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Family caregivers of persons with dementia and their care recipients frequently experience sleep and mood disturbances throughout their caregiving and disease trajectories. Because conventional pharmacologic treatments of sleep and mood disturbances pose numerous risks and adverse effects to elderly persons, the investigation of other interventions is warranted. As older adults use complementary and alternative medicine interventions for the relief of sleep and mood disturbances, cranial electrical stimulation, an energy-based complementary and alternative medicine, may be a viable intervention. The proposed mechanism of action and studies that support cranial electrical stimulation as a modality to reduce distressing symptoms are reviewed. Directions for research are proposed. [ABSTRACT FROM AUTHOR]

The objective of this 12-week study was to determine whether a relaxation-guided imagery (R-GI) intervention designed as a primary prevention strategy for stress management was perceived as beneficial to African American women during the second trimester of pregnancy. All participants documented perceived benefits of the R-GI intervention that included the following: (1) improved breathing; (2) ability to relax, clear one's mind, and become calm; (3) ability to channel and decrease stress; (4) release of anxiety; (5) use of R-GI throughout the day helped control anger and state of mind, leading to a smoother day; and (6) improved ability to fall and stay asleep. [ABSTRACT FROM AUTHOR]

Diabetes has a disproportionate impact on people of color, including Black Americans. An understanding of the perspectives of rural Blacks is needed to design effective programs of diabetes care. The purpose of this study was to examine the experience of being diagnosed with diabetes as described by rural Blacks. This descriptive, exploratory study conducted gender-separated focus groups in 3 rural communities to capture diagnosis perspectives. Findings may be useful to healthcare professionals providing diabetes care to rural Blacks. Participants could describe events surrounding diagnosis with clarity. For many, the diagnosis was not an emotional and/or surprising experience. Participants commonly used expressive or figurative language to relate their stories of diagnosis, and gender differences were noted. Descriptions of diagnosis revealed valuable infor-mation about participants' perceptions of their diabetes. [ABSTRACT FROM AUTHOR]

The specific aims of this study were to describe the experience of self-managing type 2 diabetes among rural dwelling African Americans, to identify facilitators and barriers to self-management, to describe the use of prescribed and alternative therapies, and to elicit recommendations for programs of diabetes care. Ten focus groups were held in 3 rural communities. Men and women were in separate groups with facilitators matched by race and gender. Seventy-three participants attended the focus groups to discuss the management of diabetes. Group sessions were tape-recorded and transcribed; field notes were also taken. Data were analyzed using Folio Views software and were reviewed by the multidisciplinary team. Results indicate both unique and common themes from this population. [ABSTRACT FROM AUTHOR]

PURPOSE: The purposes of this study were to (1) describe facilitators and barriers to self-care for African Americans with type 2 diabetes living in a rural community, (2) compare experiences of men and women, and (3) solicit recommendations for programs of care. METHODS: Focus groups with small numbers of men and women (n = 7) were held to explore facilitators and barriers to self-management. Groups were led by moderators of the same gender and race as participants. Data from these information-rich cases were analyzed thematically using FolioViews and Inspiration software. RESULTS: Final categories included 'being diagnosed,' 'diabetes as betrayal by the body,' 'provider-individual-family relationship,' 'self-management,' and 'difficulty getting help.' Although limited by sample size and methodology, results indicate differences by gender that require additional investigation. CONCLUSIONS: Knowledge of self-care patterns is foundational to designing culturally appropriate interventions and programs of care for rural African Americans living with diabetes. [ABSTRACT FROM AUTHOR]

The optimum growth and scientific progress of nursing knowledge during the next century will depend upon the development and execution of focused programmes of clinical and theoretical research. The planning and design of such programmes must originate with the clear definition of nursing research questions. Nesting such questions within established theoretical frameworks provides a nursing context, lends precise language and suggests relevant variables for study. The development of a sequence of related studies exploring and describing the self-care needs of people with symptomatic mitral valve prolapse illustrates one such systematic research programme. Orem's Self-Care Deficit Theory of Nursing was used as a theoretical framework for four completed studies which describe one population's need for nursing assistance. The evolving nature of the research programme and plans for future research are discussed. [ABSTRACT FROM AUTHOR]

