Mary L. Keller

Impact of symptoms and aging attribution on emotions and coping.

Two experimental studies and a large field study were designed to examine how symptom severity, symptom duration, symptom ambiguity, and the association of symptoms with aging affected emotional responses and coping with illness threats. In Study 1, 280 respondents from the surrounding community reported the emotional and coping responses they would manifest to scenarios that varied the severity, duration, and ambiguity (i.e., labeled vs. unlabeled) of a common set of symptoms. Severity had more of an impact on coping strategies than did duration or illness label; severe symptoms elicited stronger emotional upset and a higher incidence of both self-care behaviors and seeking of medical care. Symptoms of longer duration also resulted in increased seeking of medical care. Responses of the 334 adults participating in Study 2 replicated and extended these findings: A closed-ended item asking participants whether the symptoms could be attributed to aging showed that attribution of symptoms to aging increased with age, was more frequent for mild symptoms, and was associated with reduced emotional response to symptoms and a tendency to delay seeking treatment. Participants in the field study (168 patients seeking medical care for a variety of symptoms) completed interviews tracing symptom processing and emotional and coping reactions. The results provided evidence for the external validity of the scenario studies, as the attribution of symptoms to aging was greater for older than younger patients and resulted in a significant tendency to delay seeking medical care. Results of these studies suggest that symptom experience and symptom interpretation must be considered in the study of coping responses to illness threats.

Self-Disclosure of HPV Infection to Sexual Partners

Disclosure decisions of persons with genital HPV infection were examined. The research questions focused on relationships among knowledge of transmission, beliefs about the obligation to disclose knowledge of HPV infection to sexual partners, factors that influence the disclosure decision, and evaluations of the decision. Participants were 92 persons diagnosed with HPV 6 months prior to data collection. Sixty-three women and 29 men whose average age was 23.1 years constituted the sample. A subset of 48 persons provided detailed information about their reasons for disclosing or not disclosing knowledge of HPV and subsequent evaluation of their behavior. Knowledge of HPV transmission was adequate; however, there was no relationship between transmission knowledge and disclosure beliefs. Participants tended to disclose the presence of HPV to partners at point of diagnosis, but not to new partners 6 months later. Both disclosers and nondisclosers felt positively about their decision. Possible changes in clinical interventions for persons with HPV infection are discussed.

Falls in a psychiatric unit

The purposes of this descriptive study were to document the prevalence of previously identified risk factors for falls in a group of acutely ill psychiatric patients, to determine if patients who fell differed from nonfallers with respect to risk factors, and to describe the circumstances surrounding falls that occurred on an inpatient unit. All patients admitted to an acute psychiatric unit during a 7-month period were entered into the study (N = 197). Twice a day, nurses who worked on the unit completed a fall-risk factors checklist for each patient. When a fall occurred, an additional instrument designed to measure circumstances associated with the fall was completed. The most frequently occurring risk factors were clinical diagnoses of depression and confusion or disorientation. Seventeen patients fell during their hospitalization. Compared with nonfallers, patients who fell were more likely to have a previous history of falls, generalized weakness, confusion or disorientation, difficulty with mobility or walking, elimination problems, and temperature elevation. Analysis of circumstances surrounding falls showed that the majority of falls occurred when patients were attempting to get out of bed, walk to the bathroom at night, or change from a sitting to a standing position. Findings from this research can be used to identify psychiatric patients who are at risk for falls during their hospitalization.

Sexuality among women recipients of a pancreas and kidney transplant.

Significant improvements in health and quality of life generally follow organ transplantation; however, there is evidence that women who have received transplants experience difficulty with sexual function. The specific nature and extent of this difficulty has not been documented. The purpose of this study was to describe sexual functioning and sexual self-esteem among women recipients of a simultaneous pancreas and kidney transplant. Perceived effect of the transplant on sexualitywas also explored. Participants completed a questionnaire that measured their sexual functioning (including sexual difficulties), sexual self-esteem, illnesses, medications, and perceived effect of the transplant on sexuality. Data analysis revealed that only 39% of the women would be classified as having normal sexual functioning. The majority reported either some difficulty with sexual function (34%) or sexual dysfunction (27%). About one third of the women reported that transplantation had only positive effects on their sexuality, whereas 28% reported negative effects, and 29% reported no effect.

