Shawn M. Kneipp

The ICD shock and stress management program: A randomized trial of psychosocial treatment to optimize quality of life in ICD patients

Background: Implantable cardioverter defibrillator (ICD) patients potentially face significant psychological distress because of their risk for life‐threatening arrhythmias and the occurrence of ICD shock.

Reinvesting in Social Justice: A Capital Idea for Public Health Nursing?

Social justice is a core ethical principle of public health nursing; yet, nurses work as social activists has largely diminished over the past century. Reengagement in social justice activities is essential to change the current social, economic, and health differentials perpetuated by market justice ideologies. Social capital has emerged in the public health literature as a promising concept for developing community interventions that diminish disparities. Public health nurses, however, must be wary of uncritically adopting social capital as a panacea for inequalities; advocating for interventions seeking to build social capital may be as harmful as the inequalities themselves.

Complex sampling designs and statistical issues in secondary analysis

Conducting secondary analysis using large national survey data sets to answer pressing research questions is gaining acceptance in the nursing science community. There are, however, challenges confronted by researchers who wish to apply secondary analysis to large data sets due to the incorporation of complex sampling designs. This article presents sampling design issues inherent in many large national surveys and explains the rationale for applying sample and variance estimation weights when conducting statistical analyses. In addition, the rationale for using statistical software packages capable of analyzing data derived from complex sampling designs is described. Examples of differences in statistical outcomes with and without weights using Stata and SPSS are provided using data from the Medical Expenditure Panel Survey (MEPS). Based on the example analyses, the implications of the statistical outcome differences for study findings are discussed.

Reasons for Enrollment, the Informed Consent Process, and Trust Among Low‐Income Women Participating in a Community‐Based Participatory Research Study

OBJECTIVEnResearch is essential for guiding public health nursing practice with low-income and/or minority populations. Despite this, little is known about fundamental recruitment problems, the degree to which the informed consent process is comprehended, or how critical a role trust may play in conducting successful research with these groups. This article describes factors influencing recruitment of underrepresented groups, preferences for the informed consent process, and degree of trust participants extended to researchers.nnnDESIGN/SAMPLEnA descriptive survey was used in this community-based participatory research study with low-income women.nnnRESULTSnThe response rate was 58% (n=35 of 60 sample). The most compelling reason for enrolling was that the researchers recognized an unmet health need among the population (91%), followed by the opportunity to talk with other women in similar circumstances (74%), and the fact that nurses were conducting the study (57%). Comprehension of informed consent was high, most preferred a group consent process, and 100% trusted the researchers to follow procedures outlined in the informed consent document.nnnCONCLUSIONnAlthough findings support previous research regarding increased likelihood of enrollment when there is concordance between enrollees goals and study topic, the establishment of trust between potential enrollees and researchers cannot be underestimated.

Handling missing data in nursing research with multiple imputation.

BackgroundIn the data analysis phase of research, missing values present a challenge to nurse investigators. Common approaches for addressing missing data generally include complete-case analysis, available-case analysis, and single-value imputation methods. These methods have been the subject of increasing criticism with respect to their tendency to underestimate standard errors, overstate statistical significance, and introduce bias. ObjectivesThis article reviews the limitations of standard approaches for handling missing data, and suggests multiple imputation is a useful method for nursing research. MethodSecondary analysis was conducted to examine the effect of a public policy on the health of women using a data set that had a large degree and complex patterns of missing data. DiscussionIn the example, accommodation of the incomplete data was critical to making valid inferences; however, complete-case, available-case, or single imputation could not be defended as an adequate method for dealing with the missing data patterns. Alternative methods for dealing with incomplete data were sought, and a multiple imputation approach was selected given the missing data pattern. Nurse researchers confronting similar complex patterns of missing data may find multiple imputation a useful procedure for conducting data analysis and avoiding the bias associated with other methods of handling missing data.