To provide quality care, health care providers must understand the beliefs and cultural perspectives of clients, for these perspectives affect clients and caregivers in both overt and subtle ways. Nursing and health care leaders have noted the urgent need for developing culturally competent care and for studies that consider the context of patients' lives and power relationships between providers and patients. To date, most studies on cultural context have focused on general health perspectives, but these are not always applicable to particular illnesses. The concepts of explanatory model and illness guided this study. The purpose of this descriptive study was to determine specific health beliefs of individuals with cardiovascular illness from two racial groups residing in rural and urban areas. Semi-structured interviews were conducted with 126 patients (51 Blacks, 75 White adults) admitted to a medical center hospital for invasive cardiovascular procedures or surgery. The interview consisted of questions about specific illness beliefs and cultural perspectives based on a cultural assessment. Data were content analyzed using Folioviews software. Results indicated many similarities in all four subgroups. Differences were observed in 1) expectations for types of treatment and self-care; 2) understanding of physiological processes; 3) use of medical terminology; 4) focus on quality of life; 5) financial concerns; 6) and feeling 'entitled' vs. 'grateful.' Results of this study reinforce the importance of determining individual client's explanatory model of illness, versus the tendency to make assumptions about client's perspectives based on observable characteristics or demographic variables. [ABSTRACT FROM AUTHOR]

Diabetes is the sixth leading cause of death in the United States. To date, most research and resulting clinical strategies have focused on the individual with short-term health improvements that have not been maintained over time. Researchers more recently have recognized the need to consider the social determinants of diabetes and health along with individual factors. The purpose of this literature review is to examine current understanding of the social determinants affecting diabetes and health. A search of medical and nursing literature was conducted using PubMed, PsychInfo, CINAHL and MEDLINE databases, selecting articles published between 2000 and 2013. Search terms included: type 2 diabetes, social determinants, and health determinants. Inclusion criteria were: English language, human studies, social determinants of diabetes and health, and research in the United States. Additional search methods included reference chaining of the literature. Twenty research articles met the inclusion criteria for the review and analysis and included quantitative and qualitative methods. All studies selected for this review were descriptive in nature (n = 20). Fifteen studies were quantitative studies and five were qualitative studies. No intervention studies met inclusion criteria. Each study is summarized and critiqued. Study findings indicate that external or upstream factors consistently affect individuals diagnosed with diabetes, influencing self-management. Significant methodological limitations result directly from small sample sizes, convenience or nonprobability sampling, and low statistical power.

Purpose: The purpose of this study is to test the feasibility of conducting a community-based randomized controlled trial evaluating a culturally tailored community-based group diabetes self-management education (DSME) program among rural African Americans., Methods: Thirty-two African American rural adults with type 2 diabetes were recruited and 25 adults were retained and participated in an interventional study designed to test the effectiveness of the "Taking Care of Sugar" DSME program for the 2-year follow-up. Participants were selected from rural central Virginia. Primary outcomes variables included average blood sugar levels, cardiovascular risk factors, and general physical and mental health. These outcomes were assessed at baseline, 3 months, 6 months, and 12 months post baseline., Results: From baseline to 3-month follow-up assessment, participants exhibited significant improvement on several physiological and behavioral measures. Given the small sample size, hypothesis testing was limited. Results show change from baseline over time, illustrating that the primary outcome of A1C decreased, although not significant. Additionally, participants reported more knowledge about diabetes self-management and personal care skills (ie, exercise and foot care) that persisted over time. The feasibility of the culturally tailored DSME was established, and participation with the program was high., Conclusions: A community-based group DSME program using storytelling is feasible. This research will help to inform clinicians and health policymakers as to the types of interventions that are feasible in a larger rural population. If such a program is carried out, we can improve knowledge, reduce complications, and improve quality of life among rural African Americans.

Recruiting rural African Americans for research presents special problems because of cultural differences, the view of researchers as cultural "outsiders", and transportation problems. This paper reports successful strategies in recruiting rural African American adults with type 2 diabetes for research studies. The researchers tested recruitment strategies commonly used in research, such as flyers, advertisements in local newspapers and radio stations. The researchers also encouraged referrals from medical professionals. When recruitment goals were not met, the researchers modified strategies. Twenty-two rural African American participants were recruited and randomly assigned to culturally-tailored Group or Individual Diabetes Self Management Education (DSME). The latter included storytelling and an interactive learning approach. The key recruitment strategies involved spending time in the community, visits to churches, and flyers to key leaders in the Black community. Enrolling rural African Americans required cultural competence, careful planning, and time in the community. Recruiting for clinical research is challenging and more difficult when targeting minority members in rural settings. Research in diabetes care is needed with rural African Americans because of high rates of diabetes, and limited health care access for this population. Effective recruitment and retention strategies are needed to test interventions to reduce health disparities.

