. Objective To investigate if an individualized training program designed to improve activity of daily living (ADL) and physical capacity among residents in nursing homes has any impact on UI. Materials and methods This randomized controlled trial was a substudy of a Nordic multicenter study. Participants had to be >65 years, have stayed in the NH for more than 3 months and in need of assistance in at least one ADL. A total of 98 residents were randomly allocated to either a training group (n = 48) or a control group (n = 50) after baseline registrations. The training program lasted for 3 months and included accommodated physical activity and ADL training. Personal treatment goals were elicited for each subject. The control group received their usual care. The main outcome measure was UI as measured by a 24-hour pad-weighing test. There was no statistically significant difference between the groups on this measure at baseline (P = 0.15). Changes were calculated from baseline to 3 months after the end of the intervention. Results Altogether, 68 participants were included in the analysis, 35 in the intervention group and 33 in the control group. The average age was 84.3 years. The 3 months’ postintervention adjusted mean difference between groups according to amount of leakage was 191 g (P = 0.03). This result was statistically significant after adjusting for baseline level, age, sex, and functional status. The leakage increased in residents not receiving the experimental intervention, while UI in the training group showed improvement. Conclusion The intervention group had significant better results compared with the control group after an individualized training program designed to improve ADL and physical capacity. Further studies are needed to evaluate the effect of a goal-oriented physical training program toward NH residents UI complaints.

Divergent themes in maternal experience in women older than 35 years of age.

O VER THE PAST 20 years, the early maternal experience has been studied quantitatively by numerous investigators using a variety of instruments. In general, this quantitative research has contributed important knowledge about early parenting. Awareness of the meaning or special significance of what early parenting is like for first-time parents may facilitate positive coping and enhance parental competence and effectiveness (Pridham, 1987). However, for quantitative instruments to best contribute to the understanding of a human situation, their examination, refinement, and extension must be ongoing. One way to accomplish this is by testing them on a variety of samples. Another is to re-examine the concept being studied by gathering qualitative data about that particular life experience. From the literature, it has been generally accepted that the parenting experience varies depending upon maternal attributes, such as parity, age, and education (Mercer, 1986). However, most of the instruments that aim to assess this experience have been developed and validated on relatively young women and thus have not considered agerelated concerns. Two examples of this are the Revised What Being the Parent of a Baby is Like instrument (WPL-R), which was developed on a sample with a mean maternal age of 27.4 years (Pridham & Chang, 1989), and the Postpartum Self Evaluation Questionnaire, which was developed on a sample with a mean maternal age of 27 years (Lederman, Weingarten, & Lederman, 1981). The purpose of this research was to analyze maternal experience as described by first-time mothers more than 35 years of age and to see if it is similar to or divergent from the thematic categories of the WPL-R. BACKGROUND

Testing of the PHS-ES: a measure of Perimenopausal Health Self-Efficacy.

This article summarizes the development and psychometric analysis of the Perimenopausal Health Self-Efficacy Scale (PHS-ES) designed to assess women’s health promotion self-efficacy related to mid-life changes in health. Items were generated from a qualitative study of HRT decision-making and recommended health promotion activities. The PHS-ES was administered 2 weeks apart to 98 university-based women ages 45 to 64 along with the measures of functional health status, stress, and the self-concept. Internal consistency (α = .88 and .90) and test-retest reliabilities (.86) were acceptable. Four factors emerged during factor analysis with 21 of the items explaining 50% of the variance and which were consistent with the conceptual basis of the PHS-ES. The PHS-ES was significantly correlated with functional health status, self-concept, stress, age and body mass index (BMI). In conjunction with stress and BMI, the PHS-ES predicted 50% of the variance of functional health. Further reliability and validity assessments are recommended with more racially and socioeconomically heterogeneous groups of perimenopausal women. It was concluded that the PHS-ES adequately demonstrated reliability and validity in this study.

