Patricia Liehr

Community-based participatory research to prevent substance abuse and HIV/AIDS in African-American adolescents

Adolescence is a time for exploration and risk-taking; in todays urban environment, with the twin threats of substance abuse and HIV/AIDS, the stakes are particularly high. This paper describes a community-based participatory research project to design, implement, and evaluate a faith-based substance abuse and HIV/AIDS prevention program for African-American adolescents. A coalition of university-based investigators and African-American church member stakeholders collaborated on all aspects of Project BRIDGE, the 3-year intervention to reduce substance abuse and HIV/AIDS in African-American adolescents. Our results support the use of community-based participatory research to create desirable change in this setting. Adolescents who participated in Project BRIDGE reported significantly less marijuana and other drug use and more fear of AIDS than a comparison group. Project BRIDGE has been designated an official ministry of the church and the program has been extended to others in the larger metropolitan community. The church now has a well-trained volunteer staff. University faculty developed skills in negotiating with community-based settings. The coalition remains strong with plans for continued collaborative activities.

National evaluation of healthcare provider attitudes toward organ donation after cardiac death

Objective:Organ donation after cardiac death will save lives by increasing the number of transplantable organs. But many healthcare providers are reluctant to participate when the withdrawal of intensive care leads to organ donation. Prior surveys indicate ethical concerns as a barrier to the practice of organ donation after cardiac death, but the specific issues that characterize these concerns are unknown. We thus aimed to identify what barriers healthcare providers perceive. Design:We conducted a qualitative analysis of focus group transcripts to identify issues of broad importance. Setting:Healthcare setting. Participants:Participants included 141 healthcare providers representing critical care and perioperative nurses, transplant surgeons, medical examiners, organ procurement personnel, neurosurgeons, and neurologists. Interventions:Collection and analysis of information regarding healthcare providers’ attitudes and beliefs. Measurements and Main Results:All focus groups agreed that increased organ availability is a benefit but questioned the quality of organs recovered. Study participants identified a lack of standards for patient prognostication and cardiopulmonary death and a failure to prevent a conflict between patient and donor interests as obstacles to acceptance of organ donation after cardiac death. They questioned the practices and motives of colleagues who participate in organ donation after cardiac death, apprehensive that real or perceived impropriety would affect public perception. Conclusions:Healthcare providers are uncomfortable at the clinical juncture where end-of-life care and organ donation interface. Our findings are consistent with theories that care providers are hesitant to perform medical tasks that they consider to be outside the focus of their practice, especially when there is potential conflict of interest. This conflict appears to impose moral distress on healthcare providers and limits acceptance of organ donation after cardiac death. Future research is warranted to examine the effect of standardized procedures on reducing moral distress. The hypothesis generated by this qualitative study is that use of neutral third parties to broach the subject of organ donation may improve acceptance of organ donation after cardiac death.

Change in stress levels following Mindfulness-Based Stress Reduction in a therapeutic community

ObjectivesThis pilot was designed to study identified changes in the psychologic and physiological stress response of individuals who participated in a Mindfulness-Based Stress Reduction intervention while in treatment of substance abuse in a therapeutic community. MethodsTwenty-one participants in a residential therapeutic community received the intervention, which consisted of training in 5 mindfulness practices. Stress response was assessed by measuring awakening salivary cortisol and the Perceived Stress Scale (PSS) pre- and post-intervention. ResultsAwakening salivary cortisol levels were significantly lower (P < 0.0001) following the intervention. Although there was a decrease in self reported stress between the baseline measurement and the post-intervention measurement, the change in the PSS was not statistically significant (P = 0.65). ConclusionsThese results suggest that a Mindfulness-Based Stress Reduction intervention may influence the physiological response to stress for individuals in a therapeutic community. The results also support the use of salivary cortisol as an indicator of the stress response in this setting. Future studies are needed to determine the value of this intervention as an adjunct to therapeutic community treatment.

Middle range theory: spinning research and practice to create knowledge for the new millennium.

The foundation of middle range theory reported during the past decade was described and analyzed. A CINAHL search revealed 22 middle range theories that met selected criteria. This foundation is a firm base for new millennium theorizing. Recommendations for future theorizing include: clear articulation of theory names and approaches for generating theories; clarification of concept linkages with inclusion of diagrammed models; deliberate attention to research-practice connections of theories; creation of theories in concert with the disciplinary perspective; and, movement of middle range theories to the front lines of nursing research and practice for further analysis, critique, and development.

A Pilot Study Examining the Effect of Mindfulness on Depression and Anxiety for Minority Children

From the Christine E. Lynn, College of Nursing, Florida Atlantic University, Boca Raton, FL; School of Social Work,SO284, FloridaAtlanticUniversity,BocaRaton, FL. Corresponding Author: Patricia Liehr, PhD, RN, Professor, Christine E. Lynn, College of Nursing, Florida Atlantic University, Boca Raton, FL 33431. E-mail addresses: pliehr@fau.edu, ddiaz10@fau.edu

Anger in adolescents: sex, ethnicity, age differences, and psychometric properties.

