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Fisher MC, Parrillo E, Petchler C, Kub J, Hughes MT, Sulmasy DP, Baker D, Nolan MT. "They Would Lift My Spirits": Sources of Support for Family Surrogate Decision-Makers at the End of Life. J Hosp Palliat Nurs 2023; 25:119-123. [PMID: 36907841 PMCID: PMC10175176 DOI: 10.1097/njh.0000000000000939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Surrogate decision-makers make critical decisions for loved ones at the end of life, and some experience lasting negative psychological outcomes. Understanding whom they rely on for support and the types of support they value may inform nursing care and that of other health team members who work with surrogates. The purpose of the study was to explore decision support and other types of support provided to surrogate decision-makers at the end of life of their loved one and perceived usefulness of the support. This secondary analysis of data from a mixed-methods study involved the examination of the transcripts of qualitative interviews with 13 surrogate decision-makers in the United States, conducted between 2010 and 2014. A constant comparative method was used to identify common themes surrounding surrogate decision support at the end of life. Surrogates valued advance directives and conversations with their loved one about treatment preferences. Surrogates described involving many different types of people in decision-making and other types of support. Finally, surrogates appreciated being reassured that they were doing a good job in making decisions and seemed to seek out this type of affirmation from various sources including the health care team, family, and friends. Nurses are well-positioned to provide this affirmation because of the time that they spend caring for the patient and family. Future research should further explore the concept of affirmation of surrogates in their role as a means of support as they make decisions for a loved one.
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Affiliation(s)
- Marlena C. Fisher
- Johns Hopkins School of Nursing, 525 N. Wolfe St., Baltimore, MD, 21205, USA
| | - Elaina Parrillo
- Johns Hopkins School of Nursing, 525 N. Wolfe St., Baltimore, MD, 21205, USA
| | - Claire Petchler
- Johns Hopkins School of Nursing, 525 N. Wolfe St., Baltimore, MD, 21205, USA
| | - Joan Kub
- Johns Hopkins School of Nursing, 525 N. Wolfe St., Baltimore, MD, 21205, USA
| | | | - Daniel P. Sulmasy
- The Kennedy Institute of Ethics, Georgetown University, 3700 O St NW, Washington, D.C., 20057, USA
| | - Deborah Baker
- Johns Hopkins School of Nursing, 525 N. Wolfe St., Baltimore, MD, 21205, USA
- Johns Hopkins Hospital, 1800 Orleans St., Baltimore, MD, 21287, USA
| | - Marie T. Nolan
- Johns Hopkins School of Nursing, 525 N. Wolfe St., Baltimore, MD, 21205, USA
- Conway School of Nursing, The Catholic University of America, Washington, DC
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Bower KM, Alexander KA, Levin MB, Jaques KA, Kub J. Using Critical Service-Learning Pedagogy to Prepare Graduate Nurses to Promote Health Equity. J Nurs Educ 2021; 60:38-43. [PMID: 33400807 DOI: 10.3928/01484834-20201217-09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 07/15/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Despite calls from professional organizations to prepare a nursing workforce with the requisite skills to address social determinants of health (SDOH), there is little guidance for nurse educators about how to actively promote student learning of these complex issues. METHOD We applied a critical service-learning (CSL) pedagogy to enhance graduate public health nursing curriculum and support learner skill building in approaches to combat health disparities by addressing the underlying social conditions. RESULTS Course content and critical reflection activities were built incrementally across four courses and semesters to introduce and apply antioppressive frameworks, encourage students to examine their personal identities of privilege and oppression, and examine historical context and systems of power in public health settings. CONCLUSION CSL supports student development of structural competence and their understanding of approaches that can dismantle inequitable systems by addressing SDOH that contribute to health disparities. [J Nurs Educ. 2021;60(1):38-43.].
