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West Nile neuroinvasive disease (WNND) is a rare and severe manifestation of West Nile virus (WNV) infection that occurs in less than 1% of infected persons. It should be considered in patients who present with fever, neurological symptoms, and a history of recent outdoor activity where mosquitoes were active. This article highlights a case of a 55-year-old man whose history and symptoms of WNND were confounded with an alternate diagnosis, acute alcohol withdrawal. An overview of WNV infections, and important historical clues and objective findings characteristic of neuroinvasive disease, is discussed to increase readers' knowledge of WNV and awareness of when to consider WNND in the diagnostic differential.

Spirituality is considered a universal phenomenon, but research addressing the spiritual needs of adolescents in the context of health and illness is limited. The aim of this article is to provide a description of how the spiritual development framework (SDF) was used in conducting research with adolescents. An exemplar of a qualitative descriptive study is provided to demonstrate applicability of the SDF. The SDF was used as a guiding theoretical framework in conducting research with adolescents living with sickle cell disease. The SDF is culturally applicable and methodologically appropriate. Additional research applying the SDF is warranted.

In the United States, teen dating violence (TDV) is a concern across ethnic groups. Attitudes and correlates of violence differ by gender, culture, and acculturation. This study used a qualitative interpretive approach. Data were obtained in focus groups with 23 Latino male adolescents. Themes reflected contexts of participants' lives, and definitions and nature of dating relationships and TDV. Participants described the importance of respecting dating partners, the destructive effects of TDV, and the pressure to display masculinity that can lead some young men to perpetrate TDV. These results may advance culturally relevant interventions to promote healthy relationships and prevent dating violence.

The purpose of the current article is to describe the use of photovoice with individuals from vulnerable population groups. Ten African American men and women ages 66 to 72 with heart failure from three different low income public housing facilities were recruited for participation in a qualitative photovoice project. Participants were given 5 weeks to take photographs of images that represented facilitators of and barriers to engaging in self-care behaviors. Each week, participants met as a group to discuss the photographs and their meanings to other participants. The photovoice method was empowering to participants, easy to use, and shown to be appropriate within African American older adults with heart failure. The photovoice method assisted in providing the opportunity for this vulnerable population to share their personal beliefs and perspectives. Use of this method assisted in identification of themes that represented facilitators of and barriers to engaging in self-care and was effective in meeting the specific aims of the research project. Findings from the current study support photovoice as a valuable method to use with vulnerable individuals with chronic conditions. [ Journal of Gerontological Nursing, 44 (7), 43–49.]

Purpose To explore inpatient pediatric nurses' current experiences and perspectives on medication teaching. Design and Methods A descriptive qualitative study was conducted at a Midwest pediatric hospital. Using convenience sampling, 26 nurses participated in six focus groups. Data were analyzed in an iterative group coding process. Results Three themes emerged. 1) Medication teaching is an opportunity. 2) Medication teaching is challenging. Nurses experienced structural and process challenges to deliver medication teaching. Structural challenges included the physical hospital environment, electronic health record, and institutional discharge workflow while process challenges included knowledge, relationships and interactions with caregivers, and available resources. 3) Medication teaching is amenable to improvement. Conclusion Effective medication teaching with caregivers is critical to ensure safe, quality care for children after discharge. Nursing teaching practices have not changed, despite advances in technology and major changes in hospital care. Nurses face many challenges to conduct effective medication teaching. Improving current teaching practices is imperative in order to provide the best and safest care. Practice Implications This study generated knowledge regarding pediatric nurses' teaching practices, values and beliefs that influence teaching, barriers, and ideas for how to improve medication teaching. Results will guide the development of targeted interventions to promote successful medication teaching practices.

