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We assessed a subset of behavioral indicators from the American Heart Association Life's Essential 8 cardiovascular health (CVH) construct—diet, physical activity, sleep, and nicotine exposure—and quantified associations in scores between members of 12 grandparent-grandchild dyads (grandparents, 52–70 years old; children, 7–12 years old). We also assessed the number of adverse childhood experiences from the dyads. Using the Life's Essential 8 scoring algorithm (0–100, with 100 as optimal), we calculated averages and used Spearman's ρ correlation to quantify associations. Mean score was 67.5 (±12.4) for grandparents and 63.0 (±11.2) for grandchildren. Mean scores for the dyad members were significantly correlated (r= 0.66, P< .05). The mean numbers of adverse childhood experiences were 7.0 and 5.8 for the grandparents and grandchildren, respectively. The results indicate that CVH in these dyads was suboptimal and interrelated. Adverse childhood experiences in this analysis surpass levels reported as high risk for poor CVH. Our findings suggest that dyadic-based interventions to improve CVH are warranted.

Over half of all women are affected by urinary Incontinence at some point during their lives. Due to patients' embarrassment and health care providers' reluctance to discuss this sensitive subject, [...]

The aim of this study was to examine the lived experiences of Jordanian patients with chronic kidney disease who received hemodialysis. Qualitative interviews were conducted to identify patients' lived experiences. Transcripts analyzed led to seven common themes: lifestyle change, time wasted, symptom-related suffering, marital and family role disruption, religious commitment disruption, motivators to alleviate stressors, and experience of healthcare providers' support. Findings revealed areas where nurses and other healtheare providers can improve care for this patient population and for patients with other chronic illnesses. Key Words: Chronic kidney disease, coping, hemodialysis, stressors., Chronic kidney disease (CKD) is life-threatening. When the kidneys do not function sufficiently, patients with Stage 5 CKD have three choices of therapy: hempdialysis, peritoneal dialysis, or kidney transplantation (Crawford [...]

Mothers of infants in the neonatal intensive care unit (NICU) face stressors including turbulent emotions from their pregnancy/unexpected preterm delivery and their infant's unpredictable health status. The study purpose was to examine the psychological state of mothers prior to the discharge of their technology-dependent infants (eg, feeding tubes, supplemental oxygen) from the NICU to home. The study sample consisted of mothers (N= 19) of infants dependent on medical technology being discharged from a large Midwest NICU. A descriptive, correlational design using convenience sampling was employed to recruit mothers to examine associations of infant and maternal factors, resourcefulness, and stress with psychological state (depressive symptoms, posttraumatic stress symptoms). Forty-two percent of mothers were at high risk for clinical depression, with 37% in the clinical range for posttraumatic stress disorder. Increased maternal depressive symptoms were significantly associated with the increased frequency and perceived difficulty of their stress and posttraumatic stress symptoms. Increased posttraumatic stress symptoms were significantly associated solely with elevated depressive symptoms. This study identified factors associated with the mothers' increased psychological distress, providing beginning evidence for future interventions to employ prior to their technology-dependent infant's NICU discharge.

PurposeThe transition from the NICU to home is a complicated, challenging process for mothers of infants dependent on lifesaving medical technology, such as feeding tubes, supplemental oxygen, tracheostomies, and mechanical ventilation. The study purpose was to explore how these mothers perceive their transition experiences just prior to and during the first three months after initial NICU discharge.DesignA qualitative, descriptive, longitudinal design was employed.SampleNineteen mothers of infants dependent on lifesaving technology were recruited from a large Midwest NICU.Main Outcome VariableDescription of mothers' transition experience.ResultsThree themes were identified pretransition: negative emotions, positive cognitive-behavioral efforts, and preparation for life at home. Two posttransition themes were negative and positive transition experiences. Throughout the transition, the mothers expressed heightened anxiety, fear, and stress about life-threatening situations that did not abate over time despite the discharge education received.