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Kub J. An Interview With Joanne Schwartz, PhD, CRNP, PMHNP-BC, CNE, CARN-AP, FIANN, Certified Registered Nurse Practitioner, Nurse Educator. J Addict Nurs 2019; 30:280-281. [PMID: 31800521 DOI: 10.1097/jan.0000000000000313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Butz AM, Tsoukleris M, Elizabeth Bollinger M, Jassal M, Bellin MH, Kub J, Mudd S, Ogborn CJ, Lewis-Land C, Thompson RE. Association between second hand smoke (SHS) exposure and caregiver stress in children with poorly controlled asthma. J Asthma 2019; 56:915-926. [PMID: 30307351 PMCID: PMC6551304 DOI: 10.1080/02770903.2018.1509989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 07/31/2018] [Accepted: 08/05/2018] [Indexed: 10/28/2022]
Abstract
Objective: Urban children with asthma experience high rates of second hand smoke (SHS) exposure. The objective was to examine whether SHS exposure is associated with symptom frequency in children with poorly controlled asthma. Methods: Children were enrolled in a RCT to test the efficacy of an environmental control behavioral intervention versus an attention control group and followed over 12 months. SHS exposure assessed using salivary cotinine measurement. Frequency of child asthma symptoms, healthcare utilization, household smoking and caregiver daily life stress were obtained via caregiver report. Time of enrollment was recorded to assess seasonal factors. Symptom days and nights were the primary outcomes. Multivariable models and odds ratios examined factors that best predicted increased frequency of daytime/nighttime symptoms. Results: Children (n = 222) with a mean age of 6.3 (SD 2.7) years, were primarily male (65%), African American (94%), Medicaid insured (94%), and had poorly controlled asthma (54%). The final multivariable model indicated symptoms in the fall (OR 2.78; 95% CI 1.16, 6.52) and increased caregiver daily life stress (OR 1.13, 95% CI 1.02, 1.25) were significantly associated with increased symptom days when controlling for cotinine level, intervention status, child age and home and car smoking restrictions. Conclusions: There was no impact of SHS exposure on increased symptom frequency. High caregiver daily life stress and symptoms in fall season may place children with asthma at risk for increased day/nighttime symptoms. Close monitoring of symptoms and medication use during the fall season and intervening on caregiver life stress may decrease asthma morbidity in children with poorly controlled asthma.
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Affiliation(s)
- Arlene M Butz
- a Department of Pediatrics, The Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Mona Tsoukleris
- b The Univeristy of Maryland School of Pharmacy , Baltimore , MD , USA
| | - Mary Elizabeth Bollinger
- c Department of Pediatrics, The University of Maryland School of Medicine , Baltimore , MD , USA
| | - Mandeep Jassal
- a Department of Pediatrics, The Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Melissa H Bellin
- d The University of Maryland School of Social Work , Baltimore , MD , USA
| | - Joan Kub
- e Department of Nursing, The USC Suzanne Dworak-Peck School of Social Work , Los Angeles , CA , USA
| | - Shawna Mudd
- f The Johns Hopkins University School of Nursing , Baltimore , MD , USA
| | - C Jean Ogborn
- g Department of Pediatric Emergency Medicine, The Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Cassia Lewis-Land
- a Department of Pediatrics, The Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Richard E Thompson
- h Biostatistics Department, The Johns Hopkins University Bloomberg School of Public Health , Baltimore , MD , USA
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Brockie T, Azar K, Wallen G, O'Hanlon Solis M, Adams K, Kub J. A conceptual model for establishing collaborative partnerships between universities and Native American communities. Nurse Res 2019; 27:27-32. [PMID: 31468833 DOI: 10.7748/nr.2019.e1613] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND Collaborative partnerships are increasingly recognised as valuable and essential tools for improving community health. AIM To present the process used to establish a collaboration between a university and a community, including a description of the conceptual model that provided guidance for one such project. DISCUSSION While numerous studies explore the potential benefits of such efforts, few have addressed how to initiate partnerships. The initiation phase and formative work required are arguably the most crucial step, as they become the foundation on which all future efforts are built and through which sustainability is achieved. CONCLUSION These formative steps are essential when working with Native American communities, which experience severe health disparities, but for which limited initiatives are available for community health interventions. IMPLICATIONS FOR PRACTICE The approach used in this project can guide the establishment of a university-community collaboration, from initiation to evaluation.
