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The experiences of pediatric oncology nurses with prognosis-related communication (PRC) remain largely unknown. The purpose of this article is to report results of focus groups wherein 15 pediatric oncology nurses from three Midwestern pediatric cancer programs provided descriptions of PRC and how they experience PRC within their daily practice. Data from focus groups were analyzed via an interpretive descriptive approach, which resulted in three themes: (1) nurses' operational definition of PRC, (2) nurses' roles in PRC, and (3) nurses' preparation for engagement in PRC. From discussions within the focus groups, nurses recognized that PRC occurs across a continuum. Nurses distinguished that the definition of PRC expands beyond simply reporting life expectancy to describing the consequences of cancer- and treatment-related toxicities and effects. When nurses are not actively invited by their physician partners to participate in PRC, nurses will often develop workarounds to ensure that they understand what was said to patients and families. This allows them to function more effectively as supporters, advocates, and informants. Nurses described little preparation to participate in such challenging conversations. Pediatric oncology nurses need to acknowledge and embrace that they are an integral part of PRC. Interprofessional communication training is necessary to enhance the comfort and confidence of nurses engaging in PRC.

Background: Assessing patients' preferences for engaging in healthcare is needed to inform the planning and delivery of individualized healthcare. Unfortunately, patients are often not engaged in their care to the extent that they would like, leading to patient feelings of disempowerment and frustration., Objectives: The purpose of this study was to (a) develop and (b) psychometrically test the Patient Preferences for Engagement Tool (PPET), a clinical assessment tool that can be used by nursing staff to identify patient preferences for engagement in healthcare. The usability of the PPET was also examined for both nurses and patients participating in the study., Methods: The psychometric evaluation design used content and construct validity testing (exploratory and confirmatory factor analysis, known groups comparisons) and reliability estimation using Cronbach's alpha coefficient. The sample consisted of 308 adult patients aged 18-101 years from a Midwestern U.S. Magnet-designated academic medical center., Results: Content validity index was at least 0.8 for all but one item. Using a split sample, a six-factor solution was first identified using exploratory factor analysis and then confirmed using confirmatory factor analysis. Demographic and illness factors were not significant predictors of factor scores. Cronbach's alpha coefficients of all six factors were >0.7. Both patients and nurses gave high ratings to the tool on effectiveness, efficiency, and satisfaction with use., Discussion: The PPET demonstrated acceptable validity and reliability estimates. Assessing patient preferences for engagement gives value to the patient voice and provides an opportunity to have discussions with patients about various ways they can engage in their healthcare. Future research will focus on reducing the number of items on the PPET to construct a clinically useful resource for providers to use to assess patient preferences for healthcare engagement, leading to the development of more personalized care delivery methods.

This study was conducted to examine the feasibility and acceptability of a self-report activity diary completed by parents and older children to assess the child's daily activity in children with and without special needs. The study included 36 child/parent dyads stratified by child age and diagnosis. Parents (n = 36) and children ≥13 years (n = 12) were asked to report on the child's daily activity using an activity diary. Feasibility was determined based on successfully returned diaries and acceptability via post-study interview. Activity diaries were submitted by 94% of the parents and 100% of the children, with 83% and 80%, respectively, successfully completed. Comments provided post-study regarding the diaries were primarily on the format and were generally negative. The activity diary was feasible to use, but not well accepted within our sample of children with and without special needs or their parents. Further research is needed to create valid physical activity assessment measures that are population specific for individuals with special needs.