Purpose: The purpose of this pilot study was to evaluate a culturally tailored intervention for rural African Americans. Social Cognitive Theory provided the framework for the study., Methods: Twenty-two participants were recruited and randomly assigned to either Group or Individual diabetes self-management (DSME). Group DSME included story-telling, hands-on activities, and problem-solving exercises. Individual DSME sessions focused on goal-setting and problem-solving strategies. Sessions were offered in an accessible community center over a 10-week period., Results: Outcomes included glycosylated hemoglobin (A1C), self-care actions, self-efficacy level, goal attainment, and satisfaction with DSME. Participants in both Group and Individual DSME improved slightly over the 3-month period in self-care activities, A1C level, and goal attainment. Although differences were not statistically significant, trends indicate improved scores on dietary actions, foot care, goal attainment, and empowerment for those experiencing Group DSME., Conclusions: The culturally tailored approach was well received by all participants. Improvements among those receiving Individual DSME may indicate that brief sessions usinga culturally tailored approach could enhance self-care and glycemic control. Additional testing among more participants over a longer time period is recommended.

Purpose: The purpose of this study was to examine the impact of family and friends on the management of persons with diabetes and their willingness to be involved in a culturally tailored program., Methods: This qualitative study was based within a larger quasi-experimental study that focused on the impact of a culturally tailored group intervention compared with individual standard diabetes education on the outcomes of self-management and glycemic control among rural African Americans with type 2 diabetes. Twenty-one participants were randomly assigned to an individual education group or a culturally tailored intervention group. Family members/peers (n = 6) attended invited group sessions to obtain information about diabetes and family/peer support. The facilitator of the invited group sessions used a guide to help with group discussions. The investigators used an iterative approach to enhance the examination of the responses from the discussion guide, thus identifying recurring themes within the participants' responses., Results: The data revealed that family and friends made a difference in the diabetes management of individuals with diabetes. Although family and friends may have been helpful at times, they also created moments of problems and an environment that made it more difficult to care for diabetes. The data also revealed that diabetes is hard to manage and control. Participants reported that taking medications and being aware of types of foods to keep a well-maintained glucose level were often challenging., Conclusions: These findings confirm that family and peers greatly influence diabetes management among rural African Americans. The study's results will help health care providers understand the importance of involving family members and friends in the treatment and diabetes management of individuals with type 2 diabetes, particularly within rural African American communities where resources are limited.

The prevalence of diabetes in the United States is higher among those living in rural/ nonmetropolitan statistical areas than in urban centers. Managing this complex chronic illness is complicated by factors such as limited access to care, low socioeconomic status, aging, and membership in a racial or ethnic minority group. A review of the literature was conducted focusing on research about rural Americans with diabetes by searching databases of CINAHL, PubMed, and MEDLINE, and selecting articles in English that were published between 2000 and 2007. Search terms included: nursing, research, rural, rural nursing, rural health services/programs, and diabetes care. Additional search strategies included journal hand searching and networking. Twenty-six research reports were found and included qualitative and quantitative methods and program evaluations. All regions of the United States were represented except the Northwest. The vast majority of research reports were of descriptive studies (n = 16), with program evaluation reports (n = 7) and studies testing an intervention (n = 3) also represented. The quality of each study is examined and summarized.

Purpose: To describe how decisions occurred to transfer nursing home (NH) residents to emergency departments (EDs)., Design: Three nursing homes (NHs) in Virginia were selected based on geographic and ownership variability. The phenomenon of concern was the decision-making process culminating in the transfer of NH residents to EDs. Sixteen transfers met the inclusion criteria and were analyzed. A minimum of two informants per transfer were interviewed, with a range of 2 to 4 interviews per transfer. All 42 respondents were asked to describe how the transfer decision was reached, to identify who participated in making the decision, and to describe any particular positive or negative aspects of reaching the transfer decision., Method: Data were analyzed with hermeneutic phenomenological methods. Journal writing, audit trails, informal and formal member checks, and expert consultation were used to control bias., Findings: The three main themes identified were Consensus, Conflict, and Cogency. Consensus, or agreement, occurred when all decision participants reported similar interpretations as to the severity and acuity of the presenting problem or had shared interpretations of the best interests of the elder. When decision participants held dissimilar interpretations, conflict occurred. Decision participants used cogency by persuading others, in order to reach consensus., Conclusions: The findings cannot be generalized to long-term care facilities across the US or to other countries, but they enhance understanding about some of the ways transfer decisions occur and the role of nurses in those transfers, especially when conflict arises.

Documentation of patient care, outcomes, and report writing are important aspects of the role of the case manager. In this article, the author examines the types of documentation approaches used by nurses in recent years and the new applications called for in the case manager role. Issues such as standardized language and multidisciplinary documentation are explored. Approaches to examining computerized documentation systems are presented. Finally, the importance of documentation in demonstrating what nurses do, allowing comparison of outcomes, and supporting reimbursement for nurses, are discussed.