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Affiliation(s)
- Teresa Brockie
- Johns Hopkins School of Nursing, Community Public Health, Baltimore MD
| | | | - Gwenyth Wallen
- Nursing Research and Translational Science, National Institutes of Health Clinical Center, Bethesda MD
| | | | | | - Joan Kub
- University of Southern California, Los Angeles CA
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Bellin MH, Newsome A, Lewis-Land C, Kub J, Mudd SS, Margolis R, Butz AM. Improving Care of Inner-City Children with Poorly Controlled Asthma: What Mothers Want You to Know. J Pediatr Health Care 2018; 32:387-398. [PMID: 29540280 PMCID: PMC6026044 DOI: 10.1016/j.pedhc.2017.12.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 12/06/2017] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Low-income caregiver perspectives on asthma management are understudied but may illuminate strategies to improve care delivery and child outcomes. METHOD Purposive sampling methods were used to recruit 15 caregivers of children with frequent asthma emergency department visits. Interviews explored how poverty and stress affect asthma management. Grounded theory coding techniques were used to analyze the data. RESULTS Participants were the biological mother (100%) and were poor (75% had mean annual income ≤ $30,000). Their children (mean age = 6.9 years) were African American (100%), enrolled in Medicaid (100%), and averaged 1.5 emergency department visits over the prior 3 months. Four themes emerged: (a) Deplorable Housing Conditions, (b) Allies and Adversaries in School-Based Asthma Management, (c) Satisfaction With Asthma Health Care Delivery, and (d) Prevalent Psychological Distress. DISCUSSION Impoverished caregivers of children with frequent asthma emergency department visits describe stress that is multifaceted, overwhelming, and difficult to eradicate. Their experiences underscore the need for improved school-based asthma management and family-centered approaches to health care delivery.
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Affiliation(s)
| | | | - Cassie Lewis-Land
- Johns Hopkins University School of Medicine, Division of General Pediatrics and Adolescent Medicine
| | - Joan Kub
- University of Southern California School of Social Work-Department of Nursing
| | - Shawna S. Mudd
- Johns Hopkins University School of Nursing, Medicine and Public Health
| | | | - Arlene M. Butz
- Johns Hopkins University School of Medicine, Division of General Pediatrics and Adolescent Medicine
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Butz AM, Bellin M, Tsoukleris M, Mudd SS, Kub J, Ogborn J, Morphew T, Lewis-Land C, Bollinger ME. Very Poorly Controlled Asthma in Urban Minority Children: Lessons Learned. J Allergy Clin Immunol Pract 2018; 6:844-852. [PMID: 28958744 PMCID: PMC5862725 DOI: 10.1016/j.jaip.2017.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 07/20/2017] [Accepted: 08/07/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Very poorly controlled (VPC) asthma in children is associated with ongoing acute exacerbations but factors associated with VPC are understudied. OBJECTIVE To examine the risk factors associated with VPC asthma in urban minority children. METHODS This descriptive study examined asthma control levels (well-controlled [WC], not well-controlled [NWC], and VPC) at baseline and 6 months in children participating in an ongoing randomized controlled trial of an emergency department/home environmental control intervention. Data collection occurred during the index emergency department visit and included allergen-specific IgE and salivary cotinine testing and caregiver interview of sociodemographic and child health characteristics. Follow-up data were collected at 6 months. Unadjusted analyses examined the association of sociodemographic and health characteristics by level of asthma control. Multivariate analysis tested significant factors associated with VPC asthma at 6 months. RESULTS At baseline most children were categorized with VPC asthma (WC, 0%; NWC, 47%; VPC, 53%) and rates of VPC minimally improved at 6 months (WC, 13%; NWC, 41%; VPC, 46%). Risk for VPC asthma was twice as likely in children with allergic rhinitis (odds ratio [OR], 2.42), having 2 or more primary care provider asthma visits within the past 3 months (OR, 2.77), or caregiver worry about medication side effects (OR, 2.13) and 3 to 4 times more likely when asthma control was assessed during the fall or spring season (OR: fall, 3.32; spring, 4.14). CONCLUSIONS Improving asthma control in low-income, high-risk children with VPC asthma requires treatment of comorbidities, attention to caregiver medication beliefs, and adept use of stepwise therapy.
