Joanne Kraenzle Schneider

Using the Health Belief Model to Understand Caregiver Factors Influencing Childhood Influenza Vaccinations

Objective: This study applied the Health Belief Model to investigate factors in the decision by caregivers to vaccinate their children for influenza. Design: Cross-sectional study. Sample and Measurements: Purposive sampling obtained 2,778 useable responses to surveys of 33 public health centers and 40 medical institutions participating in vaccination programs in southern Taiwan. Data were collected using the Caregiver Demographics and Childrens Health History Questionnaire, Childrens Influenza Vaccination History Questionnaire, and a Health Belief Model Questionnaire. Multiple logistic regression was used to analyze predictors of influenza vaccinations in children. Results: Predictors of vaccination revealed by logistic regression analysis included age, current employment, and residence of the caregiver as well as chronic disease, hospitalization, and influenza histories of the child. Other predictors revealed by the Health Belief Model were perceived susceptibility of the children to influenza, perceived benefits of vaccinations to children, perceived barriers to vaccinations, and cues to action. Eleven items in the model were also significant predictors of vaccination. Conclusions: The survey results can be used to develop strategies for increasing influenza vaccination rates.

A medication discharge planning program: measuring the effect on readmissions.

Repeated hospitalizations result in high costs and may occur as a result of patient errors in their medication regimen. To reduce rehospitalizations (hospitalizations within 31 days of the previous discharge), health care professionals have turned to the discharge planning process. Using Orems theory of self-care, a medication discharge planning program was developed to provide instruction on the requisites necessary for medication self-care. The purpose of this pilot study was to examine the effects of this program on readmissions within 31 days. Five nurses implemented the program for 54 patients with an admitting diagnosis of congestive heart failure. These patients were alternately assigned to a control or an experimental group. The experimental group received the medication discharge planning program. The control group received the usual informal discharge planning provided on the nursing unit. Eight (28.6%) of the 28 patients in the control group were readmitted within 31 days of the previous discharge. Two (7.7%) of the 26 patients in the experimental group were readmitted within 31 days. These results showed a statistically significant difference using Fishers Exact Test (p = .05). Those receiving the medication discharge planning program were less likely to be readmitted, suggesting the importance of a medication discharge planning program.

A Preliminary Investigation of the Grandparent Support Scale for Teenage Mothers

Although numerous instruments are available to assess the teen mother’s social support, an instrument that is more narrowly focused on the support teen mothers receive from their parents (the grandparents) is lacking. To remedy this gap, the Grandparent Support Scale for Teenage Mothers (GSSTM) was developed. The purpose of this article is to review what is known about grandparent support and describe the initial psychometric testing of the teen version of the GSSTM. Four questionnaires were completed by 72 teen mothers. Factor analysis of the GSSTM resulted in reduction of the questionnaire from 22 to 16 items and yielded three factors: Grandparent Responsiveness (α = .90), Grandparent as Decision Maker (α = .76), and Grandparent as Actor (α = .72). GSSTM subscales significantly correlated with the other measures, supporting their validity. Although further psychometric testing is needed with a larger sample, the GSSTM shows promise in assessing teen mothers’ perceptions of family support.

Unexpected effects of cognitive-behavioural therapy on self-reported exercise behaviour and functional outcomes in older adults

BACKGROUND nearly 61% of older adults do not maintain recommended exercise levels emphasising the need for interventions that promote exercise. OBJECTIVES to compare self-reported exercise behaviour and functional outcomes over 1 year across three groups of older adults: a cognitive-behavioural therapy group, an attention-control education group and a control group. DESIGN randomised intervention. SETTING community exercise facilities. PARTICIPANTS three hundred and thirty-two older adults (mean age = 71.8 ± 5.1 years). METHODS all three groups received exercise training three times per week for 2 weeks and then one time per week for 8 weeks, during which time the therapy and education groups received their interventions. Blinded data collectors measured follow-up exercise behaviour and functional outcomes at 3-month intervals. RESULTS after controlling for previous year exercise behaviour, results showed that relative to the control group, the therapy and education groups increased their strengthening exercises over time (0.05 and 0.06 h/week higher, respectively); only the therapy groups change was significant. Also, relative to the control group, the therapy and education groups significantly reduced their 6-min walking distances over time (-1.6 m, P = 0.030 and -1.5 m, P = 0.026, respectively). CONCLUSIONS although the therapy group increased their strength training, they reduced their 6-min walking distance.

Internalized Stigma of Mental Illness Scale - Thai Version: Translation and Assessment of Psychometric Properties Among Psychiatric Outpatients in Central Thailand

This paper reports the translation of the English Internalized Stigma of Mental Illness scale into Thai and assessment of its psychometric properties. After forward- and backward-translation, Thai experts completed the content validity index with item agreements of .86 to 1.00. Data were collected from 390 psychiatric clinic patients in central Thailand using systematic random sampling. Unweighted least squares factor analysis with Promax rotation identified five subscales. Cronbachs alpha for scale reliability was .88, and correlations for construct validity ranged from r=.55 to .69. These findings support the validity and reliability of the Thai version of the scale.

