Jillian Inouye

Relationships Between Perception of Engagement with Health Care Provider and Demographic Characteristics, Health Status, and Adherence to Therapeutic Regimen in Persons with HIV/AIDS

The purpose of this descriptive, correlational study was to examine the relationships between perception of engagement with health care provider and demographic characteristics, health status, and adherence to therapeutic regimen in persons with HIV/AIDS. The convenience sample of 707 non-hospitalized persons receiving health care for HIV/AIDS was recruited from seven U.S. sites. All measures were self-report. Perception of engagement with health care provider was measured by the newly developed Engagement with Health Care Provider scale. Adherence to therapeutic regimen included adherence to medications, provider advice, and appointments. Health status was measured by the Medical Outcomes Study Short Form 36 (MOS SF-36), Living with HIV scale, CD4 count, and length of time known to be HIV-positive. There were no significant relationships between engagement with health care provider and age, gender, ethnicity, and type of health care provider. Subscales of the MOS SF-36 and Living with HIV explained a significant, but modest amount of the variance in engagement. Clients who were more engaged with their health care provider reported greater adherence to medication regimen and provider advice. Clients who missed at least one appointment in the last month or who reported current or past injection drug use were significantly less engaged.

Health-Related Quality of Life in Persons Younger and Older than 50 Who are Living with HIV/AIDS

Mortality rates are higher in older persons with AIDS. The Wilson and Cleary health-related quality-of-life model was used to explore whether there were differences on health-related quality-of-life variables between persons aged 50 or older (n = 73) and younger persons (n = 640) in a national sample. Depending on the level of the data, either independent t tests or chi-squares were calculated. Older participants reported significantly more medical conditions such as diabetes or hypertension (p = .000), more limitations in physical functioning (p = .006), and self-disclosure of HIV infection to fewer people (p = .000). There were no significant differences on any of the other variables. There are relatively few differences in older as compared to younger persons living with HIV/AIDS, yet mortality rates are higher in older samples. The relationship between the areas where there are differences and whether they affect morbidity and mortality need further exploration.

The effectiveness of self-management training for individuals with HIV/AIDS.

This study tested the effects of a 7-week individual self-management and coping skills training program on various measures of health and well-being of persons with HIV/AIDS. Forty men and women were randomly assigned the treatment or wait-list control group. Treated participants showed significant posttreatment changes on all four major measures of mood, coping, and health attitudes. Treatment significantly improved coping strategies as measured by the use and effective measures of the Jalowiec Coping Scale and several of its subscales, including decreases in use of emotive, fatalistic, and palliative coping styles. Psychological mood was improved, as measured by the Profile of Moods Total Mood Disturbance (POMS TMD) score and specific subscales of the POMS, which were targeted in the intervention (e.g., Anger). Treated participants also showed significant increases on the Internal subscale of the Health Attribution Test.

Factors influencing osteoporosis preventive behaviours: testing a path model

AIM This paper is a report of a study to test a model of certain factors influencing people engaging in osteoporosis preventive behaviours, and to estimate the direct and indirect effects of personal and social factors on whether people engage in those behaviours. BACKGROUND Osteoporosis preventive behaviours, including exercise and calcium intake, help decreasing the risk of developing osteoporosis. Reasons for engaging in osteoporosis preventive behaviours are complex and influenced by personal and social factors. Years of education, self-efficacy, knowledge of osteoporosis, social support and social capital have been indicated to increase people engaging in osteoporosis preventive behaviours; but age has been shown to decrease those behaviours. METHODS The proposed model was developed using Social Cognitive Theory and a conceptual framework for addressing the social context of health behaviour. A correlational cross-sectional study was carried out in 2005, using questionnaires and a convenience sample of 243 participants. Data analysis included descriptive statistics, correlation techniques and path analysis. RESULTS Self-efficacy was a better predictor of engaging in osteoporosis preventive behaviours than were the other variables. Social capital had a statistically significant direct and indirect effect on osteoporosis preventive behaviours. The modified path model showed good fit with the data. CONCLUSION The associations between personal and social factors extend our knowledge from previous studies and increase our understanding of the complex relationships among the study variables. The model provides guidance for future nursing practice, research, and education programs related to osteoporosis prevention.

Predictors of Perception of Cognitive Functioning in HIV/AIDS

This is a descriptive, correlational study of the predictors of perceived cognitive functioning. The convenience sample of 728 nonhospitalized persons receiving health care for HIV/AIDS was recruited from seven sites in the United States. All measures were self-reported. Self-perception of cognitive functioning, the dependent variable, was composed of three items from the Medical Outcomes Study HIV scale: thinking, attention, and forgetfulness. Data related to age, gender, ethnicity, education, injection drug use, CD4 count, and length of time known to be HIV-positive were collected on a demographic questionnaire. The scale from the Sign and Symptom Checklist for Persons with HIV Disease was used to measure self-reported symptoms. Data were analyzed using hierarchical multiple regression analysis. Predictors of perception of cognitive functioning explained a total of 36.3% of the variance. Four blocks--person variables (1.5%) (age, gender, education, history of injection drug use), disease status (2.3%), symptom status (26.5%), and functional status (5.4%)--significantly contributed statistically to the total variance. Among those individuals who completed the questions related to depression (n = 450), 28% of the variance in cognitive functioning was explained by this variable. The findings in this multi-site study indicate that symptom status explained the largest amount of variance in perceived cognitive functioning. Early identification of cognitive impairment can result in appropriate clinical interventions in remediable conditions and in the improvement of quality of life.