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Affiliation(s)
- Arlene M Butz
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Melissa Bellin
- School of Social Work, The University of Maryland, Baltimore, Md
| | - Mona Tsoukleris
- The School of Pharmacy, The University of Maryland, Baltimore, Md
| | - Shawna S Mudd
- The Johns Hopkins University School of Nursing, Baltimore, Md
| | - Joan Kub
- The Johns Hopkins University School of Nursing, Baltimore, Md
| | - Jean Ogborn
- Department of Pediatric Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, Md
| | | | - Cassia Lewis-Land
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Md
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Bellin MH, Collins KS, Osteen P, Kub J, Bollinger ME, Newsome A, Lewis-Land C, Butz AM. Characterization of Stress in Low-Income, Inner-City Mothers of Children with Poorly Controlled Asthma. J Urban Health 2017; 94:814-823. [PMID: 28560612 PMCID: PMC5722723 DOI: 10.1007/s11524-017-0162-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The goal of this longitudinal analysis was to characterize factors associated with the experience of life stress in low-income, inner-city mothers of minority children with high-risk asthma.Participants (n = 276) reported on family demographics, child asthma control and healthcare utilization, social support, contemporary life difficulties (housing, finances, violence exposure) measured by the validated Crisis in Family Systems scale, and daily stress. Latent growth curve modeling examined predictors of life stress across 12 months as a function of home and community difficulties, asthma-specific factors, and social support. Mothers were primarily single (73%), unemployed (55%), and living in extreme poverty with most (73%) reporting an annual family income <$20,000 (73%). The children were young (mean age = 5.59, SD = 2.17), African-American (96%), and had poorly controlled asthma (94%) at study enrollment. Higher daily stress was associated with financial difficulties, safety concerns in the home and community, and housing problems. Access to social support was consistently related to reduced stress. The only asthma-specific factor associated with life stress was healthcare utilization, with more emergency services for asthma related to higher daily stress. Findings underscore the clinical significance of assessing diverse home and community stressors and social support in low-income, inner-city caregivers of children with poorly controlled asthma.
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Affiliation(s)
- Melissa H Bellin
- University of Maryland School of Social Work, 525 West Redwood Street, Baltimore, MD, 21201, USA.
| | - Kathryn S Collins
- University of Maryland School of Social Work, 525 West Redwood Street, Baltimore, MD, 21201, USA
| | - Philip Osteen
- Florida State University College of Social Work, Tallahassee, USA
| | - Joan Kub
- Department of Nursing, University of Southern California, Los Angeles, USA
| | - Mary Elizabeth Bollinger
- Division of Pediatric Pulmonary and Allergy, University of Maryland School of Medicine, Baltimore, USA
| | - Angelica Newsome
- University of Maryland School of Social Work, 525 West Redwood Street, Baltimore, MD, 21201, USA
| | - Cassie Lewis-Land
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Arlene M Butz
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
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Sulmasy DP, Hughes MT, Yenokyan G, Kub J, Terry PB, Astrow AB, Johnson JA, Ho G, Nolan MT. The Trial of Ascertaining Individual Preferences for Loved Ones' Role in End-of-Life Decisions (TAILORED) Study: A Randomized Controlled Trial to Improve Surrogate Decision Making. J Pain Symptom Manage 2017; 54:455-465. [PMID: 28712987 PMCID: PMC5632104 DOI: 10.1016/j.jpainsymman.2017.07.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 06/02/2017] [Accepted: 07/06/2017] [Indexed: 11/23/2022]
Abstract
CONTEXT Patients with terminal illnesses often require surrogate decision makers. Prior research has demonstrated high surrogate stress, and that despite standards promoting substituted judgment, most patients do not want their surrogates to make pure substituted judgments for them. It is not known how best to help loved ones fulfill the surrogate role. OBJECTIVES To test the effectiveness of an intervention to help surrogate decision makers. METHODS One hundred sixty-six patients (41% with amyotrophic lateral sclerosis and 59% with gastrointestinal cancers) and their surrogates at two university medical centers were randomized to an intensive nurse-directed discussion of the end-of-life decision control preferences of the patient (TAILORED) or a discussion of nutrition (CONTROL); 163 completed baseline interviews and underwent the intervention. RESULTS Twelve patients died during follow-up and 137 dyads completed the study. Post-intervention, using all available data, TAILORED patients and surrogates became more likely to endorse mutual surrogate decision making, that is, a balance of their own wishes and what the surrogate thinks best (adjusted odds compared with baseline for patients = 1.78, P = 0.04; adjusted odds for surrogates = 2.05, P = 0.03). CONTROL patients became 40% less likely to endorse mutual surrogate decision making (P = 0.08), and CONTROL surrogates did not change significantly from baseline (adjusted odds = 1.44, P = 0.28). Stress levels decreased for TAILORED surrogates (impact of events scale = 23.1 ± 14.6 baseline, 20.8 ± 15.3 f/u, P = 0.046), but not for CONTROL (P = 0.85), and post-intervention stress was lower for TAILORED than CONTROL (P = 0.04). Surrogates' confidence was uniformly high at baseline and did not change. Caregiver burden (Zarit) increased from 12.5 ± 6.5 to 14.7 ± 8.1 for TAILORED (P < 0.01), while not changing for CONTROL, yet satisfaction with involvement in decision making was higher at follow-up for TAILORED than for CONTROL (71% vs. 52%, P = 0.03). CONCLUSION TAILORED patients and surrogates who completed the study adopted a more mutual decision-making style, balancing their own wishes with what the surrogate thinks would be best for them. Surrogates reported less stress and more satisfaction. Confidence was high at baseline and did not change. There was a modest increase in caregiver burden. These findings suggest that interventions like TAILORED might positively impact surrogate decision making.