Planning Psychoeducational Groups for Older Adults

Psychoeducational group work, with its focus on education and psychological growth, is a versatile and effective method of teaching older adults new skills and behaviors. Planning a psychoeducational group should be systematic and well thought out. Each session outline should include objectives, information to be imparted, life-skill experiential activities, and process questions to make the connection between the information and the experience.

A model of risk reduction for older adults vulnerable to nursing home placement.

Because of the cost of nursing home care and desire of older adults to stay in their homes, it is important for health care providers to understand the factors that place older adults at risk for nursing home placement. This integrative review of 12 years of research, as published in 148 articles, explores the risk factors for nursing home placement of older adults. Using the framework of the vulnerable populations conceptual model developed by Flaskerud and Winslow (1998), we explored factors related to resource availability, relative risks, and health status. Important factors include socioeconomic status, having a caregiver, the availability and use of home- and community-based support services, race, acute illness particularly if hospitalization is required, medications, dementia, multiple chronic conditions, functional disability, and falls. Few intervention studies were identified. Development of evidence-based interventions and creation of policies to address modifiable risk factors are important next steps.

Motivational Interviewing–Based Compliance/Adherence Therapy Interventions to Improve Psychiatric Symptoms of People With Severe Mental Illness: Meta-Analysis:

BACKGROUND: Nonadherence is the leading cause of relapse in mental illness. No quantitative synthesis of multiple studies has been conducted to determine the effect of motivational interviewing (MI)–based compliance/adherence therapy (CAT) interventions on people with severe mental illness. OBJECTIVE: To synthesize the studies that examined the effectiveness of MI-based CAT interventions to improve psychiatric symptoms. DESIGN: Quantitative meta-analysis. RESULTS: Sixteen primary studies were retrieved (N =1267 participants). MI-based CAT interventions significantly improved psychiatric symptoms with a moderate effect size (ES) of .45. Longer sessions and higher intervention doses showed significantly greater ESs than shorter sessions and lower doses. ESs were significantly lower when participants were older and when there was a longer period between the intervention and outcome measurement. CONCLUSIONS: These findings support the effectiveness of MI-based CAT interventions. Session length and dose effect should be considered when tailoring MI to clients.

Ethical dilemmas in nursing: An integrative review

AIMS To identify themes and gaps in the literature to stimulate researchers to develop strategies to guide decision-making among clinical nurses faced with ethical dilemmas. BACKGROUND The concept of ethical dilemmas has been well explored in nursing because of the frequency of ethical dilemmas in practice and the toll these dilemmas can take on nurses. Although ethical dilemmas are prevalent in nursing practice, frequently leading to moral distress, there is little guidance in the literature to help nurses resolve them. DESIGN This study is an integrative review of published research from 2000 to 2017. METHODS The keywords ethics, ethical dilemmas and nurs* were searched in CINAHL, PubMed, OVID and SCOPUS. Exclusion criteria were sources not available in English, not in acute care, and without an available abstract. Seventy-two studies were screened; 35 were retained. Garrards matrix was utilised to analyse and synthesise the studies. RESULTS Ethical dilemmas arose from end-of-life issues, conflict with physicians or families, patient privacy concerns and organisational constraints. Differences were found in study location, and yet international research confirms that ethical dilemmas are universally prevalent and must be addressed globally to protect patients and nurses. CONCLUSIONS This review offers an analysis of the available evidence regarding ethical dilemmas in acute care, identifying themes, limitations and gaps in the literature. The gaps in quantitative intervention work, US paucity of research, and lack of comparisons across practice settings/nursing roles must be addressed. Further exploration is warranted in the relationship between ethical dilemmas and moral distress, the significance patient physical appearance plays on nurse determination of futility, and strategies for pain management and honesty. RELEVANCE TO NURSING PRACTICE Understanding and addressing gaps in research is essential to develop strategies to help nurses resolve ethical dilemmas and to avoid moral distress and burnout.

Symptomology of Elevated Blood Pressure in Black Women with Hypertension

Understanding factors that influence hypertension self-management may improve blood pressure control in Black women; however, little is known about Black women’s perceptions of symptoms associated with hypertension. In this study, using the revised version of the Illness Perception Questionnaire (IPQ-R), we examined Black women’s perceptions of symptoms that they associate with hypertension. While over half (52.5%) reported no symptoms of high blood pressure, 41.3% of the women reported one to six symptoms they attributed to high blood pressure. This study has the potential to increase clinicians’ understanding of patients’ perceptions of the symptomology of hypertension.