Marie Annette Brown

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.

Social Support During Pregnancy: A Unidimensional Or Multidimensional Construct?

The purpose of this study was to test empirically a conceptually derived multidimensional formulation of social support. Analyses were based on responses of 313 expectant couples who varied in age, income, and education. A questionnaire, which included the Support Behaviors Inventory (SBI), was given in the latter half of pregnancy. A four-phased analysis was conducted: discriminate validity testing of the multidimensional support structure, further subscale analysis, factor analysis of the structure of the SBI, and reformulation of the SBI based on results of the factor analyses. Results did not demonstrate independence of measurement with items that were developed to represent a priori social support dimensions of emotional, material, informational, and appraisal support. The factor analysis in particular revealed that the scree test by Cattell (1966) demonstrated a large, dramatic discontinuity in eigenvalues and suggested that there was only one systematic factor. These results implied a dominant construct of social support in pregnant couples that organizes at the broad level the perceived degree of experienced support during pregnancy. This broader concept was so dominant in the current study, explaining 48% of the variance in partner support and 61% of the variance in others support, that the idea of multidimensionality was not confirmed. These data suggest an ongoing need to scrutinize carefully and validate empirically the hypothesized multiple dimensions of social support proposed in a number of recent support instruments.

The Labor of Caregiving: A Theoretical Model of Caregiving During Potentially Fatal Illness:

The purpose of this study was to explore the influence that chronic and potentially fatal illness has on the caregiving process over time. Data were collected through in-depth interviews with 26 family caregivers of people experiencing AIDS or advanced cancer over a 4-month period. Constant comparative analysis was used to analyze the data. A substantive theory of family caregiving for people with life-threatening illnesses was developed around a core organizing theme: the labor of caregiving. Four phases emerged: becoming a caregiver, taking care, midwifing the death, and taking the next step. This study validates the taking-care or “tasks” aspect of caregiving, revealing that issues and tasks vary in each phase of caregiving. The key role of the caregiver in contributing to the quality of life of the ill person was apparent in the initial phase of an illness as well as at the time of death.

From Limbo to Legitimacy: A Theoretical Model of The Transition to the Primary Care Nurse Practitioner Role

The initial transitional year of professional practice is thought to provide the critical foundation on which new professionals build their expertise. The purpose of this study was to describe the experiences of new nurse practitioner graduates during their first year of primary care practice. Thirty-five persons were interviewed alone or in focus groups at approximately 1, 6, and 12 months after graduation. Grounded theory methodology guided the data collection and analysis. A theoretical model was constructed that represents the transition to the primary care nurse practitioner role. This model consists of a process called From Limbo to Legitimacy, which encompasses four major categories: Laying the Foundation, Launching, Meeting the Challenge, and Broadening the Perspective. Each category contains a set of subcategories that detail the multiple aspects of the experience. This model highlights both the distress and the accomplishments of the initial year of advanced practice.

TAKING CARE : CAREGIVING TO PERSONS WITH CANCER AND AIDS

The purpose of this study was to provide an in-depth description of Taking Care, one of the phases of a grounded theory (The Labor of Caregiving) of caregiving for families experiencing life-threatening illnesses such as cancer and acquired immune deficiency syndrome (AIDS). In-depth interviews were conducted with 26 family caregivers of persons with cancer and AIDS during a 4-month period. Grounded theory methodology served as the basis for data collection and analysis. Data were analyzed in terms of the strategies, consequences, and interactions involved in the caregiving experience. The strategies of Taking Care included these data themes: Managing the Illness, Facing and Preparing for Dying, and Managing the Environment. The consequences of Taking Care included the data themes Coming to Know Ones Own Strength, and Personal Suffering. Interactions that occurred as a result of Taking Care included Responding to Family Relationship Issues, and Struggling with the Health Care System. Findings from this research reveal that family caregivers dedicate an enormous portion of their lives to caring for their ill family members. They experience their own form of suffering as they watch their loved one die. Some also find personal meaning in the experience and an awakening of their own strengths. One of the implications from these findings is the need for a partnership between health care professionals and the families providing care.

