Juliette Shellman

Nobody ever asked me before: understanding life experiences of African American elders.

With the unprecedented growth in the African American elderly population, there exists an urgent need to prepare nurses to deliver culturally competent care. The purpose of this study was to increase the knowledge available about the cultural heritage, worldviews, and life experiences of African American elders. Reminiscence interviews were conducted with African American elders living in a medium-sized northeast urban community. Data were analyzed using Spiegelberg’s phenomenological method. The following themes emerged: (a) nobody ever asked me before, (b) stories of discrimination, (c) coping with discrimination, (d) the hurt of discrimination, and (e) self-discoveries. Nurses, through the use of reminiscence, can gain insight into the cultural heritage, worldviews, and life experiences of African American elders and improve their ability to deliver culturally competent care to this population.

The Effects of Integrative Reminiscence on Depressive Symptoms in Older African Americans

The purpose of this pilot study was to evaluate the effect of integrative reminiscence on depressive symptoms in older African Americans. Fifty-six community-dwelling participants from a northeast urban setting were randomized into a reminiscence intervention group (n = 19), attention control group (health education; n = 19), or true control group (n = 18). Data were collected pre- and posttest using the Center for Epidemiological Studies Depression Scale. Significant differences were found between groups, F(2, 52) = 8.6, p = .001, η2 = .10. Using Holm’s method of post hoc analysis, the mean score for the reminiscence group was 6.8 (SD = 4.7), significantly different from the control group 14.6 (SD = 10.1) and the health education group 11.7 (SD = 7.1). Findings demonstrate that integrative reminiscence has a positive effect on decreasing depressive symptoms in older African Americans.

The level of cultural self-efficacy among a sample of Spanish nurses in southeastern Spain.

A collaborative study between faculty from the United States and Spain was undertaken to investigate levels of cultural self-efficacy among a sample of Spanish nursing students and nurses. Bandura’s self-efficacy theory provided the conceptual framework for this descriptive study. The Spanish version of the Cultural Self-Efficacy Scale (CSES-S) was translated from the original developed by Bernal and Froman using the back-translation technique recommended by Brislin. The CSES-S was administered to 113 Spanish nurses and students. Alpha coefficient results for the CSES-S ranged from .90 to .95. Low to neutral levels of confidence in caring for four ethnic groups were found. Regression analyses showed significant relationships between cultural exposure and cultural self-efficacy for the practicing nurses. Results will assist this collaborative transcultural nursing research effort between the United States and Spain to develop and implement programs and experiences to increase cultural self-efficacy among Spanish nurses and improve care provided to Spain’s diverse population.

Misconceptions of older adults with hypertension concerning OTC medications and alcohol.

Knowledge and self-efficacy concerning interactions of antihypertensives with over-the-counter (OTC) analgesics and alcohol were assessed in 51 adults aged 60 and older taking antihypertensives and attending a blood pressure clinic. The subjects had low self-efficacy about how to prevent interactions of antihypertensives with OTC analgesics and alcohol. Inspection of knowledge item responses revealed eight general misconceptions about OTC medications. These data guide educating those with hypertension about potential drug interactions arising from self-medication.

Overcoming Barriers to Conducting an Intervention Study of Depression in an Older African American Population

The purpose of this article is to describe barriers and strengths of a study testing the effects of reminiscence on depressive symptoms in community-dwelling older African Americans. Primary data sources included debriefing sessions, reflective journals, participant observations, and key informant interviews. Data were analyzed using immersion/crystallization technique. Mistrust between gatekeepers and universities, recruitment and retention of research assistants and participants, culturally insensitive instruments, and stigma associated with depression were barriers. Successful approaches used to overcome the barriers experienced by the research team are described. Implications for transcultural nursing research and practice are discussed.

Knowledge and self-efficacy of community health nurses concerning interactions of prescription medicines with over-the-counter agents and alcohol.

