Diabetes mellitus affects 20.8 million Americans in the United States and is the fifth leading cause of death in the United States. Acute and chronic disease-related complications can have a devastating effect on the life of individuals with Type 2 diabetes. Reduction in acute and chronic complications can be best achieved by individuals’ adhering to appropriate lifestyle changes and maintaining tight glycemic control through a process of self-regulation. Self-regulation treatment decisions and lifestyle behavioral changes can be influenced by physiological and psychosocial factors. The purpose of this study was to examine the relationship between illness representations, emotional distress, coping strategies, and coping efficacy as predictors of outcomes (self-care behavior and A1c levels) in individuals with type 2 diabetes. A descriptive, correlational design was used to examine the relationship between illness representations, emotional distress, coping strategies, and coping efficacy as predictors of outcomes for self-care behavior and metabolic control in individuals with Type 2 diabetes as it relates to diabetes management. A convenience sample of 119 men (46.2%) and women (53.8%) between the ages of 22 and 93 years of age living in two urban cities located in a southeastern state with documented type 2 diabetes were recruited. Participants were recruited from four endocrinology offices, one internal medicine office, two medical clinics, and three diabetes education centers. The majority of the participants were caucasian (74.8%). Inclusion criteria were that participants a) had been diagnosed with type 2 diabetes for at least 1 year or more, (b) were able to read and write in English, (c) were 18 years of age or older, and (d) had an A1c level drawn within the past 30 days. Questionnaire booklets were mailed to participants. Participants’ A1c levels were obtained from their medical records. Data were analyzed with descriptive and inferential statistics including frequencies, percentages, means, standard deviations, bivariate correlations, multiple linear regressions, and hierarchical multiple linear regressions. Participants perceived their diabetes to be a chronic, moderately cyclical condition with negative consequences and with moderate amounts of symptomatology that greatly influenced their emotional status. Hierarchical multiple linear regression analysis revealed that coping efficacy uniquely accounted for 9% of the variance in self-care behavior. Perceptions of higher coping efficacy were associated with higher beliefs of personal control and treatment control, a greater understanding of diabetes, engagement in higher levels of self-care behavior, and lower A1c levels. In addition, hierarchical multiple linear regression analysis revealed illness representations, particularly timeline cyclical, accounted for 12% of the variance in A1c levels. Perceptions of a more cyclical disease course were predicted of higher A1c levels. Interestingly, a perception of diabetes being a less chronic illness was associated with higher self-care behavior. This study affirms the importance of how illness representations and coping efficacy influence self-care behavior and A1c levels. The findings from this study have important implications for nursing practice in the areas of assessment, diabetes management, coping skills training, behavior modification, motivational interviewing, and diabetes education. Further research is needed to expand the knowledge base and develop targeted interventions related to illness representations, especially timeline cyclical, and coping efficacy in the diabetes population.