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Affiliation(s)
| | | | | | - Joan Kub
- Johns Hopkins University, Baltimore, Maryland
| | | | | | | | - Grace Ho
- Johns Hopkins University, Baltimore, Maryland
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Kub J, Bellin MH, Butz A, Elizabeth Bollinger M, Lewis-Land C, Osteen P. The Chronicity of Depressive Symptoms in Mothers of Children With Asthma. West J Nurs Res 2017; 40:1581-1597. [PMID: 28508700 DOI: 10.1177/0193945917705858] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Depression can disproportionately affect low-income women. The purpose of this study was to explore the chronicity of depressive symptoms in a sample of 276 low-income inner-city mothers of children with high-risk asthma. The aims were to identify factors (asthma health status, stress, social support) associated with change in depressive symptomatology over 12 months as well as to ascertain what factors are most consistently associated with depressive symptoms. Using latent growth curve analysis, demographic variables, asthma severity, stress, and social support failed to explain changes in depressive symptomatology. The growth curve models, however, were predictive of Center for Epidemiologic Studies-Depression Scale (CES-D) scores at distinct time points indicating that higher daily stress and lower social support were associated with increased depressive symptoms. Our data highlight the chronic nature of depressive symptoms in low-income mothers of children with poorly controlled asthma. Integrating questions about caregiver psychological state across all clinical encounters with the family may be indicated.
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Affiliation(s)
- Joan Kub
- 1 University of Southern California, Los Angeles, CA, USA
| | | | - Arlene Butz
- 3 Johns Hopkins University, Baltimore, MD, USA
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Bellin MH, Newsome A, Land C, Kub J, Mudd SS, Bollinger ME, Butz AM. Asthma Home Management in the Inner-City: What can the Children Teach us? J Pediatr Health Care 2017; 31:362-371. [PMID: 27955875 PMCID: PMC6407130 DOI: 10.1016/j.pedhc.2016.11.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 11/07/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Knowledge of asthma home management from the perspective of poor, minority children with asthma is limited. METHOD Convenience sampling methods were used to recruit families of low-income children who are frequently in the emergency department for uncontrolled asthma. Thirteen youths participated in focus groups designed to elicit reflections on asthma home management. Data were analyzed using grounded theory coding techniques. RESULTS Participants (Mean age = 9.2 years) were African American (100%), enrolled in Medicaid (92.3%), averaged 1.4 (standard deviation = 0.7) emergency department visits over the prior 3 months, and resided in homes with at least 1 smoker (61.5%). Two themes reflecting multifaceted challenges to the development proper of self-management emerged in the analysis. DISCUSSION Findings reinforce the need to provide a multipronged approach to improve asthma control in this high-risk population including ongoing child and family education and self-management support, environmental control and housing resources, linkages to smoking cessation programs, and psychosocial support.
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Butz A, Morphew T, Lewis-Land C, Kub J, Bellin M, Ogborn J, Mudd SS, Bollinger ME, Tsoukleris M. Factors associated with poor controller medication use in children with high asthma emergency department use. Ann Allergy Asthma Immunol 2017; 118:419-426. [PMID: 28254203 PMCID: PMC5385291 DOI: 10.1016/j.anai.2017.01.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/03/2017] [Accepted: 01/09/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Understanding health and social factors associated with controller medication use in children with high-risk asthma may inform disease management in the home and community. OBJECTIVE To examine health and social factors associated with the Asthma Medication Ratio (AMR), a measure of guideline-based care and controller medication use, in children with persistent asthma and frequent emergency department (ED) use. METHODS Study questionnaires, serum allergen sensitization, salivary cotinine, and pharmacy record data were collected for 222 children enrolled from August 2013 to February 2016 in a randomized clinical trial that tested the efficacy of an ED- and home-based intervention. Logistic regression was used to examine factors associated with an AMR greater than 0.50, reflecting appropriate controller medication use. RESULTS Most children were male (64%), African American (93%), Medicaid insured (93%), and classified as having uncontrolled asthma (44%). Almost half (48%) received non-guideline-based care or low controller medication use based on an AMR less than 0.50. The final regression model predicting an AMR greater than 0.50 indicated that children receiving specialty care (odds ratio [OR], 4.87; 95% confidence interval [CI], 2.06-11.50), caregivers reporting minimal worry about medication adverse effects (OR, 0.50; 95% CI, 0.25-1.00), positive sensitization to ragweed allergen (OR, 3.82; 95% CI, 1.63-8.96), and negative specific IgE for dust mite (OR, 0.33; 95% CI, 0.15-0.76) were significantly associated with achieving an AMR greater than 0.50. CONCLUSION Clinical decision making for high-risk children with asthma may be enhanced by identification of sensitization to environmental allergens, ascertaining caregiver's concerns about controller medication adverse effects and increased referral to specialty care. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01981564.