The Health of Women in Transition from Welfare to Employment

Although numerous studies of welfare policy exist, studies of women’s health within the context of U.S. welfare reform policy have been limited. From an ecological health perspective, welfare policy shapes the immediate environment in which women live. The environment has long been recognized by nursing as a major determinant of health status. Using data from the Washington State Family Income Study (FIS), this research examined women’s psychosocial health when making the transition from welfare receipt to employment. No differences in psychosocial health were found between women leaving welfare for employment and those remaining on welfare (p> .05 on depression, self-esteem, self-efficacy, and emotional support). This finding is consistent with earlier qualitative research, which indicates the life circumstances of women leaving welfare for paid employment rarely improve. To better understand how public policies such as those related to welfare affect the lives and health of women, additional research is sorely needed.

Problems with parsimony in research on socioeconomic determinants of health.

Despite growing evidence that social and economic factors are important determinants of health disparities, there is a lack of understanding of how these factors operate in relation to health. This article explores 3 conceptual and methodological issues impeding nursing research in this area: (1) ambiguity surrounding socioeconomic status (SES), both conceptually and as a scientific indicator; (2) the narrow focus on biological and behavioral risks for chronic disease development; and (3) the persistent centrality of individual behavior in studies examining SES-health contextual relationships. A brief overview of emerging approaches for enhancing nursing science in the area of SES and health disparities is presented.

Low-Income Housing Policy and Socioeconomic Inequalities in Women’s Health: The Importance of Nursing Inquiry and Intervention

Decent, affordable housing is the building block of healthy neighborhoods. Housing characteristics not only shape the quality of life in communities but also affect individual and family health. The structural and social aspects of housing have a significant impact on the health of individuals and populations. Early public health nursing pioneers such as Lillian Wald and Jane E. Hitchcock understood the adverse impact of substandard housing on population health and incorporated advocacy for housing and other social policy reforms as an integral aspect of their nursing interventions. Contemporary nursing literature, however, is lacking in its critical examination of relationships between housing and health. This article presents historical and current issues in low-income housing policy, discusses how low-income housing policy has contributed to social inequalities in health, and advocates for the importance and inherent value of nursing inquiry and intervention in this area.

Psychosocial and physiological stress among women leaving welfare.

Women receiving Temporary Assistance for Needy Families (TANF) report more stress and have poorer health than women in the general population. Studies suggest chronic stress may contribute to poor health via physiological mechanisms, yet little is known about these mechanisms in this population. This study examined psychosocial stress, salivary cortisol, 24-hr ambulatory blood pressure and heart rate, and health among 40 single mothers before and after exiting TANF. As a group, perceived stress decreased after leaving TANF (p = .02), with other measures of psychosocial and physiological stress remaining unchanged. Within participants, changes in psychosocial stress predicted depression and general health over time (adjusted R 2 = .30 and .22; p = .006 and .004, respectively). These findings indicate psychosocial stress is positively associated with depression and negatively associated with general health as women exit welfare. Psychosocial stress was not associated with changes in physiologic indicators of stress.

Altered Beta-2 Adrenergic Receptor Gene Expression in Human Clinical Hypertension

Objectives: The beta-2 adrenergic receptor is involved in mediating vasodilatation via neurohumoral and sympathetic nervous system pathways. Alterations in beta-2 adrenergic receptor gene expression (mRNA transcription) may contribute to the hypertensive phenotype. Human gene expression in clinical phenotypes remains largely unexplored due to ethical constraints involved in obtaining human tissue. We devised a method to obtain normally discarded internal mammary artery tissue from coronary artery bypass graft patients. We then investigated differences in hypertensive and normotensive participants beta-2 adrenergic receptor gene expression in this tissue. Methods: We collected arterial tissue samples from 46 coronary artery bypass patients in a surgical setting. Using 41 of the samples, we performed TaqMan real-time polymerase chain reaction (RT-PCR) and used the delta delta cycle threshold (ΔΔCt) relative quantitation method for determination of fold-differences in gene expression between normotensive and hypertensive participants. The beta-2 adrenergic receptor target was normalized to glyceraldehyde-phosphate dehydrogenase. Results: Participants with hypertension had significantly less-expressed beta-2 adrenoceptor gene (2.76-fold, p < .05) compared to normotensive participants. After Bonferroni correction, gene expression did not differ by race, gender, type/dose of β-blocker prescribed, positive family history of hypertension, or diagnosis of diabetes mellitus type 2. Conclusions: These data support the possibility of a molecular basis for impaired adrenoceptor-mediated vascular tone in hypertension. Modification and extension of this research is required.