In a time of budget constraints, health professionals are turning to minimal-contact smoking cessation programs as the most financially feasible alternative for smoking cessation. The purpose of this study was to evaluate a program by the American Lung Association using the manual Freedom From Smoking for You and Your Family (Strecher & Rimer, 1988) in a community-based smoking cessation self-help intervention. Results showed a quit rate of 15%, and study findings were consistent with other similar studies. Those most likely to succeed were over 40 years old, better educated, and among the most confident of quitting at the onset.

The purpose of this article is to describe current developments in the area of research-based nursing interventions and to suggest ways nurses can translate these new developments into their advanced practice roles. Past and present works by nurse scholars in the areas of classifying and systematic testing of nursing interventions are described briefly. Examples are provided to illustrate how the CNS can incorporate these recent developments in various ways into current practice, particularly as related to utilization and conduct of research.

An experimental study was conducted in which 40 subjects, randomly assigned to four groups, were given differing instructions about using auditory biofeedback to lower forehead muscle tension. During each of three sessions, measures were taken of forehead electromyograph (EMG) and ability to discriminate and control muscle tension in order to measure learning during biofeedback. Cognitive strategies used by subjects were measured by taped verbal reports which were judged using four criteria based on two models of learning in biofeedback: "feedforward" and "feedback." Data were analyzed by chi-square, ANOVA, ANCOVA, and content analysis. Results indicate that subjects used predominantly a feedforward type of learning strategy in all four groups. Implications for teaching during biofeedback are discussed.

Nursing has a long history of a holistic focus on patient care. The current emphasis on the need for holism indicates that the "world" is more aware of the value of nursing. To enhance this possibility, nurses need to use empirical evidence to support holistic practice.

One of the nursing diagnoses accepted by NANDA is noncompliance. However, this diagnosis has been criticized because it implies coercion and dominance by health professionals, and because of the negative stereotyping the term promotes. The authors argue that noncompliance should not be used as a nursing diagnosis because of incongruence with nursing history, philosophy, ethics, theory, and the need for clinical utility of diagnoses. Alternative diagnoses are proposed.

Epidemiological studies in the United States indicate that 5% of the population or nearly 7 million people have Mitral Valve Prolapse. This incidence has also been confirmed by British physicians. Approximately half of these persons seek medical care for treatment of symptoms. Persons with symptoms are often said to have "Mitral Valve Prolapse Syndrome." The purpose of this study was to describe experiences and self-care needs of persons diagnosed with Mitral Valve Prolapse Syndrome (MVPS). In Phase I of the study, medical records of 124 subjects were reviewed to identify the medical experience and typical symptoms associated with MVPS. In Phase II, 20 subjects with typical symptoms were interviewed using a semi-structured questionnaire based on health deviation self-care requisites developed by Orem. Results of this pilot study indicate that interviewed subjects with MVPS frequently had unresolved health concerns and were seeking help. Nursing assistance may therefore be needed to help such clients understand this health deviation, to make decisions regarding appropriate actions, and to accomplish self-care actions.

Twenty subjects with diagnosed Mitral Valve Prolapse (MVP) were interviewed regarding self-care needs. Transcripts were analyzed for evidence of perceived health state and altered body image. The majority of subjects described experiences indicating that their perceptions of body image and health state were affected by the diagnosis of MVP. Using Smith's (1981) four categories of health perceptions, most subjects were judged to perceive their health state from a combination of clinical, role-performance and adaptive perspectives.

In summary, the scientific literature on mitral valve prolapse reveals many unanswered questions about the significance of MVP. Patients with MVP exhibit a wide range of symptoms and problems, ranging from none to serious and disabling ones. Although the prognosis is highly favorable in the majority of cases, patients with significant symptoms may not experience improvement from medications and may benefit from nursing interventions directed toward reducing discomfort and fear.

This paper describes differences in response in seventeen patients with essential hypertension who participated in a treatment program consisting of electromyograph biofeedback assisted relaxation training. Responders were found to have higher treatment values of urinary and plasma cortisol, Trait Anxiety and forehead muscle tension compared to treatment failures. Responders also sustained greater decreases in plasma, and urinary cortisol after treatment. These data are discussed in light of the ability to predict which hypertensive patients may be most benefitted by a relaxation based treatment.

Twenty participants responded to inquiries about strategies used, and thoughts during, each of three electromyograph biofeedback sessions. The purpose of the study was to learn more about what individuals report doing during biofeedback and, specifically, to determine if individuals construct a response using feedback to sense subtle differences in muscle tension (feedback processes), or select a response from an existing repertoire using feedback primarily for confirmation (feed-forward processes). Protocol analyses found considerable support for feed-forward processes and little support for feedback processes. Such results are important because early reliance on feed-forward processes may result in limited control and limited transfer.