Sharon Tucker

The long-term efficacy of a behavioral parent training intervention for families with 2-year-olds.

The effectiveness of a behavioral parent training (BPT) intervention for improving maternal self-efficacy, maternal stress, and the quality of mother-toddler interactions has been demonstrated (Gross, Fogg, & Tucker, 1995). The 1-year follow-up of the 46 parents of toddlers (assigned to an intervention or comparison group) who participated in that study is reported. It was hypothesized that (a) BPT would lead to enduring positive changes in parenting self-efficacy, parenting stress, and parent-toddler interactions; and (b) the amount of parent participation in the intervention would be correlated with greater gains in parent-child outcomes at 1 year. All the families were retained and significant gains in maternal self-efficacy, maternal stress, and mother-child interactions were maintained. Minimal BPT effects were found for fathers. BPT dosage was related to reductions in mother critical statements and negative physical behaviors at 1-year postintervention. The findings are consistent with self-efficacy theory and support parenting self-efficacy as a target for BPT in families of young children.

Influenza vaccination among registered nurses: Information receipt, knowledge, and decision-making at an institution with a multifaceted educational program

OBJECTIVE To evaluate the receipt of information and knowledge about influenza and vaccination, as well as influenza vaccination status and reasons for declining vaccination, among registered nurses. DESIGN Cross-sectional survey of registered nurses (RNs). SETTING A large tertiary medical center with a long-standing, multifaceted influenza vaccination program and relatively high vaccination rates among employees overall (76.5%). PARTICIPANTS Randomly selected group of 990 RNs employed as inpatient staff nurses at the institution. RESULTS The survey was completed by 513 (51.8%) of 990 RNs. Most RNs (86.7%) had received an influenza vaccination in the past, and 331 (64.5%) intended to receive vaccination during the 2005-2006 influenza season. More than 90% of RNs acknowledged exposure to educational bulletins, and most had received information about influenza severity (383 [74.7%]), transmission (398 [77.6%]), vaccine safety (416 [81.1%]), and the time and location of free vaccination (460 [89.7%]). A majority (436 [85.0%]) felt they had received all the information they needed to make good decisions about vaccination. However, only 49 RNs (9.6%) gave correct answers to more than 85% of the knowledge questions on the survey. The reasons most frequently reported for declining vaccination were doubts about the risk of influenza and the need for vaccination, concerns about vaccine effectiveness and side effects, and dislike of injections. CONCLUSIONS RNs exposed to a longstanding, multifaceted educational program had received information about influenza vaccination, but misconceptions were common and only 331 (64.5%) intended to receive vaccination. Strategies other than educational interventions are needed to increase influenza vaccination rates and thereby to ensure healthcare worker and patient safety.

Effects of a 1.5-day multidisciplinary outpatient treatment program for fibromyalgia: a pilot study.

Pfeiffer A, Thompson JM, Nelson A, Tucker S, Luedtke C, Finnie S, Sletten C, Postier J: Effects of a 1.5-day multidisciplinary outpatient treatment program for fibromyalgia: A pilot study. Am J Phys Med Rehabil 2003;82:186–191. Objective The purpose of this pilot study was to determine the effect of a 1.5-day multidisciplinary fibromyalgia treatment program on impact of illness, depression, and life fulfillment. Design A sample of 100 consecutive enrollees in a 1.5-day multidisciplinary group outpatient fibromyalgia treatment program between February 14, 2000, and May 9, 2000, in a tertiary medical center was used for this study. The Fibromyalgia Impact Questionnaire, the Life Fulfillment and Satisfaction Scales, and the Center for Epidemiologic Studies Depression Scale were administered to subjects immediately preceding the treatment program and by mail 1 mo after completing the program. Results The 78 subjects who returned their surveys 1 mo after treatment demonstrated significant improvement in the area of the impact of illness as measured by the Fibromyalgia Impact Questionnaire total score (51.3–44.7, P < 0.002). There was no significant improvement in depressive symptoms (P < 0.056) or the level of life fulfillment (P < 0.53). Subjects with depression improved on the Fibromyalgia Impact Questionnaire to the same degree as those without depression. The 22 nonresponders did not differ significantly from the responders in the variables of sex, age, pretreatment Fibromyalgia Impact Questionnaire score, marital status, educational level, family income, duration of symptoms, or history of depression. Conclusions These results suggest that a 1.5-day multidisciplinary fibromyalgia treatment program does have a significant positive effect on the impact of illness among patients with fibromyalgia with or without concomitant depression and may be a cost-effective model for the treatment of these patients.

