Diabetes mellitus, a serious and costly disease, is a public health challenge. Diabetes is controllable, yet non-adherence to prescribed medications causes diabetesrelated complications resulting in hospital admissions and readmissions that may be prevented. A cross-sectional, descriptive-correlational study was conducted to investigate the relationship of metabolic control (A1C) to hardiness, self-efficacy, and perceived medication adherence. Health-Related Hardiness Scale (Pollock, 1990); Long-Term Medication Behavior Self-Efficacy Scale (De Geest et al., 1994); and Perceived Medication Adherence Scale (Allison, 2000) were administered to 215 participants. Data analyses of correlation and multiple linear regression using SPSS 10.0 statistical software were performed. Metabolic control was not significantly predicted by hardiness, self-efficacy, and perceived medication adherence. However, 42% (n = 88) had A1C level < 7%. The Perceived Medication Adherence Scale was found to be of one factor structure and reliable. The findings indicate that physiological phenomena were not predicted by self-reported behavioral phenomena. Further research using an intervention study, such as patient education and/or telephone followup intervention in conjunction with diet and medication therapy needs to be conducted to determine whether metabolic control will be improved in adults with diabetes mellitus.

The purpose of this investigation was to develop an instrument to test the theory of reasoned action (Fishbein & Ajzen, 1975) in a new behavioral domain the health promotive behaviors of geriatric nurse practitioners (GNPs). The two behavioral categories included in the study were health assessment and health teaching, each with its individual index of actions. A questionnaire was developed to examine the beliefs of a sample of 200 certified geriatric nurse practitioners and to test the relationships of the theoretical model. Names of the subjects were randomly selected from the American Nurses' Association 1989 list of certified GNPs. Ninety-four returned questionnaires were included in the data analyses. Data analysis included frequency of demographic attributes, correlation, stepwise multiple regression, and factor analysis. Estimation of validity and reliability of the instrument were sufficient to warrant reuse of the instrument. As a homogeneous group, the geriatric nurse practitioners shared strong personal and social beliefs about carrying out health promotive behaviors with older clients. They perceived that important others in the organization think the GNP should carry out health assessment and health teaching with clients. The theory was partially supported in the investigation. Intention was a determinant of behavior in both categories. Attitude was a more significant predictor of intent to carry out behavior than were the perceived social pressures. Motivation to comply with important others was not a determinant of the subjective norm. Results from this study hold implications for both nurse educators, clinicians and health care administrators. In a period when reimbursement for nurse practitioners and cost containment have become realities in the health care system, a GNP who carries out health promotive behaviors with the ever increasing number of elderly clients will be a desirable asset in any health care system.

Loneliness is a topic of growing concern in the literature. Despite inherent difficulties in measuring such a personal experience, the present study was undertaken in order to gain knowledge concerning emotional needs of the dying cancer patient. The conceptual frameworks for loneliness of Francis and Brown were combined and added to Bowen’s theory of “family reaction to death” to formulate the framework for this research. The relationship of secondary loneliness among adult clinic patients with metastatic cancer, and openness of their relationship system with a significant other was explored using the structured interview method. The loneliness scale and relationship system scale generated scores which were analyzed to determine correlation.

This descriptive study explored loneliness among pregnant adolescents in a southeastern metropolitan area. Numerous psychosocial variables of the special population of pregnant teens remain to be studied. One such variable is loneliness, a feeling often experienced by adolescents. The present study hypothesized that loneliness may occur during adolescent pregnancy. To date, one study exists (Diiorio & Riley, 1988) of loneliness and adolescent pregnancy. The problem statement was: Does loneliness exist among pregnant adolescents? Three research questions were addressed: Within this sample: 1. To what extent does loneliness exist? 2. Is loneliness more frequent during certain ages? 3. Do pregnant black and white adolescents differ in the extent to which they experience loneliness? Participants between the ages of 14 and 18 receiving prenatal care in public health clinics and a university affiliated obstetric clinic were selected for the study. The final sample size was 78. The loneliness study was conducted as part of a larger longitudinal study, Nursing Role Supplementation for Adolescent Parents (NIH #1R01NR01939-01A1). The dependent variable, loneliness, was measured by the Revised UCLA Loneliness Scale (Russell, Peplau, & Cutrona, 1980), a 20-item Likert-type instrument. Possible scores on the tool ranged from 20 to 80, with 80 constituting the loneliest end of the continuum. The extent of loneliness was determined by the summation of numerical responses. Data were analyzed by two methods: (a) analysis of variance (ANOVA), to determine any differences between age and loneliness score, and (b) the t-test for two independent samples, in order to examine differences in mean loneliness scores between blacks and whites in the sample. Scores ranged from 25 to 58. "Low" to "moderate" loneliness existed among the sample; however, loneliness did not exist in greater amplitude than among nonpregnant adolescents in other studies reviewed. No significant relationship was found between age of participants and loneliness scores. Furthermore, differences in loneliness scores between blacks and whites were not statistically significant. Finally, pregnancy may not intensify loneliness for adolescents. On the other hand, pregnancy did not diminish loneliness among pregnant adolescents in this sample.