Alzheimer’s disease (AD), a chronic terminal disease, progressively impairs cognitive function resulting in deterioration of intellect, memory, and personality. With disease progression, the surrogate decision-maker becomes more involved in intervention choices and end-of-life (EOL) care, which may or may not be based on patients’ wishes or best practice guidelines. Yet surrogate decision outcomes involve important issues of medical futility, quality of life and death. The purpose of this study was to examine factors that influence surrogate health care decision-making for a family member during the terminal stage of AD. A descriptive, predictive design was used to address the research questions: 1.What is the relationship between surrogate gender and decision motives?; 2. Do structure (surrogate age and gender, attachment, interpersonal conflict), interactional context (elder image, caregiving beliefs), situational context (dementia level), and perception (burden) variables predict the type of decision motive (reward seeking, altruistic, distress reduction, punishment avoidance) used by surrogates’ when making healthcare decisions for their family member with AD?; 3. What healthcare decision choices do surrogate decision-makers make for a family member with AD? A convenience sample of 58 women (67.2%) and men surrogates between the ages of 43 to 84 years of age (M = 62.22, SD = 9.67) living in one urban and several rural cities in a southeastern state were recruited. Participants were recruited during facility meetings for families at 15 long-term care facilities and 1 dementia care assisted living facility. The majority of participants were Caucasian (84.5%). Questionnaires were distributed to participants at a facility meeting. After the study was explained, written informed consent was obtained. Each participant was asked to complete the questionnaire booklet and return via mail in a stamped self-addressed envelope to the researcher. Data were analyzed with descriptive and inferential statistics including frequencies, percentages, means, standard deviations, t-tests, and multiple linear regressions. Types of decision motives did not differ by gender. For the regression models, the independent variables included gender, feelings of attachment, interpersonal conflict with the elder, beliefs about caregiving, dementia level and caregiver burden. For the model predicting punishment avoidance decision motive, simultaneous multiple linear regression results indicated that the overall model significantly predicted the dependent variable. The regression model predicting reward seeking decision motive results indicated that the overall model significantly predicted the dependent variable. Two of the variables, dementia level and surrogate burden, significantly contributed to the variance in the reward seeking decision motive. When asked about the decisions they have been asked to make in the past 12 months, surrogates were asked to make life supportive interventions (pain management and nutritional supplements) more frequently than life extending interventions. The most frequent life extending interventions chosen in descending order of frequency include surgery, central line placement, and feeding tube placement. This study supports the importance of providing surrogate and family information on AD and end-of-life healthcare interventions in a therapeutic and supportive environment. Nursing implications address pain management of the cognitively impaired patient, advocacy for advance directive completion and non-futile care, and patient and family AD education. Health care implications include process for completion of an advance directive and the burden of medical futility.

Each year in the United States between 800,000 and 900,000 adolescents, aged 19 or younger, become pregnant. Over one-half of these pregnancies end in a live birth. Several studies have shown that the younger sisters of adolescent mothers have teenage childbearing rates two to six times higher than childbearing rates of women in the general population. The purpose of this focused ethnography was to gain a better understanding of the influences of a pregnant and parenting adolescent on her younger sister. Purposeful sampling was used to recruit younger sisters of parenting teens. Fifteen (15) African American females, ranging in age from 12 to 17 years old, participated in the study. The mean age of the participants was 14. The researcher identified and selected informants through community agencies in which the informants’ older sisters participated in services for teen mothers. Data were collected through semi-structured interviews, field observation notes, a fieldwork journal, and a demographic information sheet. Interviews were conducted in the informant’s home. Data were analyzed using Spradley’s Development Research Sequence of a domain analysis, taxonomic analysis, componential analysis, and cultural themes (Spradley, 1979). Seven cultural themes emerged from the data: (a) Mixed Emotions, (b) Centering on Mother/Baby, (c) Childcare Engagement, (d) Sharing of Experience as Warnings, (e) Recognition of Hardship, (f) Change in Family Relationships, and (g) Intentions, Hopes, and Dreams. Findings from this study indicated that the younger sisters of parenting adolescents are greatly impacted by their older teen sister’s pregnancy and parenting. Knowledge from this study may be used to shape future interventions designed and tailored for younger sisters to discontinue the cycle of teenage childbearing in families. Nurses involved in providing care for pregnant and parenting teens need to identify younger sisters, be aware that they are at particular risk for early sexual activity and parenting, and encourage involvement of the entire family in prevention efforts.

The purpose of this descriptive correlational study was threefold: (a) to assess the relationships between boundary ambiguity, spirituality, marital relationship quality, and caregiver strain and depression among older African American spousal caregivers of persons with Alzheimer’s Disease (AD); (b) to identify which variables are the best predictors of caregiver strain; and (c) to identify which variables are the best predictors of depression. The sample consisted of 25 female and 15 male spouses, who were ages 60 to 87. The data were analyzed using descriptive statistics, Pearson correlation coefficients, and multiple regression. Marital relationship quality was correlated with the two dependent variables, caregiver strain and depression. In hierarchical multiple regression, a model containing gender, years since spouse’s diagnosis with AD and marital relationship quality predicted 40% of the variance in caregiver strain. Marital relationship quality was the only significant predictor for depression. The model containing marital relationship quality predicted 22% of the variance in depression. Additional findings were that participants scored high on the spirituality measure, that years since diagnosis of AD was negatively correlated with boundary ambiguity, spirituality, and caregiver strain, that there was a significant decrease in the quality of the marital relationship since the spouse became a caregiver, and that almost half had no help with caregiving. There was limited support for the proposed conceptual model, therefore, a revised model was proposed. Based on the study results, in dealing with spouses who are providing caregiving to AD patients, nurses need to assess the quality of the marital relationship, and to recognize that the longer the spouse is a caregiver the greater the strain and depression, and that community resources need to be mobilized to assist the spouse with caregiving. A depression screen and marital assessment may provide cues regarding psychosocial needs of spousal caregivers.