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Affiliation(s)
- Arlene Butz
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland; School of Nursing, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | | | - Cassia Lewis-Land
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joan Kub
- School of Nursing, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Melissa Bellin
- School of Social Work, University of Maryland, Baltimore, Maryland
| | - Jean Ogborn
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shawna S Mudd
- School of Nursing, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mary Elizabeth Bollinger
- Department of Pediatric Pulmonary and Allergy, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Mona Tsoukleris
- School of Pharmacy, University of Maryland, Baltimore, Maryland
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Mudd SS, Ogborn CJ, Bollinger ME, Morphew T, Kub J, Lewis-Land C, Bellin MH, Butz A. Parental decision making associated with pediatric emergency department use for asthma. Ann Allergy Asthma Immunol 2016; 117:490-494. [PMID: 27788877 DOI: 10.1016/j.anai.2016.08.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 08/16/2016] [Accepted: 08/29/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Disadvantaged minority children are disproportionately affected by asthma. This group is also known to frequently use the emergency department (ED) for asthma care. Understanding decisions for use of the ED is important to prevent high cost. OBJECTIVE To examine caregiver factors associated with the decision to use the ED for asthma care in inner-city children with asthma. METHODS One hundred fifty participants in a randomized clinical trial testing the effectiveness of a home-based asthma intervention were enrolled, and questionnaires were administered to caregivers during the child's ED asthma visit. Sociodemographics, health characteristic data, and caregiver interview data were examined to ascertain factors that affected caregiver decision making to use the ED for asthma care. A cluster analysis was performed to correlate caregiver reasons for the decision to use the ED for asthma care. RESULTS Three clusters emerged for decision making: urgency, preference for the use of the ED, and access to care issues. The perception of urgency was the most common reason reported by caregivers (91%) followed by reporting a preference for the ED for care (37%) and reporting access to care issues (31%). Access to care was primarily attributable to the inability to get a same-day appointment with their primary care practitioner (24%). CONCLUSION The caregiver factors involved in the decision to use the ED can provide a basis for further intervention and investigation. Such factors include caregiver asthma home management, improvement in relationships with primary care practitioners, and access to care-related issues.
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Affiliation(s)
- Shawna S Mudd
- Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, Maryland.
| | - C Jean Ogborn
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | - Joan Kub
- Department of Community and Public Health, Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Cassie Lewis-Land
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Melissa H Bellin
- University of Maryland School of Social Work, Baltimore, Maryland
| | - Arlene Butz
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Bekemeier B, Zahner SJ, Kulbok P, Merrill J, Kub J. Assuring a strong foundation for our nation's public health systems. Nurs Outlook 2016; 64:557-565. [PMID: 27480677 DOI: 10.1016/j.outlook.2016.05.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 05/03/2016] [Accepted: 05/20/2016] [Indexed: 01/17/2023]
Abstract
BACKGROUND A strong public health infrastructure is necessary to assure that every community is capable of carrying out core public health functions (assessment of population health, assurance of accessible and equitable health resources, and development of policies to address population health) to create healthy conditions. Yet, due to budget cuts and inconsistent approaches to base funding, communities are losing critical prevention and health promotion services and staff that deliver them. PURPOSE This article describes key components of and current threats to our public health infrastructure and suggests actions necessary to strengthen public health systems and improve population health. DISCUSSION National nursing and public health organizations have a duty to advocate for policies supporting strong prevention systems, which are crucial for well-functioning health care systems and are fundamental goals of the nursing profession. CONCLUSION We propose strengthening alliances between nursing organizations and public health systems to assure that promises of a reformed health system are achieved.