The Effects of a Multi-Modal Intervention Trial of Light, Exercise, and Vitamins on Women's Mood

ABSTRACT The purpose of this study was to test the efficacy of a tri-modal intervention (LEVITY) to improve womens mood. This eight-week randomized experiment with a placebo-control group targeted women with symptoms of mild to moderate depression. Women in the intervention group were instructed to take a brisk 20-minute outdoor walk at target heart rate of 60% of maximum heart rate, to increase light exposure throughout the day and to take a specific vitamin regimen. Women in the control group took a daily placebo vitamin. The sample consisted of 112 women ages 19–78 who reported mild to moderate depressive symptoms. They were in otherwise good health and were not currently taking any mood-altering medication. Pre- and post-intervention assessment utilized five measures of mood: Center for Epidemiology Studies Depression Scale, Profile of Mood States, Depression-Happiness Scale, Rosenberg Self-Esteem Scale, and the General Well-Being Schedule. Analysis of covariance indicated that the intervention was effective in improving womens overall mood, self-esteem, and general sense of well-being and in decreasing symptoms on two measures of depression. Of particular note, the data from all five outcome measures supported the efficacy of the intervention. In addition, a high level of adherence to the intervention protocol was observed with two-thirds of the women reporting 100% adherence. Study implications suggest that this type of intervention may provide an effective, clinically manageable therapy for mild-to-moderately depressed women who prefer a self-directed approach or who have difficulties with the cost or side-effects of medication or psychotherapy.

Nurse practitioner practice patterns for exercise counseling.

Purpose: To describe nurse practitioner (NP) practice patterns for exercise counseling for adults. Data sources: Using a cross‐sectional design, participants completed a self‐administered questionnaire that ascertained barriers and facilitators encountered when providing exercise counseling. Participants included 398 NPs, who averaged 11 years in practice (SD = 7.9) and worked in a variety of practice areas. Conclusions: In a given week, about half (48%) of the NPs counseled more than 50% of their patients for exercise. The majority of participants (84%) agreed that exercise counseling is as valuable an intervention as prescribed medication. More than half (59%) of the participants exercised regularly. Barriers and facilitators to exercise counseling were predominately a patients lack of interest and the length of the patient visit. Specific strategies were identified for older adults and individuals residing in rural areas who may require more tailored exercise counseling. Participants demonstrated strong values about exercise counseling and observed that exercise had clear benefits for their patients. NP respondents offered recommendations focused on safety and adherence that can be used to improve exercise counseling. Clinical implications: Exercise is a crucial component of preventative health care. Studies have shown that healthcare provider recommendations can be effective in helping patients increase their exercise and activity.

Prescriptive authority and barriers to NP practice.

For decades, nurse practitioners (NPs) have faced a myriad of difficulties as they attempted to provide comprehensive patient care, including pharmacologic therapies. NPs have also struggled to remove constraints on their ability to practice to the full extent of their potential. Intensive legislative and regulatory work has been necessary to advance autonomous NP practice. This article examines issues surrounding removing barriers to practice. 1

Surviving the proving ground: lessons in change from NP pioneers.

Increasing competition, health care complexity, threats to quality, and rapidly changing environments confront nurse practitioners (NPs) as they enter the new millennium. If NPs are to strengthen their positions as health care providers and continue to make a lasting contribution, they must exhibit proficiency in creating and managing change. Lessons gleaned from those who pioneered the NP role can provide the wisdom needed to address contemporary role challenges. The purpose of this study was to identify the strategies employed by NP pioneers who contributed to role survival and growth. This article provides a discussion of the change strategies utilized by NP pioneers and highlights their relevance to current practice issues.

Work and family roles of women: sources of stress and coping strategies.

Womens lives are affected by the roles they assume, as well as when and in what sequence and combination they assume these roles. This study described the daily stressors and coping strategies reported by women with differing work and family role configurations. Ninety‐two women representing four common typologies of multiple roles (married working mothers, single working mothers, married workers without children, and homemakers) reported daily hassles and their responses to these hassles in a health diary. The predominant type of hassles reported was related to the self, including physical and emotional symptoms, unfulfilled expectations, and doubts. The major response to hassles was doing nothing, followed by problem solving. While there were no significant differences in the incidence of daily hassles among the four groups, types of hassles and coping responses differed in rank when compared among the four groups.