A descriptive correlational design based on an adapted model of Donabedian’s Structure, Process, Outcome model and Benner’s Novice to Expert theory was used to examine the clinical decision-making of nurses regarding elder abuse. The relationship of the nurses applied knowledge (assessment cues) of elder abuse; demographic questions (e.g. years of experience as a Registered Nurse (RN) and their clinical level of practice status), the use of intuition in nursing practice; and clinical decision outcomes (interventions) for patients in cases of suspected elder abuse was examined. A convenience sample of RNs who worked in the emergency department (ED) in three acute care hospitals, in southeastern United States were asked to complete questionnaires on education about elder abuse, their intuition use, demographic information, applied knowledge of elder abuse, and clinical decision outcomes for suspected elder abuse. The majority of the nurses had participated in the clinical level of practice status program.The convenience sample of 84 RNs consisted of 68 females (81%) and 16 males (19%). The average age of the respondents was 41.43 years. The mean number of years worked as a RN was 13.87 years. Multiple regression results indicated an overall model of two predictors (RNs applied knowledge (assessment cues) and years worked as a RN) significantly predicted clinical decision outcomes (interventions). The model accounted for 25.1% variance in clinical decision outcomes. The t-test revealed there was no difference (applied knowledge (assessment cues) of elder abuse, intuition use in nursing, years working as a RN, clinical level of practice status, and clinical decision outcomes (interventions)) between RNs who received elder abuse education at orientation and those who did not receive the education. The study results suggest that years of working as a nurse supported elder abuse recognition and intervention. The clinical level of practice status of nurses was found not to be a sensitive indicator. Elder abuse education during orientation varied between the hospital settings. The results indicate the educational need for nurses regarding suspected elder abuse.

Cardiovascular disease (CVD) is the leading cause of death among women in the US, and African American women (AAW) have a disproportionately high rate of deaths from CVD. Physical inactivity plays a major role in CVD development. It has been reported that some rural women have low rates of physical activity; 39% of White women and 57% of women of color are reported to be physically inactive. Rural AAW have a high mortality and morbidity rate related to CVD and a high rate of physical inactivity. The purpose of this study was to describe rural AAW’s perception of wellness in conjunction with their stage of change for engaging in exercise. A questionnaire was designed to obtain demographic information and reliable and valid questionnaires were used to measure perceived wellness and current stage of change for exercise. Using a descriptive, cross-sectional design, a convenience sample of 162 rural AAW was recruited from four rural churches in Selma, Alabama. A one-time meeting was conducted and questionnaires were completed by the participants. Statistical analyses including independent samples t-tests and one-way and two-way ANOVA’s were conducted to determine if there were associations among demographic characteristics, self-reported presence of CVD, perceived wellness, and stage of change for exercise. Findings indicated that there was no relationship between perceived wellness and stages of change for exercise among rural AAW; no relationship was found between perceived wellness and CVD, or CVD and stage of change for exercise. However, 51.3% of the sample reported they were physically active, and 21.6% planned to increase their activity within 30 days. Annual household income and employment status were positively correlated with perceived wellness, suggesting a greater sense of wellness is related to income and employment among these rural AAW. These findings have implications for nursing practice in the areas of facilitating health promoting behaviors and development of exercise and wellness programs for rural AAW.