Excessive alcohol use is a significant health issue. Underage drinking is one expression of excessive alcohol use. Researchers have identified a trajectory of alcohol involvement. Gaps exist in understanding the influences that delay and promote the trajectory of alcohol use among young people. The purpose of this study was to explore the contexts and influences that limited and contributed to the trajectory of alcohol use among young people. A qualitative descriptive design was used. Eight youth workers from a city in Northern England participated in individual audio-recorded semistructured interviews. Transcriptions were coded. Data were analyzed within, and across, codes to identify themes. The theme "Alcohol is an Expected Part of Life" characterized a hypothetical trajectory of alcohol involvement. "Fostering Community in Youth Centers" characterized how participants' perceptions informed their work. The results increase understanding of how contexts may influence initiation, promotion, and prevention of alcohol use among young people.

Nurse practitioners at a primary care clinic established a weight loss program to address high obesity rates among their African American patients. Interviews and a retrospective chart review were used to evaluate the weight loss program. Number of appointments was the only significant predictor of weight loss, and there was a strong positive correlation between total number of appointments and weight loss. The overall view of the program was positive. This description and evaluation of the program may be useful to nurse practitioners seeking to develop an individualized effective weight loss intervention for African Americans within a primary care setting.

Purpose: Sickle cell disease (SCD) is a serious debilitating chronic illness, affecting approximately 90,000 Americans and millions globally. Spirituality and religiosity (S/R) may ease the burden faced by persons living with SCD. The purpose of this study was to examine the role of S/R in adolescents and adults living with SCD in the research literature. Method: The electronic databases Cumulative Index to Nursing and Allied Health Literature, Health Source Nursing/Academic, ProQuest Health Module, PsycINFO, Medline, PubMed, and the American Theological Library Association were searched from January 1995 to December 2014. Findings: Of the 89 studies retrieved, 11 articles between 2001 and 2013 met the inclusion criteria and were reviewed. Four themes emerged. The themes included (a) S/R as sources of coping, (b) S/R enhance pain management, (c) S/R influence health care utilization, and (d) S/R improve quality of life. Discussion: Use of S/R may be significant in coping with SCD, managing pain, affecting hospitalizations, and affecting quality of life. This review can direct researchers exploring S/R in adolescents and adults living with SCD.

This study purports to address paucity in the literature regarding how adolescents with sickle cell disease (SCD) describe and experience spirituality and religiosity (S/R). This was a qualitative descriptive study. Two semi-structured interviews were conducted with nine adolescents ( Mage = 16.2 years). Data were analyzed using a template analysis style and a concurrent analysis process of data reduction. Three major themes encompassed the participants’ descriptions of the relationships between S/R, health and illness in their lives including S/R as sources for coping, influence of S/R beliefs on health and illness, and sharing S/R with Health Care Providers (HCPs). S/R as coping mechanisms included six threads: interconnecting with God, interconnecting with others, interconnecting with creative arts, scriptural metanarratives, transcendent experiences, and acceptance and finding meaning. Expectations of health providers included two threads: Religiosity is private/personal and sharing spiritual and religious beliefs is risky. S/R are particularly salient for adolescents with SCD.

Objectives The purpose of this study was to understand the influences of heart failure (HF) self-care among low income, African Americans. Background Compared to all other racial groups, African Americans have the highest risk of developing HF, coupled with high mortality and morbidity rates. Methods Using the photovoice method, participants related important lifestyle factors through photography. The participants and researcher met for reflection and discussion 2 h per week for six weeks. Results Four themes emerged: family support gives me the push I need, social interaction lifts me up, improving my mind to lift depression can improve my heart, and it is important but challenging to follow the HF diet. Conclusion The findings from this study may assist policy makers, health care professionals, patients, and support systems in understanding the complexity of engaging in HF self-care. This understanding may lead to the development of appropriate patient-centered assessments and interventions.