Introduction:In 2010, the American Heart Association (AHA) began using 7 indicators to measure cardiovascular health, known collectively as Life’s Simple 7. In June 2022, the AHA added an 8thindicator: sleep duration. Although earlier studies have examined whether/how the indicators in Life’s Simple 7 might be impacted by social determinants of health (SDoH), few epidemiological studies have examined how SDoH influence the 8thindicator in U.S. children.Purpose:We used the AHA Life Essential 8 scoring criteria to assess sleep duration among U.S. children and whether certain SDoH were associated with sleep duration.Methods:We utilized data from the 2019-2020 National Survey of Children’s Health. For all children, we calculated the score for sleep duration (range 0 [lowest] to 100 [highest]). Based on the AHA scoring algorithm and the distribution of sleep duration, participants were divided into three mutually exclusive subgroups: (1) those who met age-appropriate optimalsleep duration; (2) those who had 1-<2 hour below or ≥ 1 hour above optimal sleep duration; and (3) those who had ≥ 2 hours below optimal sleep duration. Multinomial logistic regressions were used to assess the association of sleep duration with 4 SDoH factors (adverse childhood experiences [ACEs], received preventive care during past 12 months, food insufficiency, and living in unsafe neighborhoods). We controlled for child’s sex, age, race/ethnicity, and household poverty level.Results:Among children aged 6 to 17 years (n=49,821), the mean sleep duration score was 77.1 (95% CI 76.4 to 77.7) and 65.5% of the children had age-appropriate optimal sleep scores. Three SDoH factors were associated with higher likelihood of suboptimal sleep duration. Adjusting for covariates, for each point increase in number of ACEs the likelihood of having suboptimal sleep duration was increased (relative risk ratios [RR]:1.05 [95% CI 1.02 to 1.09]; 1.21 [95% CI 1.15 to 1.27]). The likelihood of having suboptimal sleep duration was also increased for those who reported food insufficiency at home (RR:1.19 [95% CI 1.06 to 1.33]; 1.67 [95% CI 1.40 to 1.98]) as well as for those who reported living in an unsafe neighborhood (RR: 1.34 [95% CI 1.04 to 1.71]; 1.63 [95% CI 1.19 to 2.23]).Conclusions:Our findings show that using the AHA’s Life Essential 8 scoring criteria, one third of U.S. children do not meet optimal sleep duration standards. These findings highlight the need for greater attention to social and systemic influences on children's sleep health. It is critical for healthcare providers to recognize that suboptimal sleep duration is a risk factor for poor cardiovascular health, and that certain SDoH are associated with suboptimal sleep duration.

Introduction:Social determinants of health (SDoH) impact cardiometabolic health, and certain SDoH that critically influence cardiometabolic health, such as adverse childhood experiences (ACEs), differ by family structure type. In particular, children living in grandparent-headed households experience a higher number of ACEs, on average, than children living in parent-headed households. Yet, there is limited understanding of whether/how SDoH might impact cardiometabolic health risk in children by family structure type.Purpose:We assessed selected SDoH factors known to influence children’s cardiometabolic health risk, stratified by family structure type (two-parent, single-parent, and grandparent-headed households).Methods:Utilizing data from the 2019-2020 National Survey of Children’s Health, we evaluated 9 SDoH (race/ethnicity, ACEs, health insurance status, received medical care for health conditions, received preventive check-ups, received food/cash assistance, food insufficiency, school engagement, and living in a safe neighborhood). All these factors were compared by family structure type by using a second-order Rao and Scott X2tests.Results:Among children aged 6-17 years (n=48,901), we found all 9 SDoH significantly differed by family structure type at p<0.05. Results for each SDoH were as follows, with proportions shown for two-parent, single-parent, and grandparent-headed households, respectively, for each SDoH. Racial/ethnic minorities: 44%, 63%, and 59%; children experiencing ≥ 2 ACEs: 13.3%, 44.2%, and 54.1%; proportion uninsured: 6.3%, 8.3%, and 8.5%; proportion received medical care during past 12 months: 84.1%, 78.3%, and 78.4%; proportion received preventive check-ups during past 12 months; 80.1%, 72.5%, and 74.3%; proportion with food insufficiency: 26.2%, 45.1%, and 38.4%; proportion receiving food/cash assistance: 32.2%, 61.2%, and 73.1%; proportion with children “engaged in school”: 85.8%, 77.3%, and 79.4%; proportion living in unsafe neighborhoods: 4.3%, 8.8%, and 5.4%.Conclusions:Our findings show children living in grandparent-headed and single-headed households are more adversely affected by these cardiometabolic health-related SDoH than those living in two-parent households, and thus may be populations at particularly high risk for poor cardiometabolic health. Further investigations are needed to help identify modifiable factors that may influence the associations among family structure type, SDoH, and cardiometabolic health risk in children.