Caregivers (CG) often neglect their own self-care which may have deleterious effects if CG have a chronic illness, such as diabetes. Care demands have been linked to CG health, although the mechanisms are unclear. The purpose of this study was to examine the relationships of CG stress, depressive symptoms, and diabetes self-care practices on CG physical health (PH) and glycemic control (GC) in an underrepresented group of Hispanic CG with diabetes. A correlational design was used in a non-random sample of 42 Hispanic CG with diabetes (Type I or II) recruited from two health centers serving the uninsured. CG had diabetes for ≥ 6 months, were on average 48.0 (± 11.4) years old, 73.8% female, and 54.8 % with < 8th grade education. Care recipients were on average 53.9 (± 14.0) years old, 54.8 % male, and were functionally independent. Standard questionnaires for perceived caregiving stress (Caregiver Burden Scale), depressive symptoms (CES-D), diabetes self-care practices (Diabetes Care Profile), PH (PCS of the SF12v2) and CG characteristics were administered in person. GC was measured using the glycosylated hemoglobin A1c (HgbA1c). Statistical analysis included correlations, t-tests, and multiple linear regression. On average CG had poor GC (HgbAlc M = 9.0, ± 2.12), but rated their PH better than others with diabetes. CG with high stress had more depressive symptoms (M = 23.75 ± 12.75) than CG with lower stress (M = 15.75 ± 12.01; t (40) = 2.00, p = .026). Almost half (40.5%) had depressive symptoms indicating possible clinical depression. The hypothesized models of caregiver stress, depressive symptoms, and self-care practices were not associated with CG PH (p > .05) or GC (p >.05); however, more persons in the household was associated with poor GC. This study provided support for the influence of CG stress on psychological health in the experience of Hispanic CG with diabetes. The findings of high levels of depressive symptoms and poor GC suggest the need for health care professionals to assess the psychological health of Hispanic CG and better educate them about the importance of GC for prevention of serious health problems.

Problem: Nurses are potentially exposed to hazardous drugs (HDs) in their practice. HD exposure is associated with adverse outcomes (reproductive problems, learning disabilities in offspring of nurses exposed during pregnancy, and cancer occurrence). Safe handling precautions (safety equipment and personal protective equipment, [PPE]) minimize exposure to HDs and decrease the potential for adverse outcomes. Despite existing OSHA recommendations, adherence to precautions is below recommendations. The purpose of this study was to examine relationships among factors affecting nurses’ use of HD safe handling precautions, to identify factors that promote or interfere with HD precaution use, and to determine nurse managers’ perspectives on use of safe handling precautions. This study used a conceptual model which proposes that both individual and organizational factors influence precaution use. Methods: A cross-sectional, correlational design was used. Nurses (N = 165; 46% response rate) from oncology centers across the US who reported handling chemotherapy completed a mailed survey. Instruments measured HD precaution use, knowledge, self efficacy, barriers, perceived risk, conflict of interest, interpersonal influences and workplace safety climate. Hierarchical regression was used. Twenty managers of nurses handling chemotherapy were interviewed. Results: Nurses were experienced in oncology (M = 15.8 ± 7.6) yrs, well-educated (62.5% ≥BSN), certified in oncology nursing (85%), worked in outpatient settings (69%), and on average treated 6.8 ± 5.2 patients per day. Chemotherapy exposure knowledge was high (M = 10.9, ± 1, 0-12 scale); as was self efficacy for using PPE (M = 20.8 ± 3, 7-24 scale), and perceived risk (M = 3.14 ± .6, 0-4 scale). Total precaution use during HD administration and disposal was low (M = 1.9, SD = 1.1, 0= never to 5 = 100%). Nurse characteristics did not predict HD precaution use. In the final model (R2 = .29, F (2, 155) = 24.6, p < .000), fewer patients per day, fewer barriers and better workplace safety climate were independent predictors of higher precaution use. Conclusions: Results emphasize the importance of organizational influence on nurses’ HD safe handling precaution use and suggest fostering a positive workplace safety climate and reducing barriers as interventions.