Utilizing the child abuse potential inventory in a community health nursing prevention program for child abuse

The objectives of this study were to: (a) Determine the potential for child abuse among the Joint New Parent Support Program Hawaii (Joint NPSP) client population, (b) Determine whether client participation in this program can reduce the potential for child abuse, and (c) Determine what client demographics correlate with the potential for child abuse. Joint NPSP is a prevention program for child abuse, screening all pregnant military families in Hawaii. The instrument used in this study was the Child Abuse Potential Inventory (CAP), a reliable and valid instrument used in the screening of physical child abuse. The CAP was completed by 142 pregnant Joint NPSP patients, ages 13-40 years, at the beginning of service provision and approximately 16 months later. Statistical measures used in analyzing the data were the t test and analysis of variance (ANOVA). Paired t tests were used to compare pre- and postprogram scores. Relations between the demographic profile information and CAP scores were analyzed with multiple regression analysis to identify risk factors for high child abuse. Out of 142 surveyed, 77 scored >166 (signal detection) on the pretest abuse scale, and 65 scored <166. In the >166 group the pretest mean was a score of 257, and the posttest mean was 137. T-test results in the >166 group were highly significant at .0001 on the scales of abuse, distress, rigidity, unhappiness, problems with family, and problems with others. ANOVA results in the >166 group revealed a significant difference between an elevated abuse scale and patients with psychiatric problems (.0485), relationship problems (.0452), and past or present spouse abuse (.0421). This study validated that Joint NPSP is servicing a population at risk for child abuse potential. After intense home visitation by the community health nurses, the scores for child abuse potential decreased. A major limitation was the lack of a control group, the problem of maturation and history, and the possibility of regression toward the mean in scores. These limitations should be addressed in future studies with the use of 2 treatment modalities. Results highlight the need for focusing on relationship and spouse abuse issues in a military population.

Inquiry-based learning as a teaching strategy for critical thinking.

Changes in the healthcare system have prompted educators to rethink and revise nursing curricula. The National League for Nursing has outlined recommendations for the successful implementation of socially relevant curricula that reflect the diversity and plurality of local communities. Such revisions should better prepare graduates to function in a reformed healthcare system. Educational goals have shifted from curricula content to curricula outcomes. Beyond the mastery of content (which may quickly become outdated), the development of specific skills (critical thinking) and innovative responses to problems are now required of advanced practice nurses. Inquiry-based learning (IBL) offers an opportunity for graduate students to develop the necessary skills for effective practice. This article presents a model of IBL in graduate mental health education and an investigation of critical thinking skills as a possible outcome of the IBL method.

Inquiry-Based Learning and Critical Thinking in an Advanced Practice Psychiatric Nursing Program

The advanced practice psychiatric nurse must be prepared to meet the changing demands being placed on the nursing profession. Some changes are the product of health care reforms, especially managed care. Others are more fundamental, because continuing scientific advances drive rapid changes in the knowledge base required of mental health nurses. Curricular reforms initiated earlier this decade were intended to equip nurses with the problem-solving and critical-thinking skills required to deal with novel and complex situations in a rapidly changing healthcare system. This article describes how the Inquiry-Based Learning tutorial method attends to the mental processes of graduate students and fosters critical-thinking skills.

Depression and Chronic Illness: Asian/Pacific Islander Adults in Hawaii

Asian/Pacific Islanders (APIs) are comprised of many subgroups, such as Filipinos, Hawaiians, Japanese, Chinese, Koreans, and Samoans. They are often portrayed as the model minority for health, though they rarely seek help for depression. Few studies have reported findings for each of the subgroups separately. Because depression has been related to health care and outcomes of people with chronic illness, this study, utilizing previously collected data, compared the prevalence of mild, moderate, moderately severe and severe depression and self-reported chronic illnesses among several API groups. Understanding subgroup cultural differences in the prevalence of depression may contribute to better assessment of early signs of depression for this population. A descriptive statistical analysis found Pacific Islanders were three times more likely to have severe or moderately severe depression compared to Asians (4.8% vs. 1.5%). Other characteristics related to these findings include: cigarette use, employment status, emotional support, life satisfaction, and health care access.

Child Abuse Prevention Program with POTS-Based Telehealth: A Feasibility Project

Child abuse and neglect have devastating financial and psychological effects on children, families, and communities. Home visitation has been found to reduce the risk of child abuse by enhancing parent–child interaction and decreasing the incidence of physical punishment. This project was instituted to assess the acceptance and reliability of integrating inexpensive Plain Old Telephone Service (POTS)-based video technology (8 × 8 VIATV) into an existing program and to determine client and nurse satisfaction with the technology. At-risk families were recruited for the study if the mother was pregnant or had delivered within the past year and was available to participate in the study for 6 months. Subjects participated in the regular family intervention program in addition to having the POTS technology installed in their homes. Nurses also had the technology in their homes to give subjects access to them at all times. The POTS system had low acceptance by patients and nurses because of logistic and technica...