Molly A. Rose

Family Factors in End-of-Life Decision-Making: Family Conflict and Proxy Relationship

BACKGROUND Few studies have examined proxy decision-making regarding end-of-life treatment decisions. Proxy accuracy is defined as whether proxy treatment choices are consistent with the expressed wishes of their index elder. The purpose of this study was to examine proxy accuracy in relation to two family factors that may influence proxy accuracy: perceived family conflict and type of elder-proxy relationship. METHODS Telephone interviews with 202 community-dwelling elders and their proxy decision makers were conducted including the Life-Support Preferences Questionnaire (LSPQ), and a measure of family conflict, and sociodemographic characteristics, including type of relationship. RESULTS Elder-proxy accuracy was associated with the type of elder-proxy relationship. Adult children demonstrated the lowest elder-proxy accuracy and spousal proxies the highest elder-proxy accuracy. Elder-proxy accuracy was associated with family conflict. Proxies reporting higher family conflict had lower elder-proxy accuracy. No interaction between family conflict and relationship type was revealed. CONCLUSIONS Spousal proxies were more accurate in their substituted judgment than adult children, and proxies who perceive higher degree of family conflict tended to be less accurate than those with lower family conflict. Health care providers should be aware of these family factors when discussing advance care planning.

Quality of life and coping styles of HIV-positive women with children.

This descriptive study explored the quality of life and coping methods of HIV positive women (N = 52) with children. The sample consisted of women with HIV/AIDS who answered an adapted Padilla Quality of Life Index and the Jalowiec Coping Scale. Among the psychological, physical, and social quality of life subscales, social quality of life was rated highest and the psychological scale rated the lowest. Among the three styles of coping, confrontive was used most frequently, passive and emotive less frequently. Significant relationships between coping and quality of life were examined. It is essential that nurses working with women with HIV disease be aware of their common concerns and provide effective strategies to improve quality of life such as enhancing decision making and coping skills within the context of the family unit.

Knowledge and Awareness Concerning Chemical and Biological Terrorism: Continuing Education Implications

BACKGROUND A survey on knowledge and awareness concerning chemical and biological terrorism was used to assess the knowledge base of health care providers at an urban medical center in preparation for developing a workshop on domestic terrorism preparedness. A second survey assessing domestic terrorism preparedness of infection control personnel and nurse educators also was conducted. METHOD A total of 291 nurses, physicians, nursing students, and medical students completed the knowledge and awareness survey. A total of 24 infection control personnel and nurse educators completed the second survey on domestic terrorism preparedness. FINDINGS The knowledge scores of the respondents were low, with less than one fourth of the knowledge questions answered correctly. In addition, less than 23% of the respondents reported confidence to provide health care in a hypothetical chemical terrorism situation. CONCLUSION These findings indicate a need for nurses in continuing education and staff development to develop, implement, and evaluate innovative domestic terrorism preparedness programs.

Knowledge of human immunodeficiency virus and acquired immunodeficiency syndrome, perception of risk, and behaviors among older adults

In a study of knowledge and beliefs about human immunodeficiency virus among older persons, 458 senior center participants completed a questionnaire derived from the Health Belief Model. The older adults had a fairly good knowledge base about acquired immunodeficiency syndrome (AIDS). Although they recognized the seriousness of the disease, they generally did not believe that they were susceptible to AIDS. Those who expressed an interest in receiving AIDS education had significantly higher perceived susceptibility scores than those who did not. African American respondents were statistically more interested in AIDS education than white or Hispanic respondents. Recommendations for interventions and further research are discussed.

Caregivers of children with HIV/AIDS: Quality of life and coping styles

The purpose of this study was to explore the quality of life and coping styles of caregivers of children with HIV/AIDS and to identify if there were differences between mothers and alternative caregivers in these areas. There were 54 mother-caregivers and 25 alternative caregivers in the study. The alternative caregivers scored significantly higher in each area of quality of life than the mothers, except for physical health. The mothers used passive and emotive coping significantly more than the alternative caregivers. The study concluded that caregivers provide support to children with HIV/AIDS, but they also need physical and emotional support themselves. Nurses must be aware of the importance of providing interventions for these caregivers to improve coping mechanisms, decrease stress, and thereby improve their quality of life.