Background: Statistical models for predicting readmissions have been published for high-risk patient populations but typically focus on patient characteristics; nurse judgment is rarely considered in a formalized way to supplement prediction models., Objectives: The purpose of this study was to determine psychometric properties of long and short forms of the Registered Nurse Readiness for Hospital Discharge Scale (RN-RHDS), including reliability, factor structure, and predictive validity., Methods: Data were aggregated from two studies conducted at four hospitals in the Midwestern United States. The RN-RHDS was completed within 4 hours before hospital discharge by the discharging nurse. Data on readmissions and emergency department visits within 30 days were extracted from electronic medical records., Results: The RN-RHDS, both long and short forms, demonstrate acceptable reliability (Cronbach's alphas of .90 and .73, respectively). Confirmatory factor analysis demonstrated less than adequate fit with the same four-factor structure observed in the patient version. Exploratory factor analysis identified three factors, explaining 60.2% of the variance. When nurses rate patients as less ready to go home (<7 out of 10), patients are 6.4-9.3 times more likely to return to the hospital within 30 days, in adjusted models., Discussion: The RN-RHDS, long and short forms, can be used to identify medical-surgical patients at risk for potential unplanned return to hospital within 30 days, allowing nurses to use their clinical judgment to implement interventions prior to discharge. Use of the RN-RHDS could enhance current readmission risk prediction models.

Purpose: To describe the weight loss information-seeking behaviors of postpartum women., Study Design and Methods: The study is part of a larger longitudinal descriptive study of factors associated with women's self-management of their gestational weight loss after birth. Participants answered questions about weight loss information they planned to access, had received, wished they had received, and desired sources of information. A total of 250 women were enrolled during the postpartum hospital stay; 179 completed a 4-month follow-up., Results: A large portion of the sample (53.3% of normal weight women, 79% of overweight women, and 81.4% obese women) identified plans to seek weight loss information, yet nearly 85% received no information from healthcare providers by 4 months postpartum. The most frequently reported desired information topics fell under the category of specific strategies to lose weight. The majority of women in the sample had access to online health information from home, work, or a library; however, more White women had this access than did Black or Hispanic women., Clinical Implications: Postpartum hospital nurses are in a unique position to provide high-quality information with strategies for managing postpartum loss of gestational weight. Provision of high-quality online or print information can provide the foundation for successful weight-management support for prevention of gestational weight retention and long-term maintenance of a healthy weight.

Objective: To identify women's patterns of readiness to engage in weight self-management behaviors during the postpartum period., Design: Prospective, longitudinal design with repeated measures, guided by the transtheoretical model of behavior change (TTM)., Setting: A tertiary perinatal center in an urban setting in the midwestern United States with approximately 3,000 births annually., Participants: One hundred ninety-one (191) adult postpartum women., Methods: Participants were surveyed in person during their postpartum hospitalizations, and by telephone at 4 and 8 weeks postpartum using the Stages of Change for Weight Management (SOCWM) and the Decisional Balance for Weight Management (DBWM) tools., Results: There was a significant effect of time on stage of change for women in the postpartum period, with women in a higher stage of change at 8 weeks than during the postpartum hospitalization. There were no significant differences in stage of change at any of the three time points by prepregnant weight category or by race. Nearly one half of the sample was in the contemplation stage during the postpartum hospitalization, and more than 80% were in action or maintenance stages by 8 weeks postpartum., Conclusions: The early postpartum period is an opportune time to influence stage of change in women's weight management behaviors. Assessment of readiness to engage in or continue weight management behaviors will allow providers to use stage-matched interventions guided by the TTM to facilitate women's self-management of weight., (© 2012 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.)

Relatively new discoveries of a genetic component to attitudes have challenged the traditional viewpoint that attitudes are primarily learned ideas and behaviors. Attitudes that are regarded by respondents as "more important" tend to have greater genetic components to them, and tend to be more closely associated with authoritarianism. Nonlinear theories, nonetheless, have also been introduced to study attitude change. The objective of this study was to determine whether change in authoritarian attitudes across two generations would be more aptly described by a linear or a nonlinear model. Participants were 372 college students, their mothers, and their fathers who completed an attitude questionnaire. Results indicated that the nonlinear model (R2 = .09) was slightly better than the linear model (R2 = .08), but the two models offered very different forecasts for future generations of US society. The linear model projected a gradual and continuing bifurcation between authoritarians and non-authoritarians. The nonlinear model projected a stabilization of authoritarian attitudes.