Objective Test a novel intervention to help sexually experienced girls increase abstinence behaviors and attitudes. Design A quasi-experimental repeated measures design using qualitative and quantitative data. Setting Two alternative public schools. Participants Thirty-three females whose mean age was 16 and who were 79% African American participated. Most (79%) had experienced a pregnancy. Intervention A 6 session, weekly, interactive intervention was delivered. Data were collected at baseline, last session, and at 5 and 7 month follow-ups. Main Outcome Measures Measured outcomes related to abstinence included participants' reasons, behaviors, stages of change, and attitudes. Results The most common reason for abstinence was not wanting to have sex. At each postintervention data collection point, most participants (greater than or equal to 74%) reported that they had purposefully avoided sex. Duration of consecutive days of abstinence increased although only significantly at 5 month follow-up. Abstinence behaviors increased with the largest change from first to last session. Stage of change advanced from preparation to action by 7 month follow-up. Attitudes toward abstinence became more favorable. Conclusion Effective sexual risk reduction interventions are critically needed to promote safety. Nurses may assist young women to decrease their sexual risks by teaching them to practice periodic abstinence.

The purpose of this study was to determine the main and interactive effects of religiosity, gender, and language preference acculturation on sexual activity among 570 Latino/a adolescents from the 2002 National Survey of Family Growth. Results indicated that adolescents who viewed religion as very important, had frequent church attendance, and had more traditional attitudes on sexuality were less likely ever to have sex compared with adolescents who were less religious. Those with frequent church attendance and high traditional attitudes had fewer lifetime and recent sex partners. Unassimilated religious youth were less likely ever to have sex, had fewer lifetime and recent sexual partners, and a later age of sexual debut. Females were less likely to have had sex, had fewer recent and lifetime partners, and had a later age of coital debut than males. Religiosity had a healthy dampening of sexual activity among Latino/a adolescents and, in particular, among those who were less assimilated.

Purpose: To describe sexual abstinence from the perspective of abstinent African American female adolescents. Design: Descriptive qualitative. Methods: Data were collected from 14 sexually abstinent, African American adolescent girls during two semi-structured interviews. Data were collected using the life history method and were analyzed in the style of narrative analysis. Findings: This analysis indicated four themes in descriptions of abstinence: limited information, categorization of sexual behaviors, activities that lead to intercourse, and abstinence as a self-determined choice. For most participants, “having sex” referred to heterosexual vaginal intercourse and being abstinent meant that one chose to refrain from intercourse. Conclusions: The participants' limited definition of abstinence might lead them to unknowingly put themselves at risk by engaging in other forms of genital sexual activities. They may think that they are protected because they believe that they are practicing abstinence.

This study describes a group of six African American grandmothers parenting their grandchildren secondary to cocaine abuse on the part of the parents. It explores the manner in which such parenting affected the grandmothers’ health. Data for this ethnography design were collected through participant observation, field notes, taped interviews, and supplementary data sources. The identification of cultural themes evolved from domain and taxonomic analyses. The themes—parenting a second time around, sacrifice, and God’s presence in daily life—expressed aspects of the grandmothers’ culture. The effects on health varied from none to exacerbation of chronic illnesses. The study results, and its picture of life from the grandmothers’ perspectives, suggest areas of nursing assessment and intervention that otherwise might be left unexplored.

PURPOSE. Adolescents receive less primary care than other age groups. One reason may be the negative ways that providers sometimes interact with adolescents. The purpose was to develop knowledge regarding adolescents' preferences for provider interactions. DESIGN AND METHODS. Design was descriptive and mixed method. Donabedian's healthcare quality model guided the study. Data were collected via focus groups and a survey. RESULTS. Twenty-four adolescents participated. Four themes described their preferences: forming a relationship, supporting independence, assuring confidentiality, and conveying caring. PRACTICE IMPLICATIONS. Care that is congruent with adolescents' preferences may improve quality of, and access to, care and, ultimately, health outcomes.