BackgroundThe State-Trait Anger Expression Inventory (STAXI), a self-report questionnaire, is designed to measure the experience and expression of anger. Reliability and validity of the STAXI have been well established among African and European Americans aged 13 years and older. However, little is known of the use of this instrument among adolescents younger than 13 years and Hispanic American adolescents. ObjectivesObjectives were (a) to test ethnic, sex, and age group differences in STAXI scores in a sample of 11-to-16-year-old African, Hispanic, and European American adolescents; and (b) to assess the psychometric properties of the STAXI among these same adolescents with special emphasis on Hispanic youths, for whom no data are available. MethodsA cross-sectional design was used with stratified quota sampling techniques. Participants (N = 394) were African, Hispanic, and European Americans aged 11–16 years and were drawn from one public middle school and two public high schools in Houston, Texas. ResultsInternal consistency reliability for the anger scales (STAXI) ranged from 0.61 (anger-in) to 0.91 (state-anger) for the younger group (aged 11–13 years), and 0.68 (anger-in) to 0.88 (state-anger) for the older Hispanic Americans (aged 14–16). No notable differences were seen among the three ethnic groups in regards to internal consistency. Results of factor analyses of the five anger scales were similar to those reported originally by the scale author. Ethnicity and age had statistically significant main effects on the anger scales, and there was only one interaction. DiscussionThe use of the STAXI among a tri-ethnic adolescent population is warranted. The anger-in scale may be less reliable, especially among younger adolescents.

Story theory: advancing nursing practice scholarship.

Stories are a fundamental dimension of human experience and nursing practice. Story theory describes a narrative happening that occurs through intentional nurse-person dialogue. Seven inquiry phases are associated with story theory, including gathering the story, reconstructing the story, connecting it to the literature, naming the complicating health challenge, describing the story plot, identifying movement toward resolving, and gathering additional stories. This article describes the use of story theory to advance nursing practice scholarship in both academic and everyday nursing practice.

Mindfulness-Based Stress Reduction in Therapeutic Community Treatment: A Stage 1 Trial

Objective: This trial compared Mindfulness-Based Stress Reduction, adapted for therapeutic community treatment (MBTC), with treatment as usual (TAU) for reducing stress and increasing retention in a residential facility for substance use disorders. Method: Four-hundred and fifty-nine participants, who met DSM-IV criteria for substance dependence were recruited (TAU = 164, MBTC = 295). Results: A survival analysis of time to dropout did not show a significant difference between groups, however level of participation in MBTC was associated with decreased likelihood of dropout (p = < .01), and higher Symptoms of Stress Inventory (SOSI) scores at baseline were associated with increased likelihood of dropout (p = .03). Conclusion: The association between retention and level of stress on intake as well as level of participation in MBTC provides support for further research on integrating MBTC into therapeutic community treatment.

The Core of True Presence: A Loving Center

may hold. To attend in this way, the nurse’s sensitive awareness of the other extends beyond a facial expression or beyond the content of verbal interchange. The nurse’s sensitivity is expressed as a shared feeling which seeps out between smiles, frowns, groans, and words. Although the feeling may not yet be identified by the person sharing the interchange with the nurse, it may surface in awareness and be confirmed by the other if verbalized by the nurse. For instance, it is not uncommon for the nurse to feel another’s loneliness before the lonely person specifically identifies it. To share another’s loneliness is

Stress-induced alterations of blood pressure and 24 h ambulatory blood pressure in adolescents.

OBJECTIVE To examine the extent to which ambulatory blood pressure was predicted by blood pressure levels exhibited during talking segments of a laboratory protocol and by resting blood pressures in male and female adolescents from three ethnic groups: African, European and Hispanic Americans. DESIGN This was a laboratory-field study incorporating an experimental study of reactivity of blood pressure during a laboratory protocol and an observational study of 24h ambulatory blood pressure (ABP) monitoring. METHODS Resting blood pressure, reactivity of blood pressure, 24h ABP, and activity, height, and maturation of a multi-ethnic sample of 373 male and female adolescents aged 11-16 years were measured. A mixed-effects model for repeated measures was the statistical approach, with systolic and diastolic blood pressures as separate, dependent variables. RESULTS Percentiles of ABP by sex, ethnic group, and height are presented. High and mixed blood pressure reactors in the laboratory had higher levels of 24h ABP and higher levels of blood pressure load during the daytime. African Americans had higher ABP than did European and Hispanic Americans. CONCLUSIONS Blood pressure measured during laboratory tasks that require talking might be useful as a screening device to identify adolescents with high blood pressures. Further study will be necessary in order to quantify the sensitivity of the laboratory protocol as an indicator of high blood pressure compared with casual measurement of blood pressures. If laboratory patterns of blood pressure could be used to predict which individuals have high levels of blood pressure during the course of daily activities, the laboratory protocol would be a useful screening tool, identifying high-risk individuals.