Genital Herpes: Gender Comparisons and the Disease Experience

The purpose of this descriptive study was to examine gender differences in the disease experience of persons who have genital herpes. Participants were 60 volunteers (34 females, 26 males) with recurrent genital herpes. Their average age was 31.7 years and the average length of time since diagnosis was 5.3 years. They completed questionnaires that included items about disease characteristics, disease stressors, and disease impact. The majority of reported stressors related to the consequences of the disease. A wide diversity of stressors were described, and results gave evidence of gender similarities in the disease experience. Exceptions were that women reported experiencing more worry with regard to negative effects on future and present health, disruption of daily activity, and disease symptoms. Men reported that recurrences last longer. Both disease symptoms and the presence of an intimate relationship were related to the perceived disease impact. Implications for sensitive interventions are discussed.

Predictors of Taiwanese nurses' intention to care for patients who are HIV positive.

The purpose of this research was to explore the knowledge of, attitudes toward, and intention to care for HIV-positive patients among 223 Taiwanese nurses. They worked in many different settings and had a variety of levels of exposure to HIV-positive patients. The findings of this research revealed that most Taiwanese nurses lacked sufficient knowledge to prevent themselves from becoming infected in the workplace. Their attitude about giving care to HIV-positive patients was generally negative; most nurses stated that they did not intend to care for these patients. A regression analysis revealed that knowledge was not a significant predictor of intention. Attitudes about societal treatment of HIV-positive people and nursing care were significant predictors of intention. Implications for practice and education of Taiwanese nurses are discussed.

Situational Factors Involved in College Students’ Safer and Risky Sexual Encounters

OBJECTIVE To ascertain the differences between the situational factors of risky and safer sexual encounters in college students. DESIGN Descriptive. SETTING Community-dwelling college students from a large Midwestern university. PARTICIPANTS Participants were 84 college students ages 18 to 20 years. Fifty-five were female (67.5%), the majority (95.2%) were White, and all reported being heterosexual. MAIN OUTCOME MEASURE Use of safer or risky practices in last or most memorable sexual encounter. RESULTS Important situational characteristics of safer encounters were negative ambiance of the place, type of partner, unattractive qualities of the partner, communication with the partner, and having the encounter because of feeling desire. Important situational characteristics of risky encounters were a cozy ambiance, partners attractiveness inducing desire, asking directly for the encounter, and encounters occurring after celebration or partying. CONCLUSIONS Many characteristics were similar for both risk groups. However, practitioners can tailor interventions to make clients aware of factors that were more prevalent in risky sexual encounters, such as having the encounter with a boyfriend or girlfriend and having an encounter after drinking alcohol and partying.

Emotions involved in college students' sexual encounters.

The number of sexually transmitted infections continues to rise among late adolescents and young adults. One possible explanation is that an important variable, emotion, is missing from theories and programs promoting safer practices. This study performed a thorough examination of emotions involved during and after sexual encounters and how these related to risk and planning of the sexual encounter. Eighty-two college students were given recall instructions and a questionnaire designed to elicit detailed information about their recent or most memorable sexual encounter. Using content analysis, open-ended questions concerning emotions and thoughts about the sexual partner, the participant in the situation, the place of the encounter, and feelings after the encounter were analyzed. Major findings included individuals who experienced negative or mixed emotions expected certain sexual behaviors less than those who had positive emotions. Unlike previous studies, there were no differences in emotions and planning of the sexual encounter, type of partner, and sexual risk.

The Development of Sexual Risk Taking in Adolescence

This chapter reviews literature from 1985 to the present that is focused on the development of sexual behaviors in adolescents, decision making about sexual behavior, and sexual risk-taking behaviors. Results show that sexual behavior is part of most people’s lives from childhood through adulthood, and that the majority of adolescents begin to engage in sexual behaviors in their teenage years. Synthesis of this large body of research reveals a lack of theoretical frameworks to guide research in sexual risk taking, resulting in an incomplete understanding of the predictors of sexual risk-taking behavior in adolescents. New and broader approaches in the study of sexual risk taking are needed that include consideration of the social and developmental context from which adolescents make decisions about sexual behavior.