Knowledge and self-efficacy concerning interactions of prescription medications with over-the-counter (OTC) agents were assessed in community health nurses. Three convenience samples of community nurses were recruited to complete the instruments. The first was a sample of 20 experienced nurses working for a local visiting nurse agency (VNARNs). The second was a sample of 20 bachelor of science in nursing (BSN) students (graduate nurses [GNs]) completing their final nursing rotation with the VNARNs. The third was a sample of 31 nurses enrolled in a graduate program training nurses for advanced practice (APRNs). There were no significant differences in overall mean self-efficacy scores among the groups of community health nurses. The mean scores indicated moderate self-efficacy about prescription-OTC interactions. Post-hoc analyses determined VNARNs had significantly greater knowledge scores than APRNs. Overall mean self-efficacy was not correlated with mean knowledge scores. Inspection of the knowledge item responses revealed nine general misconceptions about OTC medications held by many community nurses in the sample. The data can guide the development of continuing education programs about prescription-OTC interactions aimed at community health nurses.

Psychometric testing of the Modified Reminiscence Functions Scale.

Background and Purpose: The Modified Reminiscence Functions Scale (MRFS) measures the patterns and functions of reminiscence. The purpose of this study was to examine the factor structure of the MRFS in a sample of community-dwelling Black adults. Methods: A convenience sample (N = 335) of Black adults from the Northeast completed the 39-item MRFS. Seven- and 8-factor models were evaluated given the uncertainty regarding the number of factors in previous reminiscence research. Results: Confirmatory factor analysis established validity of the 7-factor model (relative chi-square [χ2/df] = 1.9, Tucker-Lewis index [TLI] = .919, comparative fit index [CFI] = .929, root mean square error of approximation [RMSEA] = .05). Reliability of the subscales ranged from .64 to .90. Conclusions: The MRFS is a reliable and valid measure of reminiscence patterns and functions in Black adults with similar characteristics.

CARELINK: partners in a caring model: a cardiac management program for home care.

As a model of care, CARELINK promotes self-care and self-management of chronic illnesses for homebound older adults no longer eligible for skilled nursing services. A case-study method is used to highlight the key constructs and outcomes related to the model. The benefits of applying the CARELINK model as a cardiac management program for home care are discussed.

Developing a dedicated education unit in long-term care: a pilot project

Within long-term care, the transitional care setting provides post-acute and short-stay rehabilitation to older adults, easing the transition between the acute care hospital and home or long-term care. The current nursing shortage makes it difficult for these facilities to attract and retain qualified nursing staff. In order to meet the rehabilitation needs for this patient population while at the same time addressing the challenge in nursing education of limited clinical placements and severe nurse faculty shortages, an academic-practice partnership was developed to establish a Dedicated Education Unit (DEU). The DEU is an innovative clinical education model in which experienced staff nurses serve as clinical teachers to nursing students. This paper describes the process of developing a DEU using the Partners in Caring Model as the framework. Formative and summative evaluation results and recommendations for program improvement of this pilot project are discussed.

Acceptability of the Fetzer/NIA Multidimensional Measure of Religiousness and Spirituality in a Sample of Community-Dwelling Black Adults

Purpose: To examine the acceptability of the National Institute on Aging/Fetzer Multidimensional Measure of Religiousness and Spirituality in a sample of Black, community-dwelling, older adults using focus group inquiry (N =15). Design and Method: Focus group methodology was used for data collection and analysis. Three focus groups (N = 15) were conducted in two different urban settings in the northeastern part of the United States. Findings: Key findings were that (a) self-rating on religiousness was uncomfortable for many participants, (b) selfless was a word many participants confused with selfish, and (c) spirituality was an important concept. Conclusion: Overall, the Measure was found to be culturally acceptable and required little modification. Implications for Practice: Religious health beliefs such as “rebuking” or “not claiming” medical diagnoses are important considerations to bear in mind in seeking to understand the impact of religiousness on health in this population.