Evaluation of the Chronic Disease Self-Management Program with low-income, urban, African American older adults.

A 1-group pretest–posttest design to assess for changes in outcomes at 10 weeks and 6 months was the method used to evaluate the standardized 6-session Chronic Disease Self Management Program (CDSMP) with low income, urban African American older adults. Participants included 153 older adults (primarily African American) with 1 or more chronic health conditions. Classes were provided in the community at senior citizen centers, senior housing, and churches. Significant improvements were noted in selected areas at 10 weeks and 6 months after the program completion. The CDSMP was feasible and well-received with the older adults who participated in the study. This study was funded by The Barra Foundation, Inc., Wyndmoor, Pennsylvania.

The health mentors program: three years experience with longitudinal, patient-centered interprofessional education.

Abstract Increased emphasis on team care has accelerated interprofessional education (IPE) of health professionals. The health mentors program (HMP) is a required, longitudinal, interprofessional curriculum for all matriculating students from medicine, nursing, occupational therapy, physical therapy, pharmacy, and couple and family therapy. Volunteer lay health mentors serve as educators. Student teams complete four modules over 2 years. A mixed-methods approach has been employed since program inception, evaluating 2911 students enrolled in HMP from 2007 to 2013. Program impact on 577 students enrolled from 2009–2011 is reported. Two interprofessional scales were employed to measure attitudes toward IPE and attitudes toward interprofessional practice. Focus groups and reflection papers provide qualitative data. Students enter professional training with very positive attitudes toward IPE, which are maintained over 2 years. Students demonstrated significantly improved attitudes toward team care, which were not different across programs. Qualitative data suggested limited tolerance for logistic challenges posed by IPE, but strongly support that students achieved the major program goals of understanding the roles of colleagues and understanding the perspective of patients. Ongoing longitudinal evaluation will further elucidate the impact on future practice and patient outcomes.

AIDS and IV Drug Abusers: Current Perspectives

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Planning HIV Education Programs for Older Adults: Cultural Implications

In this article the author discusses a needs assessment, through the use of discussion groups of various cultures, exploring the perceptions and attitudes of older adults about human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), and HIV education. Five discussion groups (one with Latino older adults, two with African-American older adults, one with White older adults, and one with Chinese-American older adults) were conducted. Semi-structured guiding questions were used with all groups. The questions centered on three major areas: perceptions of older adults and HIV and AIDS, use of condoms for HIV and AIDS prevention, and HIV prevention programs for older adults. The group sessions were approximately 1 hour, were recorded on tape, and were transcribed. The sessions were conducted in the languages of the target population. Because the project was a needs assessment for program development, the number of participants in each cultural discussion group was small, and the nurse group leaders were not experienced in focus group methodology themes and generalizations cannot be made. However, specific findings from the group sessions and recommendations for HIV prevention are presented for further exploration.

Home care nursing practice: The new frontier

Home care is an integral part of the health care delivery system. Although home care has been discussed as a less costly alternative to hospital care, it is quite reasonable to consider the home the primary site for the delivery of health care, with the institution the alternative site. Thus, home care nursing, as the new frontier of health care, does and will continue to involve an array of nursing responsibilities from high-technology skills to case management of the chronically ill patients multiple needs. There are specific areas that need to be addressed in home care, three of which were included in this discussion. These include the changing practice of the home care nurse, the lack of preventive and supportive services, and home care financing. Home care nursing has changed since the first sick poor people were visited in their homes by nurses in 1877. It would behoove nurses to try creative ways to reconstruct Walds model of home care in todays home care system. Nurses in home care must be actively involved in practice (including care of the sick, chronically ill, and those at risk for potential health problems), continuing education, research, and political action. Home care nursing is more than caring for an individual or family at home; it is being aware of and involved in changing the home care climate for a holistic nursing practice.