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Research shows that 20 of grandmothers raising grandchildren experience stress and depression. Heart rate variability (HRV) biofeedback may help grandmothers track and regulate their physiological response to stress. This study therefore examined correlations between coherence scores reflecting HRV and self-report measures of stress, negative emotions, and depressive cognitions in 20 grandmothers raising grandchildren. Higher coherence scores were inversely and significantly correlated with self-report measures, suggesting the need to examine the effects of HRV biofeedback on biomarkers reflecting stress and depression.

Introduction:Obesity is a major risk factor for cardiometabolic disease.Research shows that children living in grandparent-headed households are more likely to have obesity compared to children living in two-parent headed households. However, little is known about modifiable risk or protective factors that influence that association.Purpose:To assess the mediator role of three key factors (families eating meals together, family resilience, and sleep duration; all reported to be associated with childhood obesity) on the association between family structure type and children’s obesityMethods:We utilized data from the 2019-2020 National Survey of Children’s Health (n=37,688 to 37,699). Path models were used to assess the mediating (indirect) effect of “frequency of families eating meals together,” “family resilience,” and “child sleeps recommended age-appropriate hours (yes or no)”, on the association between family structure type and obesity. We controlled for child’s sex, age, race/ethnicity, health insurance, number of adverse childhood experiences, and physical activity level.Results:We found that family meals was not a significant mediator between family structure type and obesity, whereas family resilience and reaching recommended age-appropriate standards for sleep were both significant mediators. Living in grandparent-headed households was associated with lower family resilience, which in turn was associated with higher odds of having obesity, after adjusting for covariates (indirect effect adjusted Odds Ratio=1.01; 95% confidence interval [1.00, 1.02]). Similarly, living in grandparent-headed households was associated with getting less sleep, which was associated with higher odds of having obesity, after adjusting for covariates (indirect effect adjusted Odds Ratio=1.04; 95% confidence interval [1.03, 1.06]).Conclusions:Although the effects were small, our findings suggest that promoting family resilience and adequate sleep could be suitable intervention targets for youth living in grandparent-headed households. Further investigations are required to validate our findings.

Background:A recommendation in the Institute of Medicine’s report, A recommendation in the Institute of Medicine’s report, The Future of Nursing: Leading Change, Advancing Health, challenges the nursing profession to enhance nursing’s leadership role in health care redesign.Method:This descriptive, correlational, cross-sectional study examined the self-perceived leadership behaviors of RNs enrolled in a clinical ladder career pathway. A self-report survey was conducted using the Leadership Practice Inventory and a demographic questionnaire.Results:Significant associations between continuous and categorical demographic factors and ladder levels were reported. Nurses with more experience showed fewer leadership behaviors.Conclusion:Leadership development is necessary for nurses in all areas of practice. The findings from this study provide evidence of the strengths and weaknesses in leadership behaviors of staff clinical RNs who often make frontline decisions for patients.2014;45(11):506–513.J Contin Educ Nurs.2014;45(11):506–513.

Over one million American grandmothers raise grandchildren, and many experience stress that may be alleviated by biofeedback. This pilot trial of 20 grandmothers used a pretest-posttest design with repeated measures to test the effects of heart rate variability (HRV) biofeedback on perceived stress, negative emotions, and depressive cognitions. Significant decreases in stress, negative emotions, and depressive cognitions were found. Biofeedback is thus potentially effective for reducing stress and depressive thoughts and feelings in grandmothers raising grandchildren, and the intervention warrants further testing.

Costly complications of diabetes often arise from poor glycemic control. Appropriate diabetes self-care management may improve control. This study examined whether self-care management affects glycemic control and mediates relationships between self-efficacy and self-care agency with glycemic control. In a cross-sectional correlational design, data from a prior study of 141 insulin-requiring adults with type 1 or type 2 diabetes were examined using descriptive statistics, Pearson’s correlation, and multiple hierarchical regression. Findings indicated that greater self-care agency and self-efficacy lead to greater self-care management, in turn leading to better glycemic control. Self-care management did not mediate between self-efficacy or self-care agency and glycemic control. Thus, beliefs or capabilities for self-care are insufficient to improve glycemic control; doing so requires self-care management.