Receptivity to Mandatory Influenza Vaccination Policies for Healthcare Workers Among Registered Nurses Working on Inpatient Units

A survey that included questions about preferred methods of influenza prevention was completed by 513 registered nurses working on inpatient units. Vaccination was the preferred influenza prevention method among 83.0% of respondents. Of 506 respondents, 283 (56.0%) stated that mandatory influenza vaccination was appropriate for healthcare workers, and 394 (59.4%) of 512 RNs reported that they would support a policy requiring annual influenza vaccination for healthcare workers that allowed for informed declination.

The Chicago Parent Program: Comparing 1-Year Outcomes for African American and Latino Parents of Young Children

Data were merged from two prevention randomized trials testing 1-year outcomes of a parenting skills program, the Chicago Parent Program (CPP) and comparing its effects for African-American (n = 291) versus Latino (n = 213) parents and their preschool children. Compared to controls, intervention parents had improved self-efficacy, used less corporal punishment and more consistent discipline, and demonstrated more positive parenting. Intervention children had greater reductions in behavior problems based on parent-report, teacher-report, and observation. Although improvements from the CPP were evident for parents in both racial/ethnic groups, Latino parents reported greater improvements in their childrens behavior and in parenting self-efficacy but exhibited greater decreases in praise. Findings support the efficacy of the CPP for African American and Latino parents and young children from low-income urban communities.

Health Coaching and Chronic Obstructive Pulmonary Disease Rehospitalization. A Randomized Study

RATIONALE Hospital readmission for chronic obstructive pulmonary disease (COPD) has attracted attention owing to the burden to patients and the health care system. There is a knowledge gap on approaches to reducing COPD readmissions. OBJECTIVES To determine the effect of comprehensive health coaching on the rate of COPD readmissions. METHODS A total of 215 patients hospitalized for a COPD exacerbation were randomized at hospital discharge to receive either (1) motivational interviewing-based health coaching plus a written action plan for exacerbations (the use of antibiotics and oral steroids) and brief exercise advice or (2) usual care. MEASUREMENTS AND MAIN RESULTS We evaluated the rate of COPD-related hospitalizations during 1 year of follow-up. The absolute risk reductions of COPD-related rehospitalization in the health coaching group were 7.5% (P = 0.01), 11.0% (P = 0.02), 11.6% (P = 0.03), 11.4% (P = 0.05), and 5.4% (P = 0.24) at 1, 3, 6, 9, and 12 months, respectively, compared with the control group. The odds ratios for COPD hospitalization in the intervention arm compared with the control arm were 0.09 (95% confidence interval [CI], 0.01-0.77) at 1 month postdischarge, 0.37 (95% CI, 0.15-0.91) at 3 months postdischarge, 0.43 (95% CI, 0.20-0.94) at 6 months postdischarge, and 0.60 (95% CI, 0.30-1.20) at 1 year postdischarge. The missing value rate for the primary outcome was 0.4% (one patient). Disease-specific quality of life improved significantly in the health coaching group compared with the control group at 6 and 12 months, based on the Chronic Respiratory Disease Questionnaire emotional score (emotion and mastery domains) and physical score (dyspnea and fatigue domains) (P < 0.05). There were no differences between groups in measured physical activity at any time point. CONCLUSIONS Health coaching may represent a feasible and possibly effective intervention designed to reduce COPD readmissions. Clinical trial registered with www.clinicaltrials.gov (NCT01058486).

Development and feasibility of a self-management intervention for chronic obstructive pulmonary disease delivered with motivational interviewing strategies.

