Mary Ann Jezewski

Spirituality in nursing and health-related literature: a concept analysis.

Spirituality has become an increasingly popular concept among the nursing and health-related literature. The purpose for conducting this concept analysis, guided by Walker and Avants methodology, was to (a) examine how spirituality has been used within the current body of nursing and health-related literature, (b) clarify the meaning of spirituality by discovering what this concepts current critical attributes/characteristics are, and (c) propose a definition of spirituality based on the concept analysis findings. A total of 90 references were reviewed, including 73 nursing and health-related references. Concept analysis findings revealed that spirituality was defined within four main themes in the nursing and health-related literature: (a) spirituality as religious systems of beliefs and values (spirituality = religion); (b) spirituality as life meaning, purpose, and connection with others; (c) spirituality as nonreligious systems of beliefs and values; and (d) spirituality as metaphysical or transcendental phenomena.

The Effectiveness of Interventions to Increase Advance Directive Completion Rates

Objectives: Despite federal and state laws governing advance directives (ADs), interventions to increase rates of legally completed ADs have not produced significant results. This study synthesizes the state of the science regarding effectiveness of interventions to increase AD completion rates. Methods: Garrards method for conducting a systematic literature review was followed. In all, 25 studies meeting inclusion criteria were reviewed. Interventions fell into two types: (a) didactic—information distributed through an educational program or clinical encounter or by a mailing and (b) interactive—person-to-person interaction where participants had the opportunity to ask questions and/or receive assistance completing the forms. Results: Postintervention rates of AD completion were: didactic = no change to 34% increase; interactive = 23% to 71% increase. Discussion: Education without the ability to ask questions does not significantly increase the AD completion rate. Didactic interventions did not usually increase completion rates higher than the predicted average rate for the general population.

Mexican Americans’ Explanatory Model of Type 2 Diabetes

The purpose of this study was to develop a culturally specific explanatory model (EM) of diabetes mellitus from the perspective of Mexican Americans living along the United States-Mexican border. Kleinman’s concept of EMs of illness was used as the theoretical orientation, and the grounded theory method was used to sample, collect, and analyze data. The Mexican Americans in this study described their perceptions of type 2 diabetes using the following constructs: causes, symptoms, treatment, and social significance. Each of the components of Mexican Americans’ EM contained elements of both the folk and the biomedical perspective. Susto (a fright or scare) was perceived to be the primary cause of diabetes, although participants also incorporated biomedical causes. Treatment included the use of both herbal and biomedical modalities. The use of herbal remedies was not well understood by the participants despite the fact that some used herbal therapies to control their diabetes.

Voices of oncology nurses: What is needed to assist patients with advance directives.

The process of completing and executing advance directives (ADs) is not without problems and issues that need to be studied. Nurses, by the nature of their practice, are in a unique position to help patients complete ADs. The findings reported in this article focus on an open-ended question that was part of a larger quantitative survey. The open-ended question, “What do oncology nurses need to increase their ability to assist patients with ADs?” was asked of a random sample of Oncology Nursing Society members. The Knowledge, Attitudinal, Experiential Survey on Advance Directives instrument was used to survey a random sample of oncology nurses in four states: California, Illinois, New York, and Texas. Of the 900 nurses who responded to the survey, 677 (75%) wrote responses to the open-ended question. Grounded theory was used to analyze data to establish and saturate categories. The four topics discussed most often by the nurses were time, education, support, and the nurse’s role. Nurses also wrote about philosophical issues related to dying, end-of-life issues, and ADs, as well as institutional issues that have an impact on the assistance they can give patients completing ADs. In addition, the category “communicating” was frequently discussed by nurses. The importance of communication was a thread woven throughout their responses.

Attitudes toward oral contraceptive use among women of reproductive age: a systematic review.

Despite the effectiveness of oral contraceptives (OCs), their popularity differs across populations. Attitudes are a significant factor that influences OC use. This report systematically reviews 28 studies on attitudes toward OC use among women. The Matrix Method was used to review the literature. Affective, cognitive, and behavioral components of attitudes were analyzed, including satisfaction, safety, fear/anxiety, and inconvenience. In general, negative attitudes still prevail across countries. Positive attitudes are more prevalent in Europe. Effective counseling and education are needed for those negatively disposed toward OC use. For favorable users, compliance strategies for longer continuation with OC regimen must be provided.