A mental health clinic was developed for toddlers with developmental disabilities and significant behavior problems from families living in poverty. The clinic was a collaborative effort between a community-based Birth-to-Three agency and a university. The purpose of this clinic was threefold: to provide direct mental health services for these young children, to train graduate students to work with this population, and to begin to contribute to the limited research available in this area. This paper describes the clinical intake procedures and outcomes for the 81 children served by the clinic over a 2-year period. Referral concerns included tantrums, aggression, oppositional behaviors, hyperactivity, and self-injury. The children came from a diverse group of families living in poverty; single mothers with less than a high school education headed most of the households. The clinical intake included direct observations of parent-child interactions, child behavior assessments, and parental interviews and self-report measures. For the present sample, 77% of the children met the criteria for a developmental disability and nearly 70% also met the criteria for a psychiatric disorder. The most common diagnosis was oppositional defiant disorder. Discussion regarding the challenges inherent in working with families of toddlers with developmental delays and psychiatric disorders living in low-income circumstances is included.

The purpose of the study was to assess the psychometrics properties of the Readiness for Hospital Discharge Scale (RHDS), a 23-item instrument that measures patients' perception of readiness for discharge. Data were obtained from 356 respondents from two urban tertiary medical centers (adult and children's) in the midwestern United States who were participants in a larger study of predictors and outcomes of readiness for hospital discharge. Confirmatory factor analysis, contrasted group comparisons, and predictive validity testing supported the 4-factor structure and construct validity of the instrument. Following deletion of two poorly performing items, Cronbach's alpha for the revised 21-item scale was 0.90. The RHDS can be a useful tool for measurement of readiness for discharge for clinical and research purposes.

In this study, the authors examined the parenting practices, developmental expectations, and stress levels of 136 fathers and the challenging and prosocial behaviors of their 1- to 5-year-old children. In addition, the authors systematically addressed fathers' qualitative concerns about their parenting. The authors divided the participants into 4 groups and controlled for family socioeconomic status (SES) and the focus child's gender. Results showed a significantly higher use of corporal and verbal punishment and parenting stress among lower income fathers. Secondary analyses demonstrated a significant effect of paternal disciplinary practices that emphasized the frequent use of corporal and verbal punishment on child behavior problems, regardless of SES level. On a positive note, fathers from both lower and higher SES groups had reasonable developmental expectations for their boys and girls, and they reported similar frequencies of their children's prosocial behavior. The authors discuss the need for early parent education programs that include fathers and that teach specific strategies to address child behavior problems.

Guided largely by the theory of reasoned action, the Get Real about Violence curriculum attempts to reduce verbal and physical aggression, as well as behaviors that encourage verbal or physical aggression, such as watching a fight and spreading rumors about a fight that is going to happen. This 12-lesson curriculum was evaluated using a pretest-posttest control group design. Participants were 293 seventh-grade boys and girls enrolled in two public junior high schools in a moderate size Midwestern city. The curriculum had its greatest effect on verbal aggression, where the experimental school outperformed the control school on three of four variables, including behavior, behavioral intent, and attitudes. The experimental school also outperformed the control school in several other instances, including intent to watch a fight, intent to spread rumors about a fight, and beliefs and opinions about fighting and violence in general. Implications for the Get Real about Violence curriculum, and for youth violence prevention and intervention programs are discussed.

The purpose of this study was to compare the early child-rearing practices between mothers of young children with congenital heart disease (CHD) and mothers of healthy children. In addition, maternal stress, parental developmental expectations, and the early behavioral and emotional development of their children were explored. Maccoby's (1992) socialization theory emphasizing the reciprocal nature of mother-child interactions provided the framework for this study. Findings from quantitative self-report measures and videotaped parent-child interactions showed a remarkable similarity between mothers of children with CHD and mothers of healthy children. In contrast, qualitative data revealed important differences with mothers of CHD children reporting high levels of vigilance with their children. The important role of promoting the principle of normalization among mothers of children with CHD and ensuring a sufficient support system is discussed., (Copyright 2002, Elsevier Science (USA). All rights reserved.)