Helene Moriarty

Differences in bereavement reactions within couples following death of a child.

Differences in distress within couples who have experienced the sudden death of a child were examined. Results from two independent samples (N = 50 couples and N = 60 couples) were compared. The SCL-90-R and the BSI were used to measure global psychological distress and distress in nine symptom dimensions. Paired t tests revealed similar findings in the two samples: Within couples, women had significantly greater global distress than men and significantly greater distress than men in most symptom dimensions. Hostility scores within couples were similar and indicated a high level of hostility. The findings may explain relational problems observed within bereaved couples. Interventions designed to help couples cope with their differences and their hostility may decrease relational problems.

Issues to consider when choosing and using large national databases for research of families

Secondary analysis of large national databases offers promise for research of families. In this article, issues that the secondary analyst must consider when choosing a database for research of families are described. Potential advantages and limitations of databases are discussed. Strategies to minimize potential limitations are highlighted.

Methodological Challenges in Research with Vulnerable Families

Researchers studying vulnerable families can face formidable impediments. The purpose of this article is to provide an overview of methodological challenges commonly encountered in research with vulnerable family units or members and to suggest problem-solving strategies. The following issues are examined: (a) obstacles to identifying, accessing, recruiting, and retaining vulnerable families as research participants; (b) responsibilities of researchers concerning unanticipated health care crises, informed consent, and participant and researcher safety; and (c) issues in training clinicians as research team members. Examples are drawn from the literature as well as from family and family-related research studies conducted by the authors that involve both quantitative and qualitative designs, along with various family situations.

Understanding the current state of infection prevention to prevent Clostridium difficile infection: A human factors and systems engineering approach

BACKGROUND Achieving and sustaining high levels of health care worker (HCW) compliance with contact isolation precautions is challenging. The aim of this study was to determine HCW work system barriers to and facilitators of adherence to contact isolation for patients with suspected or confirmed Clostridium difficile infection (CDI) using a human factors and systems engineering approach. METHODS This prospective cohort study took place between September 2013 and November 2013 at a large academic medical center (hospital A) and an affiliated Veterans Administration hospital (hospital B). A human factors engineering (HFE) model for patient safety, the Systems Engineering Initiative for Patient Safety model, was used to guide work system analysis and direct observation data collection. There were 288 observations conducted. HCWs and visitors were assessed for compliance with all components of contact isolation precautions (hand hygiene, gowning, and gloving) before and after patient contact. Time required to complete contact isolation precautions was measured, and adequacy of contact isolation supplies was assessed. RESULTS Full compliance with contact isolation precautions was low at both hospitals A (7%) and B (22%). Lack of appropriate hand hygiene prior to room entry (compliance for hospital A: 18%; compliance for hospital B: 29%) was the most common reason for lack of full compliance. More time was required for full compliance compared with compliance with no components of contact isolation precautions before patient room entry, inside patient room, and after patient room exit (59.9 vs 3.2 seconds, P < .001; 507.3 vs 149.7 seconds, P = .006; 15.2 vs 1.3 seconds, P < .001, respectively). Compliance was lower when contact isolation supplies were inadequate (4% vs 16%, P = .005). CONCLUSIONS Adherence to contact isolation precautions for CDI is a complex, time-consuming process. HFE analysis indicates that multiple work system components serve as barriers and facilitators to full compliance with contact isolation precautions and should be addressed further to prevent CDI.

Conceptual and pragmatic considerations in conducting a secondary analysis. An example from research of families.

In this article, the authors discuss conceptual and pragmatic considerations for conducting research of families using large secondary data sets. Conceptual considerations include establishing consistency among the theory, variables, and available data, and determining reliability and validity of the data in the context of the theory. Pragmatic considerations include the use of resources such as management of the data among several authors, criteria and methods for selection of a subsample, and, recoding of the data to examine dyadic difference scores. The Family Special Interest Group of the Eastern Nursing Research Society initiated this research as part of a project to analyze families using large national data sets. The purpose of the secondary analysis was to identify family beliefs about healt-promoting behaviors. Combining parent and teen data to create relational level data resulted in new information that had not been identified in the original survey.

Parent-teen worry about the teen contracting AIDS.