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Affiliation(s)
- Betty Bekemeier
- Department of Psychosocial and Community Health, University of Washington School of Nursing, Seattle, WA.
| | - Susan J Zahner
- University of Wisconsin-Madison, School of Nursing, Madison, WI
| | - Pamela Kulbok
- University of Virginia, School of Nursing, Charlottesville, VA
| | - Jacqueline Merrill
- Biomedical Informatics at Columbia University Medical Center, New York, NY
| | - Joan Kub
- Department of Community-Public Health, Johns Hopkins University School of Nursing, Baltimore, MD
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Abstract
Intimate partner violence has been demonstrated to be a significant public health problem among African American women. This study provided an opportunity to examine prevalence of intimate partner violence and health consequences among a group of primarily middle-class, employed African American women enrolled in a privately insured HMO (n = 109 abused and 97 never-abused women). Significantly more abused African American women were divorced or widowed and had incomes less than $50,000 a year. Abused women had more health problems (central nervous system, gynecological, STDs, gastrointestinal), more health problems per medical visits, and more emergency room visits (p < .05) compared to never-abused women. The health consequences of abuse and its association with health disparities are discussed.
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Campbell JC, Garza MA, Gielen AC, O'Campo P, Kub J, Dienemann J, Jones AS, Jafar E. Intimate Partner Violence and Abuse among Active Duty Military Women. Violence Against Women 2016. [DOI: 10.1177/1077801203255291] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In a sample of 616 active duty military women, 30% reported adult lifetime intimate partner violence (IPV), defined as physical and/or sexual assault. The prevalence of IPV during the time of military service was 21.6%. Lifetime prevalence of any abuse, including emotional abuse and/or stalking, was 44.3%. Risk factors for IPV (lifetime and while in the military) from multivariate logistic regression were separated or divorced marital status (odds ratio = 5.23, 6.17, respectively), being widowed (odds ratio = 3.57, 4.57), having one child (odds ratio = 2.12, 2.49) or three or more children (odds ratio = 2.72, 3.34), and being enlisted personnel rather than officers (odds ratio = 2.45, 2.77). These prevalence rates and risk factors were similar to a demographically comparable civilian sample from the same geographic area. Existing military policies and programs should be examined and enhanced to maintain military readiness as well as reduce military women's risk of harm.
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Bellin MH, Land C, Newsome A, Kub J, Mudd SS, Bollinger ME, Butz AM. Caregiver perception of asthma management of children in the context of poverty. J Asthma 2016; 54:162-172. [PMID: 27304455 DOI: 10.1080/02770903.2016.1198375] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Low-income caregivers of young children with high-risk asthma experience social stressors and illness-related demands that may impede effective home asthma management. Knowledge of the caregiving experience in the context of poverty is limited. METHODS Convenience sampling methods were used to recruit low-income caregivers of children aged 7-12 years, who are frequently in the Emergency Room (ED) for uncontrolled asthma. Thirteen caregivers participated in focus groups that were designed to elicit reflections on asthma home and community management from the caregiver perspective. A grounded theory approach was used in the open coding of transcript data from three focus groups, as well as to revise and reorganize emerging themes and sub-themes. RESULTS Participants (Mean age = 33.9 years) were predominantly the biological mother (92.3%), single (84.6%), and impoverished (69.2% reported annual household income ≤ $30,000). Their children (Mean age = 7.8 years) were African-American (100%), enrolled in Medicaid (92.3%), averaged 1.38 (SD = 0.7) ED visits over the prior 3 months, resided in homes with at least one smoker (61.5%), and nearly all (84.6%) experienced activity limitations due to asthma. Five themes emerged in the analysis: intensive caregiving role, complex and shared asthma management responsibility, parental beliefs and structural barriers to guideline-based care, lack of control over environmental triggers, and parent advocacy to improve child asthma care and outcomes. CONCLUSIONS Caregivers managing a child with high-risk asthma in the context of poverty indicate the need for ongoing asthma education, increased sensitivity to the complexity of home asthma management, and family-centered interventions that enhance communication and collaboration between caregivers and providers.