Diabetes is a major source of morbidity, mortality, and economic expense in the United States. The majority of researchers and clinicians believe that diabetes is a self-care management disease, and that patients should be reliable, capable, and sufficiently responsible to take care of themselves. However, individuals with diabetes may or may not have diabetes knowledge, social support, self-care agency (an individual’s capability to perform self-care actions), and self-efficacy (an individual’s beliefs in his or her capability to perform self-care actions) that would help them to engage in diabetes self-care management. Therefore, this study examined the relationship among those factors using a cross-sectional model testing design. A convenient sample of 141 insulin-requiring individuals with either diabetes type 1 or type 2, 21 years old and over, was recruited from an outpatient diabetes care center located in a Southeast region of the United States. Simple linear regression, multiple standard regression, and multiple hierarchical regression were used to analyze the data. Individuals with greater diabetes knowledge had greater self-care agency and self-efficacy. Those with a higher score in social support had greater self-care agency and better diabetes self-care management, and those with greater self-efficacy had better diabetes self-care management. In addition, self-care agency mediated the effects of diabetes knowledge on self-efficacy and the effects of social support on diabetes self-care management. Self-efficacy mediated the effects of self-care agency on diabetes self-care management. Furthermore, the linear combination of diabetes knowledge, social support, self-care agency, and self-efficacy, taken together, positively affected diabetes self-care management. Enhancing an individual’s diabetes knowledge, social support, self-care agency, and self-efficacy may be a strategy which can promote better engagement in diabetes self-care.

This article presents a cognitive perspective on coping. It is advanced that cognitions play a central role in coping since they reflect as well as influence how and with what people cope. Coping is seen as the aggregate of efforts aimed at modifying and regulating the impact and consequences of particular situations and events, the ultimate goal being the control of one's experiences. Three cognitive control efforts are discussed: making attributions, selecting attainable outcomes, and finding meaning in an experience. A review of strategies for psychosocial intervention based on these three cognitive processes concludes this article.

BACKGROUND: Research about the nature and scope of advanced psychiatric nurse prac tice is critical to validating advanced practice and further developing the role of the advanced practice nurse.OBJECTIVE: The purpose of this study was to describe the characteristics and the practice and prescriptive patterns of advanced practice psychiatric nurses (APPNs). Research questions included: (a) What are the characteristics of APPNs? (b) What are the prac tice patterns of APPNs? (c) What are the prescribing patterns of APPNs? (d) Do APPNs with prescriptive authority dependent on physicians differ in prescribing patterns from those APPNs with prescriptive authority independent of physicians? (e) Are APPNs with prescriptive authority dependent on physicians in the form of a protocol more likely to practice in urban areas than in rural areas?STUDY DESIGN: This study was a descriptive cross-sectional survey of a random sample of 500 APPNs selected from the approximately 800 names included in the American Nurses Credentialing Center directory.RESULTS: Nurses in this sample were most likely to be older (mean age 50 years) women holding a masters degree or higher and working less than 40 hours per week in at least one or more subspecialties with an average of 13 years experience in the role. Most of these nurses earned between $30,000 and $69,999. They tended to be employed by an organization at least part of the time, with the rest of their time spent in private prac tice. Most (93%) of the APPNs in this study spent their time divided between two or more outpatient activities. Prescribing patterns for major tranquilizers, mood stabilizers, and antiparkinsonian agents differed based on dependence on protocol of prescriptive authority. APPNs in this sample were no more likely to practice in urban or rural areas when their prescriptive authority was independent or dependent on a physician.CONCLUSION: APPNs have decisions to make about the future of their role in a climate that demands more intensive treatment for a much smaller fee.(J Am Psychiatr Nurses Assoc [1998]. 4, 111-120)

The question of what motivates elders to seek medical advice is explored among a random sample of 467 persons aged 65 and over living in Ohio, USA. The effect of physical and psychological variables on an initial physician visit was analysed for particular bodily changes the subjects had experienced. Unlike the situation in many other utilization studies, these specific complaints could be identified as leading to physician contact in a causal sequence. Multiple regression revealed limited effects of self-assessed health, body awareness, depression and anxiety on the decision to consult a physician, but significant effect of the perceived seriousness of the complaint. The findings cast doubt on the utility of self-assessed health and psychological distress as predictors of physician use in major archival studies. This research is unique among utilization studies in that it provides a cross-sectional opportunity to explain a health behavior prospectively in the presence of a specific prior health problem.