The purpose of this study was to explore and describe adolescents' perception of stress during antepartal hospitalization. The research questions answered in this study were: 1. What are the perceived stressors of hospitalized antepartum adolescents? 2. Are there differences in the perceived stressors among early, middle, and late adolescents? The study was conducted in a teaching hospital in the southeastern United States. A convenience sample of 14 adolescents participated in this study. The ages of the subjects ranged from 14 to 19 years old, with the majority of the subjects 16-19 years old. The subjects were all unmarried and had no other children. Reasons for hospitalization included preterm labor, pregnancy-induced hypertension, and vaginal bleeding. The range of gestational age was 24 to 36 weeks. The length of stay in the hospital at the time of participation in the study was 3 to 11 days. The substage of each adolescent's development was determined using the Adolescent Developmental Inventory (ADI). This tool was devised by Bernardine Clark, Virginia Commonwealth University, Medical College of Virginia. The tool is unpublished and data for reliability and validity are not yet available. The ADI included 16 responses to interview questions designated into early, middle, or late adolescence categories. The subject was identified by substage according to the highest number of responses in that category. In the sample, two subjects were identified as early adolescents, two as middle adolescents, and 10 as late adolescents. The Antepartum Hospital Stressors Inventory (ASHI) (White, 1981) was used to determine stressors identified by the subjects. The AHSI is a 47-item Likert-type scale in which the subjects assign a degree of stress on a continuum from "no stress" to "a great deal of stress." The items are grouped into seven categories: Separation, Environment, Health Status, Communication with Health Professionals, Self-image, Emotions and Family Status. The early adolescents identified the categories of Self-image and Emotions as most stressful. Both the middle and late adolescents identified Emotions and Separation as the categories of most stress. The category of Family Status was identified as least stressful for all the adolescent substage groups. In ranking the categories by intensity, both early and middle adolescents rated Separation and Emotions as most stressful. These results coincide with White's findings. Late adolescents rated Emotions, Health Status, and Self-image as most stressful. When intensity scores were examined for all substages, the majority of scores fell below the midpoint of two on the 0-4 scale. Only the early adolescent substage subjects rated intensity of six of the seven categories with scores above two.

The study was undertaken to determine the incidence of auscultatory gaps in hospitalized adults and to determine whether a relationship existed between the presence of a gap and the patient's age, sex, race, or medical diagnosis. Blood pressures were taken bilaterally on 120 randomly selected hospitalized adults using the technique recommended by the American Heart Association. None of the subjects in the sample had an auscultatory gap present.

A quasi-experimental research design was used to determine the relationship between the flow rate and the delivered temperature of prewarmed crystalloid intravenous solutions when using the Thermal Jacket™, an insulation device designed for intravenous fluid bags, as compared to a conventional blood warming apparatus. One control and three experimental groups were used. Fluids in Group 1 (control group), Group 2, and Group 4 were prewarmed in a microwave oven to 41.45 ± 1.05 ° C. Fluids in Group 3 were left near ambient room temperature and measured at 22.05 ± 0.45 ° C. Fluids in the control group were infused through a standard intravenous pump tubing, 270 em in length, using no temperature maintenance device. Fluids in Group 2 and Group 3 were delivered through a standard intravenous pump tubing connected to a blood warming coil which was immersed in a water bath blood warmer. The distance from the exit point of the blood warmer to the distal end of the infusion line measured 174 em. Fluids in Group 4 were placed in a Thermal Jacket™ and delivered through standard intravenous pump tubing. After a baseline measurement, temperatures were recorded for all groups at two sites at 10 minute intervals over a 60 minute period. One site was the lower portion of the IV solution bag, and the other site was a point 2 em from the distal end of the infusion set. Temperatures were measured at flow rates of 100, 250, 500, 750, and 1,000 ml/hr for each group. Analysis of variance showed a highly significant group effect on the delivered temperature. A Bonferroni multiple comparisons test indicated no statistically significant difference between the delivered temperatures of Group 3 (room temperature fluid + blood warmer) and Group 4 (prewarmed fluid + Thermal Jacket™). Group 2 (prewarmed fluid + blood warmer) showed a significantly higher delivered temperature (p < .05) than the other groups, and the control group (prewarmed + no temperature maintenance device) showed a significantly lower delivered temperature (12. < .05). Analysis of variance also showed a highly significant flow rate effect on delivered temperature. A Bonferroni multiple comparisons indicated a significant difference (12. < .05) between the flow rates of 100, 250, 500, and 750 ml/hr, with the higher flow rates resulting in higher delivered temperatures. There was no significant difference noted between the delivered temperatures at 750 and 1,000 ml/hr. The Thermal Jacket™, used with prewarmed intravenous fluids, was as effective as the conventional method of delivering warmed fluids. Also, within the range of flow rates studied, faster flow rates tended to yield a higher delivered temperature.