Unit-Based Intervention to Improve Urinary Incontinence in Frail Elderly

This study aimed to improve urinary incontinence (UI) among residents of a Teaching Nursing Home (TNH) in Trondheim, Norway, by implementing a unit-based educational program on UI in the elderly. Of the 33 patients on the study unit, 18 (16 women and 2 men) experienced UI. This quasi-experimental study began with baseline data collection before the unit-based educational program. The measures obtained from the residents included the following over one 24 hour period before the educational program and three months after completion of the program: pad change frequency, pad weighing, oral fluid intake, and size of pad used. As well, bladder-scanning volumes were obtained twice a day for two days at these same time periods. All direct care staff received 45 minutes education every other week. Findings include that average incontinent pad weights to be less, maximum incontinent pad weights to be less, and an increase in drinking times per night. Average post-voiding residual urine remained the same, but the average minimum amount per resident fell significantly. In conclusion, initiation of a unit-based educational program on UI may yield measurable benefits for complexly ill, frail elderly residents.

Prescriptive authority: debunking common assumptions.

Prescription of drugs is an act integral to the assessment, diagnosis and treatment cycle in the provision of primary care. To provide primary care and specialty services, advanced practice nurses are seeking prescriptive authority. This article examines the historical development of medical prescriptive authority, challenges four commonly held assumptions regarding prescriptive authority for nurses, and discusses how medicines dominance in prescriptive authority for nurses, and discusses how medicines dominance in prescriptive authority relates to nursings struggle for power and autonomony. Nurses must direct their political and educational activities toward developing true structural and attitudinal autonomy in all aspects of nursing practice.

Perspectives of Patients, Clinicians, and Health System Leaders on Changes Needed to Improve the Health Care and Outcomes of Older Adults With Multiple Chronic Conditions

Objective: To ascertain perspectives of multiple stakeholders on contributors to inappropriate care for older adults with multiple chronic conditions. Method: Perspectives of 36 purposively sampled patients, clinicians, health systems, and payers were elicited. Data analysis followed a constant comparative method. Results: Structural factors triggering burden and fragmentation include disease-based quality metrics and need to interact with multiple clinicians. The key cultural barrier identified is the assumption that “physicians know best.” Inappropriate decision making may result from inattention to trade-offs and adherence to multiple disease guidelines. Stakeholders recommended changes in culture, structure, and decision making. Care options and quality metrics should reflect a focus on patients’ priorities. Clinician–patient partnerships should reflect patients knowing their health goals and clinicians knowing how to achieve them. Access to specialty expertise should not require visits. Discussion: Stakeholders’ recommendations suggest health care redesigns that incorporate patients’ health priorities into care decisions and realign relationships across patients and clinicians.

Oral rehydration therapy for children with acute diarrhea.

Childhood diarrhea accounts for a substantial number of primary care visits. Historically, pediatric diarrheal disease was a significant cause of morbidity and mortality in children. Treatment for acute gastroenteritis has changed greatly over the past century, from I.V. therapy to the current use of oral rehydration therapy (ORT). This article high-lights the development of ORT, addresses recent ORT controversies, and provides an overview of the current practice guidelines offered by the American Academy of Pediatrics in March 1996 for the management of acute gastroenteritis in children ages 1 month to 5 years.

Perimenopausal health self-efficacy among Hispanic Caribbean and non-Hispanic white women.

The perimenopausal experience varies among different ethnic and cultural groups. This research examined perimenopausal health self-efficacy of Latinas and non-Hispanic White women and variables that predicted health in 147 women ages 40 to 60 in the Northeast United States. Self-efficacy scores were similar for both groups. Latinas scored lower, however, in the Cognition/Decision Making subscale of the Perimenopausal Health Self-Efficacy Survey (PHS-ES). Perceived health was predicted by control over health and stress for both, and greater self-efficacy was associated with higher perceptions of health. Subtle differences existed between the two groups, which may reflect cultural beliefs and barriers to care during midlife.