Obesity is a complex disease state that has challenged the health of Americans and has become a main concentration in health care. The highest rates of obesity are observed among black women. The purpose of this evidence-based review was to find evidence that specifically examined black women to determine if participation in weight loss interventions led to successful weight loss compared with usual care and control groups. Twelve experimental studies and 4 systematic reviews revealed that interventions contributed to successful weight loss among black women with obesity. However, maintenance of weight loss is an ongoing challenge.

Objective To determine community support and identify appropriate learning methodologies, parameters of delivery, and intervention content. Design Qualitative descriptive study in which participants were interviewed in a semistructured format. Data were analyzed thematically. Setting An urban pediatric primary care clinic from which youths and parents were recruited. Participants Ten youths, 10 parents, and 10 community members. Community members included professional and laypersons who had experience in working with early adolescents or in working with children of any age on sexuality issues. Overall, most participants were female (67%) and African American (67%). Results Descriptions of early adolescents' knowledge of sexuality, participants' support for sexuality education for early adolescents, recommendations for education content, and preferred methods for education delivery. Conclusion The participants supported comprehensive sexuality education for early adolescents. They believed that it would help youths to be abstinent, would provide some protection from sexual abuse, and would prepare them to practice safer sex in the future. JOGNN, 35, 369‐375; 2006. DOI: 10.1111/J.1552‐6909.2006.00048.x

The purpose was to explore the perspectives of teenage girls on how life contexts influenced sexuality and sexual abstinence. A qualitative descriptive study with a convenience sample of 14 sexually abstinent African American adolescent females who were interviewed to obtain their life histories. Narrative analysis was used to identify unique and common experiences and to develop themes. For these participants being abstinent was a way to demonstrate their emerging identities as adult women. They described themselves as faithful unique persons who defied negative stereotypes avoided risky situations wanted to be strong women like their mothers and grandmothers and were selective about their friends. The primary challenge to abstinence was their degree of vulnerability to sexual harassment romantic partner pressure and female peer pressure. Abstinence is a complex state of being that is influenced by a variety of contexts develops over time and is consciously chosen. Maintaining abstinence requires effort and a variety of skills. While these young women were cognitively familiar with reasons why they should refrain from sex nurses may still assist youth with being abstinent by providing ongoing teaching and specific dialogue on how to refrain from sex. (authors)

This article is a commentary on the life history approach, which specifically described aspects of and offered suggestions for conducting life history research with adolescents. The life history approach is well suited to a wide variety of types of health-related inquiry. In this article, the author used an exemplar study to show how well the life history approach was suited for questions regarding adolescent issues. This approach was also a good match for the developmental skills and needs of adolescents. The author uses the strengths and weaknesses of the approach and a detailed example of how she used the life history data to identify themes drawn from the exemplar study. She makes specific suggestions, including the development and implementation of an interview guide, planning and scheduling interviews, and the use of a lifehistory grid. She includes examples of each suggestion and a sample lifehistory grid.

This was a study of 102 adolescent females, 12-20 years of age, presenting to a central city clinic for medical care. Participants completed an oral questionnaire that included demographics, and questions regarding scholastic history, sexual behavior, and substance use. Each subject completed the Accuracy Level Test (ALT), a reading test. The subject's reading test grade level was subtracted from her appropriate grade in school to give a reading delay level (RDL). The mean reading grade level for all subjects was 6.7 +/- 2.6 and the average reading delay was 4.5 +/- 2.5 grades. Poor school attenders had greater reading delays (5.8 +/- 3.4 grades behind vs. 4.3 +/- 2.2 for good attenders p0.04), and those who repeated grades were also significantly delayed (5.5 +/- 2.4 grades behind vs. 3.7 +/- 2.3, p0.0007). Previously pregnant students had a greater delay in reading level than their nonpregnant peers (5.2 +/- 2.3 vs. 3.9 +/- 2.5 respectively p0.01). Delayed reading levels appear to correlate with some risk behaviors. The ALT may serve as a tool to identify high-risk patients who need more intensive clinical intervention.