A Voice for the Dying

Secondary analysis of data collected for a grounded theory study of family surrogate decision-making processes at the end of life was undertaken to describe participants’ perceptions of the needs of family decision makers as expressed through their advice to others. Data were analyzed using the constant comparative method of grounded theory, resulting in identification of the major categories and their properties describing surrogates’ recommendations. The entire data set (approximately 22 hours of audiotaped narrative data collected from persons who had functioned as surrogates during the terminal phase of a family member’s cancer) was newly analyzed for the secondary analysis. All participants experienced the role as very demanding. Those who were able to see that another’s wishes were honored experienced satisfaction. Advice from experienced surrogates offers nurses both direct guidance to help them meet surrogates’ needs and insight to assist them in coaching surrogates in the performance of this critical role.

Psychometric testing of four transtheoretical model questionnaires for the behavior, completing health care proxies

The purpose of the study was to develop four questionnaires based on the transtheoretical model (TTM) to assess the behavior, completing a healthcare proxy (HCP). The aims were to (a) operationalize the four TTM constructs for completing a HCP and (b) evaluate the psychometric properties of the questionnaires. The questionnaires were constructed and content validity established using an expert panel. Internal consistency values for each questionnaire and subscales within each questionnaire were >.79. Confirmatory factor analysis provided evidence that decisional balance and the processes of change questionnaires each contained two factors. Our data support validity and reliability of the TTM questionnaires related to HCP completion.

Advance Directive Decision Making Among Independent Community-Dwelling Older Adults A Systematic Review of Health Science Literature

The purpose of this systematic review of health science literature was to examine the current state of science regarding advance directive decision making (ADDM) among independent community-dwelling older adults. Seventeen studies fitting study inclusion criteria established for the purpose of this systematic review were examined. Findings revealed that ADDM has predominantly been explored among widowed, divorced, or never married female Caucasian independent community-dwelling older adults aged 65 years and older possessing a high school level of education. Numerous older adult/health care provider barriers to advance directive discussion and completion were found to exist. There is a lack of research regarding ADDM among independent community-dwelling male older adults, older adults from various ethnic and cultural backgrounds, and older adults receiving lower levels of education. Study replication and the implementation of new studies are needed to strengthen the existing body of older adult, advance directive, evidence-based research.

Constituting Advance Directives From the Perspective of People With Chronic Illnesses

The purpose of this study was to investigate end-of-life decision making from the perspective of people with chronic illness concerning the completion of advance directives (ADs), the meaning of ADs for them, and their experiences with, attitudes toward, and perceived needs related to ADs. The sample included 76 people with varying chronic illnesses, recruited from 16 different support groups representing 10 different chronic illnesses. Data were collected via 23 individual interviews and nine focus groups. The findings consisted of a Basic Social Process, Constituting AD, which comprised four major categories: learning about ADs, interacting with the healthcare system, barriers related to AD completion, and triggering stiles. The findings illustrated that people with chronic illnesses do not have a good understanding of ADs. Healthcare proxy was a mechanism that was easier to understand than living wills. Future intervention studies should focus on mechanisms to help individuals understand and complete ADs in a way that does not depend on a healthcare provider initiating the process.

The Meaning of Child Abuse for Nurses in Taiwan

The purpose of this study was to explore nurses’ experiences and perspectives regarding child abuse in Taiwan. Semistructured interviews with Taiwanese nurses were audiotaped and transcribed verbatim for this descriptive study. The method of category development proposed by the grounded theory method was used to develop categorical themes that reflected the nurses’ experiences and perspectives. From the 18 registered nurses interviewed, four major categorical themes emerged that were integral to nurses’ experiences working with abused children: the meaning of child abuse, conflict, feeling frustrated, and nurses’ roles. Findings provide a base for understanding child abuse from the perspectives of nurses and a beginning understanding of interventions needed to improve identification and reporting of child abuse in Taiwan. Although nurses have considerable awareness and concern about child abuse, additional education related to this issue is needed.