BACKGROUND: Self-management is proposed as the standard of care in chronic obstructive pulmonary disease (COPD), but details of the process and training required to deliver effective self-management are not widely available. In addition, recent data suggest that patient engagement and motivation are critical ingredients for effective self-management. This article carefully describes a self-management intervention using motivational interviewing skills, aimed to increase engagement and commitment in severe COPD patients. METHODS: The intervention was developed and pilot tested for fidelity to protocol, for patient and interventionist feedback (qualitative) and effect on quality of life. Engagement between patient and interventionists was measured by the Working Alliance Inventory. The intervention was refined on the basis of the results of the pilot study and delivered in the active arm of a prospective randomized study. RESULTS: The pilot study suggested improvements in quality of life, fidelity to theory, and patient acceptability. The refined self-management intervention was delivered 540 times in the active arm of a randomized study. We observed a retention rate of 86% (patients missing or not available for only 14% the scheduled encounters). CONCLUSIONS: A self-management intervention that includes motivational interviewing as the way if guiding patients into behavior change is feasible in severe COPD and may increase patient engagement and commitment to self-management. This provides a very detailed description of the process for the specifics of training and delivering the intervention, which facilitates replicability in other settings and could be translated to cardiac rehabilitation.

Knowledge, Attitudes and Use of Complementary and Alternative Therapies among Clinical Nurse Specialists in an Academic Medical Center

Background: There has been an increase in the use and awareness of complementary and integrative therapies in the United States over the last 10 years. Clinical nurse specialists (CNSs) are in an ideal place to influence this paradigm shift in medicine to provide holistic care. Purpose: This study was designed to describe the knowledge, attitudes, and use of complementary and alternative medicine (CAM) by CNSs in a large Midwest medical center. Design: This study used a descriptive exploratory correlational design. Sample/Setting: Seventy-six CNSs who work in various inpatient and outpatient units within this medical facility were surveyed electronically, in the fall of 2008, using a 26-item questionnaire developed by the research team. Method: Data were analyzed using descriptive statistics. Findings: The results demonstrate that CNSs at this academic medical center use several CAM therapies for their personal use and for professional practice with patients. The top therapies that CNSs personally used were humor, massage, spirituality/prayer, music therapy, and relaxed breathing. The top therapies requested most by patients were massage, spirituality/prayer, healing touch, acupuncture, and music therapy. The results indicated that most CNSs thought CAM therapies were beneficial and that there was some evidence for use of these therapies for use by patients or by CNSs. Implications: The results of this study will help to determine educational needs and clinical practice of CAM therapies with CNSs at this academic medical center. The survey used and the research results from this study can be a template for other CNSs to use to begin to address this topic of CAM use in other hospitals and clinical settings. This survey could be used to explore CAM use by patients in specialty areas for practice enhancement.

Assessing Suicide Ideation:Comparing Self-Report Versus Clinician Report

BACKGROUND: The accurate identification of suicidal individuals is an important but complex process. Common approaches to suicide assessment include self-report tools and clinician interview. PURPOSE: The purpose of this study was to examine and compare two assessment methods for determining suicidal ideation of patients admitted for treatment of a mood or anxiety disorder. DESIGN: A secondary analysis of an existing dataset was conducted. Sixty-eight inpatients treated for mood or anxiety disorders completed the Beck Depression Inventory (BDI) and were assessed by a clinician using an investigator-developed interview schedule. One item from BDI and one question from the interview schedule were used to compare two methods for assessing suicidal ideation. RESULTS: In 80% of cases, responses were in agreement between the two assessment methods. However, disagreement between assessment methods was found for 13 (19.4%) cases. The rate of disagreement was beyond chance (p = .00). CONCLUSION: The findings support inclusion of both a self-report method and a face-to-face interview to assess suicide ideations. Further research is warranted to examine if both methods for assessing suicide ideations are indicated during the first 24 hours after admission to an inpatient unit. J Am Psychiatr Nurses Assoc, 2004; 10(1), 9-15.

Stress ratings and health promotion practices among RNs: A case for action

Objective: The objective of this study was to investigate associations between RN perceptions of their stress levels, health-promoting behaviors, and associated demographic variables. Background: Stress and burnout are occupational hazards resulting in absenteeism, illness, and staff turnover, factors important to nurse administrators. Personal health behaviors among nurses have been linked to less stress and the delivery of health-promotion teaching. Method: An electronic survey with 2 standardized measures and demographic questions was completed by 2,247 staff nurses from a large Midwestern academic medical center. Findings: Stress levels were inversely correlated with overall health-promoting behavior scores. Outside caregiver responsibilities were associated with higher stress and lower health-promoting behaviors scores. Conclusions: Findings support work-site interventions that promote nurses’ health and wellness, reduce work and home stress, and influence positive patient care and outcomes.