The mothering role of African American women has largely been ignored in the literature. Contemporary research on the construct of becoming a mother has focused on upper middle class, White women who are partnered. When African American women are included in research, they are often poor, single, teenage mothers and their experiences have not been described within the context of the African American worldview. Hermeneutic phenomenology from an afrocentric feminist perspective is the methodological approach used in this study to provide insight, analysis, and understanding of the experiences of three generations of African American women in the transition to motherhood. A purposeful sampling of eighteen women from three generations was used to identify information-rich cases that would provide an in-depth understanding of the phenomenon. Generation one included seven women, between the ages of 65-83, who became mothers between 1950-1970, prior to the Civil Rights Movement. Generation two included five women, between the ages 51-58, who became mothers between 1971-1990, after the Civil Rights Movement, and there were six women in generation three, between the ages of 30-42, who became mothers between 1991-2003. All of the women in this study described themselves as middle-class; four women were single when they became pregnant with their first child, and education ranged from high school to master’s degree. Three constitutive patterns and their associated themes were identified. The first pattern, It Took Me a Minute, had three themes, Finding Out, Realizing What Mothers Do and Way Tricked! The second pattern, Preserving Our Home had four themes, Mothering Within the –isms: racism, classism and sexism, I Did the Best I Could, Mothers and Others, and Spiritual Mothers. Eat the Meat; Throw Away the Bone, the third pattern had two themes, The Ways in Which We Learn and Someone Who Looks like Me. The results of this study reveal some consistency with current descriptions of maternal identity and maternal role attainment and add to our understanding of the complexities that racism, classism and gender play in the lives of African American mothers and their families. The data from this study also suggests that future development of theoretical frameworks and analytical tools, used to assess the effects of stress and other psychosocial factors on health, need to be grounded in an historic understanding of the African American experience and of the African influence on family and cultural knowledge. Additionally, this study demonstrated the impact that the media, both professional and mass media outlets, has in defining and perpetuating our beliefs and feelings of the ‘good mother/bad mother’ dualism. The description of motherhood for this group of African American women illustrates that motherhood is a source of power and provides significant meaning, satisfaction and respect within the family and the larger community. It also highlighted the communal role that “othermothers” and spiritual mothers have in facilitating the transition to motherhood and providing strong social support.

The 1999 Institute of Medicine report, To Err is Human, raised awareness about the multitude of errors that occur in healthcare. Frequently, errors are not disclosed to patients or their families. While several studies have examined patient and physician perspectives on disclosure, limited research on nurse perspectives exist. In hospitals, nurses are often the last line of defense before errors reach the patient. Because nurses are often present when errors occur, nurses’ experiences with disclosure are integral to understanding the issues that surround the disclosure of errors. The purpose of this study was to gain an understanding of nurse experiences with both disclosure and non-disclosure of errors to patients. An interpretive approach was used to guide the study, combined with a feminist perspective to illuminate the issues of power and gender. Registered nurses (n=17) employed in hospitals and caring for adult medical/surgical patients participated in semi-structured interviews. After the audio-recorded interviews were transcribed, they were reviewed for accuracy by participants. Analysis consisted of an eight-step process including use of a research team and peer debriefing. Three major themes and 6 sub-themes were identified. Major themes were: (a) disclosing errors, (b) perceiving expectations for disclosure, and (c) not disclosing errors. Some nurses provided constant information to the patient, so a disclosure decision was not necessary when errors occurred. Many of these nurses felt that full disclosure was the right thing to do. Other nurses based disclosure decisions on their perceptions of the culture or policies of the work environment. Disclosing events, but not errors was a method used to vaguely disclose while others overtly concealed errors. Some nurses felt that disclosure was a professional responsibility, while others felt that nurses should align themselves with institutional expectations. Still others indicated that disclosure should be determined on a case-by-case basis depending on the context. This study contributes to nursing science by illuminating the experiences of nurses with disclosure, describing nurses’ ways of being truthful when errors occur, and examining the contextual factors that surround nurses’ practices of disclosure. Recommendations of the study for nursing practice, education and research were identified.