The purpose of this study was to explore the relationship between self-esteem and duration of low back pain. Low back pain is one of the most common types of chronic pain. Sternbach et al. (1973) have estimated that the chief complaint of at least seventy percent of the patients presenting at the Pain Clinic associated with the School of Medicine of the University of California, San Diego is back pain. They feel that the major reason for this phenomena is the failure of physicians to recognize it as a psychosomatic illness. Erena (1978) concurs with this conclusion. He notes that back pain is not always caused by something as straightforward as a ruptured disc. He feels that chronic pain can result from a multitude of mechanisms and has strong elements of learned behavior in it. Also, if one has the need for pain, the back is1 a prime site because of the large number of role models available to mimic. Wilfling, Klonoff and Kokan ·(1973:153) state that "it has become increasingly apparent during the past two decades that relationships exist among low back symptoms, their effect on the patient's functioning and the patient's psychological status.'' Associated with these circumstances are emotional reactions which may include hopelessness, anxiety about the future and loss of self-esteem (Jourard, 1963). Research findings (Hanvik, 1951; Phillips, 1964; Sternbach et al., 1973, Wilfling, Klonoff and Kokan, 1973) have supported a relationship between personality characteristics and low back pain as well as self-esteem and chronic pain (Elton, Stanley and Burrows, 1978). Self-esteem of low back pain patients has not been studied in relationship to duration of pain.

When individuals with serious mental illness are discharged to the community, continuous and coordinated care are both desirable and necessary. A lack of continuity places the individual at risk for becoming lost to further services. This study explores continuity of care for persons discharged from state psychiatric facilities in Virginia to communities. Continuity of care is defined as the successful initiation and maintenance of face-to-face contact by CSB staff with individuals to be discharged from state hospitals, and the subsequent provision of services post-discharge. This study identifies factors that influence continuity of care, examines the degree to which these factors play a role and the relationships between continuity of care and client characteristics. Predictor variables include characteristics of the population-at-risk: predisposing factors (i.e., age, gender, race), enabling factors (i.e., living situation, catchment area change, and geographic location of the CSB) and need factors (i.e., length of stay, legal status, and primary diagnoses). Data sources include two large data bases, 1) survey of CSB staff on the outcome of individuals discharged to their area in FY 1992, and 2) demographic information from state mental health authority. Findings from the survey show that 83% of persons discharged had a record of the discharge at the CSB. Inhospital contact by CSB staff prior to discharge was lower (54%). Results show that individuals are more likely to receive continuity of care if they are discharged to a CSB in a rural area, have a diagnosis of schizophrenia, and do not have a primary diagnosis of substance abuse. The theoretical framework, based on the Community Support System principles and the notion of vulnerability, leads to important policy and practice implications. For example, the study suggests that new and different programs might be more effective for individuals with substance abuse diagnoses, especially in urban areas. Recommendations include a mandate for nursing provision of services, or oversight of services to assure continuity of care between service settings. Future research could improve upon the measurement of the variables, and examine consumer and provider perceptions of continuity of care as an outcome.

This study was conducted to determine if Mivacurium (Miv) was as effective as Vecuronium (Vec) in attenuating Succinylcholine (Sch)-induced fasciculations with muscle relaxant doses based upon ideal body weight (IBW). A quasi experimental design was used to study 60 patients who were randomly assigned to one of three groups. The two study groups were compared to a control group and each other with regards to the incidence and intensity of fasciculations. Either Vec (0.01 mg/kg (IBW)), Miv (0.02 mg/kg (IBW)), or saline (control) was administered in a double-blinded manner 3 minutes prior an intubating dose of Sch (IBW). Both pretreatment modalities resulted in a significant (p < .05) decrease in the incidence (Vec 40%, Miv 60%) and intensity of fasciculations when compared to saline (90%). No significant differences (p > .05) were found between the two pretreatment groups with regards to the incidence and intensity of fasciculations. It was concluded that Miv 0.02 mg/kg (IBW) attenuated Sch-induced fasciculations with the same efficacy as Vec 0.01 mg/kg (IBW).