A secondary data analysis of the National Commission on Children: 1990 Survey of Parents and Children was conducted with a subsample of 457 parent-teen pairs who responded to the “worry about AIDS” question. The teen’s worry about contracting AIDS was associated with race, parent’s education, the amount of discipline from the parent for engaging in sex, the teen’s desire to talk to the parent about the problem of sex, the teen’s rating of the neighborhood as a safe place to grow up, whether the parent listened to the teen’s telephone interview, and the parent’s response to whether his or her teen had a history of sexually transmitted disease. Of the parent-teen pairs in the subsample, 46% (N = 210) agreed in their responses about worry. Agreement was more frequent among the parent-teen pairs when compared to randomly constructed surrogate pairs. Dyadic analysis supported a family system view of perceived susceptibility.

An Analysis of Empirical Studies Examining the Impact of the Cancer Diagnosis and Treatment of an Adult on Family Functioning

The diagnosis of cancer is a family affair. Programs of research that evaluate the impact of the cancer diagnosis and treatment on thefamily system can be used to promote more effective physical and psychosocial adjustment of individual family members and the family as a whole. The purpose of this article is to describe an analysis of published empirical studies examining the impact of the cancer diagnosis and treatment of an adult on family functioning. The theoreticalframework, sample, the unit of analysis, measures, and selectedfindings are identified for each study. Feethams criteriafor research offamilies are applied to evaluate the studies. Implicationsforfuture theory development and research are also presented.

Efficacy and acceptability of a home-based, family-inclusive intervention for veterans with TBI: A randomized controlled trial

Abstract Objective: Traumatic brain injury (TBI) often undermines community re-integration, impairs functioning and produces other symptoms. This study tested an innovative programme for veterans with TBI, the Veterans’ In-home Programme (VIP), delivered in veterans’ homes, involving a family member and targeting the environment (social and physical) to promote community re-integration, mitigate difficulty with the most troubling TBI symptoms and facilitate daily functioning. Setting: Interviews and intervention sessions were conducted in homes or by telephone. Participants: Eighty-one veterans with TBI at a VA polytrauma programme and a key family member. Design: This was a 2-group randomized controlled trial. Control-group participants received usual-care enhanced by two attention-control telephone calls. Follow-up interviews occurred up to 4 months after baseline interview. Main measures: VIP’s efficacy was evaluated using measures of community re-integration, target outcomes reflecting veterans’ self-identified problems and self-rated functional competence. Results: At follow-up, VIP participants had significantly higher community re-integration scores and less difficulty managing targeted outcomes, compared to controls. Self-rated functional competence did not differ between groups. In addition, VIP’s acceptability was high. Conclusion: A home-based, family-inclusive service for veterans with TBI shows promise for improving meaningful outcomes and warrants further research and clinical application.

Conceptual and technical considerations when combining large data sets.

Secondary analysis provides a useful method for the development of new knowledge. Larger samples can be constructed, and secondary analysis can be enhanced when data sets are combined. A standardized method for combining large data sets is crucial, yet literature on methods for combining large data sets for secondary analysis is lacking. The purpose of this article is to outline and explain the process of combining two or more large data sets (n = 276, n = 125) for secondary analysis by using these authors’previous work with large oncology and AIDS caregiver data sets.

Managing Chronic Illness: Nursing Contact and Participant Enrollment in a Medicare Care Coordination Demonstration Program.

Models of care coordination can significantly improve health outcomes for older adults with chronic illnesses if they can engage participants. The purpose of this study was to examine the impact of nursing contact on the rate of participants’ voluntary disenrollment from a care coordination program. In this retrospective cohort study using administrative data for 1,524 participants in the Health Quality Partners Medicare Care Coordination Demonstration Program, the rate of voluntary disenrollment was approximately 11%. A lower risk of voluntary disenrollment was associated with a greater proportion of in-person (vs. telephonic) nursing contact (Hazard Ratio [HR] 0.137, confidence interval [CI] [0.050, 0.376]). A higher risk of voluntary disenrollment was associated with lower continuity of nurses who provided care (HR 1.964, CI [1.724, 2.238]). Findings suggest that in-person nursing contact and care continuity may enhance enrollment of chronically ill older adults and, ultimately, the overall health and well-being of this population