Mary R. Boyd

Sleep Disturbance and Depression as Barriers to Adherence

This study examined the relationships among subjective sleep disturbance, depressive symptoms, and adherence to medications among HIV-infected women. HIV-infected women ( N = 173) were recruited through community AIDS service organizations throughout South Carolina. Participants completed the Pittsburgh Sleep Quality Index (PSQI), the Centers for Epidemiological Studies Depression Scale (CES-D), and a modified version of the Adults AIDS Clinical Trials Group Adherence Baseline Questionnaire. Women who reported greater sleep disturbance also reported a higher level of depressive symptoms and reported poor adherence to their medication regimen. Depression helped to explain the relationship between sleep quality and adherence. Results indicate that assessment and management of sleep disturbance and depressive symptoms in women with HIV disease is important to promote medication adherence.

Sleep quality and health-related quality of life in HIV-infected African-American women of childbearing age

A descriptive, correlational design was used to examine the associations of sleep quality and stage of illness with health-related quality of life (HRQOL) in HIV-infected African-American women. Participants were recruited from 12 health clinics and AIDS service organizations (ASO) in Georgia, North Carolina, and South Carolina. The sample consisted of 144 African-American women who ranged in age from 20 to 48 years (m=34.8, SD=6.8). The Pittsburgh Sleep Quality Index (PSQI) and the Medical Outcomes Short-Form Health Survey (SF-36) were administered. Participants were categorized as good sleepers (PSQI global score ≥7) or poor sleepers (PSQI global score ≥ 7) using the median global sleep quality score. Differences in HRQOL between good and poor sleepers, as measured by the SF-36, were tested using MANOVA. Good sleepers scored significantly higher (p < 0.0001) for each SF-36 quality of life dimension and the mental and physical health summary scores. Multiple regression analysis indicated that sleep quality is associated with HRQOL, independent of the individual’s stage of illness, more so with mental HRQOL than with physical HRQOL. The results suggest that treatment for poor sleep quality should be a primary concern for the treatment of HIV infection and a means for improving HRQOL.

Toward an Integration of Competencies for Advanced Practice Mental Health Nursing

As new models of health care delivery evolve, the work of advanced practice nurses is growing in importance. Graduate programs in nursing have traditionally prepared advanced practice nurses for separate roles as clinical nurse specialists or as nurse practitioners. However, there are increasing trends toward the blurring of bound aries between these two types of advanced practice roles. Hence, a future blended role is projected by many nurse educators. The merger of clinical nurse specialist and nurse practitioner roles, however, requires corresponding shifts in academic pro grams. The purposes of this article are to discuss the need for a blended clinical spe cialist-nurse practitioner role in mental health, to identify populations of clients who would be served by a blended role provider, to discuss the competencies associated with such a role, and to share an approach to the preparation of advanced practice mental health specialist/practitioners. (J Am Psychiatr Nurses Assoc [1998]. 4, 48-56)

Predicting substance abuse and comorbidity in rural women

Substance abuse in women is underdiagnosed. Moreover, women are more likely to have a primary comorbid psychiatric disorder that complicates diagnosis and treatment. The purpose of this study was to identify risk factors that would predict substance abuse and primary comorbid psychiatric disorders in rural women. Discriminant function analysis identified 2 factors, alcohol beliefs and threats of minor violence, which correctly identified substance abusing women from nonsubstance abusing women, and women with nonsubstance use psychiatric disorders from those with no psychiatric disorder. These 2 functions correctly classified 69% of women in the study. Psychiatric diagnoses and nursing implications are discussed.

Blending Specialist and Practitioner Roles in Psychiatric Nursing: Experiences of Graduates:

BACKGROUND: Blended roles in advanced practice nursing have generated much discussion but little study. As role modifications emerge in nursing, there is a need to explore their implementation. OBJECTIVE: This descriptive study examined the experiences of nurses who were implementing blended roles as psychiatric clinical specialists and adult nurse practitioners. DESIGN: Four master of science in nursing and 10 postmasters nurses who had been practicing in blended roles for 1 to 2 years were interviewed about their experiences in implementing their roles. Interviews were tape recorded, transcribed, and content analyzed. RESULTS: Respondents believed they were practicing holistically, were able to appropriately integrate physical and psychological care of the patient, and found chronic psychiatric patients to have more complex physical illnesses than they had anticipated. In addition, the advanced practice nurses were satisfied with their roles, felt supported by their physician preceptors, and described cross-consultation with physicians and nonpsychiatric nurse practitioners. CONCLUSIONS: There are roles for advanced practice nurses who blend clinical specialist and adult nurse practitioner skills in the care of psychiatric and primary care patients.

Redesigning a graduate research course for evidence-based competencies.

Nursing research is critical to establish the science for the discipline and to provide a foundation for evidence-based practice. All nurses need to understand the research process and engage in research at the level for which they were prepared. The American Association of Colleges of Nursing has clearly outlined essential learning outcomes for each level of nursing education, including the competent application of research findings to clinical problems. This article describes the evolution of a graduate-level research course to provide masters level students with a sound foundational understanding of the research process, the innovation undertaken to address identified learning needs, and the important lessons learned.

Predictors of Alcohol and Drug Problems in Rural African American Women

African American women report less alcohol and other drug (AOD) use than Caucasian women. However, health care professionals cannot afford to dismiss AOD use as significant problems for some African-American women. Although we know much more about AOD problems in women in general, we still lack information about AOD disorders and associated factors among rural African American women. Stepwise multiple regression was used to identify the best predictors of alcohol and drug problems among 142 rural African American women who took part in a study of risk factors for AOD disorders in rural women.