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Affiliation(s)
- Melissa H Bellin
- a School of Social Work, University of Maryland , Baltimore , MD , USA
| | - Cassie Land
- b Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Angelica Newsome
- a School of Social Work, University of Maryland , Baltimore , MD , USA
| | - Joan Kub
- c School of Nursing, Medicine and Public Health, Johns Hopkins University , Baltimore , MD , USA
| | - Shawna S Mudd
- c School of Nursing, Medicine and Public Health, Johns Hopkins University , Baltimore , MD , USA
| | - Mary Elizabeth Bollinger
- d Division of Pediatric Pulmonary and Allergy, University of Maryland School of Medicine , Baltimore , MD , USA
| | - Arlene M Butz
- b Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine , Baltimore , MD , USA
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Kub J. An Interview With Anna Treloar, RN, MA, MPHC, PhD, Lecturer, School of Nursing and Midwifery, University of Newcastle, Callaghan, Australia. J Addict Nurs 2016; 27:148-50. [PMID: 27272999 DOI: 10.1097/jan.0000000000000126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Joan Kub
- School of Nursing, Johns Hopkins University, Baltimore, Maryland
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Gibbons MC, Illangasekare SL, Smith E, Kub J. A Community Health Initiative: Evaluation and Early Lessons Learned. Prog Community Health Partnersh 2016; 10:89-101. [PMID: 27018358 DOI: 10.1353/cpr.2016.0011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Community-based participatory research (CBPR) has been shown to enhance trust and engagement among community academic partners. However, the value of CBPR among hyper-researched, inner-city communities has not been evaluated adequately. The purpose of this study was to evaluate the impact of a CBPR based engagement process in an inner-city, hyper-researched, underserved community. METHODS A qualitative process evaluation was conducted using focus groups, key informant in-depth interviews, and a brief survey to evaluate the attitudes, perceptions, beliefs, impact of, and satisfaction with the CBPR engagement process used to plan and conduct a community asset mapping project. RESULTS Three focus groups, eight in-depth interviews, and survey responses from 31 individuals were obtained and analyzed. Findings include a sense of accomplishment and value with the engagement process, as well as a sense of tangible benefits of the process perceived by community members and academic research partners. CONCLUSIONS CBPR may represent an effective approach to enhancing trust and community-academic collaboration even among cynical, resistant, hyper-researched, underserved communities.
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Lee MC, Sulmasy DP, Gallo J, Kub J, Hughes MT, Russell S, Kellogg A, Owens SG, Terry P, Nolan MT. Decision-Making of Patients With Implantable Cardioverter-Defibrillators at End of Life: Family Members' Experiences. Am J Hosp Palliat Care 2016; 34:518-523. [PMID: 27034436 DOI: 10.1177/1049909116641622] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Many patients with advanced heart failure (HF) experience the life-extending benefits of implantable cardioverter-defibrillators (ICD), but at the end stage of HF, patients may experience shocks with increasing frequency and change the plan for end-of-life (EOL) care including the deactivation of the ICD. This report describes family members' experiences of patients with ICD making decisions at EOL. Understanding the decision-making of patients with ICD at EOL can promote informed decision-making and improve the quality of EOL care. METHODS This pilot study used a mixed methods approach to test the effects of a nurse-guided discussion in decision-making about ICD deactivation (turning off the defibrillation function) at the EOL. Interviews were conducted, audiotaped, and transcribed in 2012 to 2013 with 6 family members of patients with advanced HF and ICDs. Three researchers coded the data and identified themes in 2014. RESULTS Three main themes described family members' experiences related to patients having HF with ICDs making health-care decision at EOL: decision-making preferences, patients' perception on ICD deactivation, and communication methods. DISCUSSION Health-care providers need to have knowledge of patients' decision-making preferences. Preferences for decision-making include the allowing of appropriate people to involve and encourages direct conversation with family members even when advance directives is completed. Information of ICD function and the option of deactivation need to be clearly delivered to patients and family members. Education and guidelines will facilitate the communication of the preferences of EOL care.
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Affiliation(s)
- Mei Ching Lee
- 1 Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Daniel P Sulmasy
- 2 School of Medicine and Divinity School, University of Chicago, Chicago, IL, USA
| | - Joseph Gallo
- 3 Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Joan Kub
- 4 School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Mark T Hughes
- 5 School of Medicine, Johns Hopkins Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
| | - Stuart Russell
- 6 School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Anela Kellogg
- 4 School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Sharon G Owens
- 7 Cardiac Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Peter Terry
- 6 School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Marie T Nolan
- 8 School of Nursing, Johns Hopkins Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
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Butz A, Bellin MH, Bollinger ME, Kub J, Mudd SS, Ogborn CJ, Lewis-Land C, Thompson RE, Tsoukleris M. Salivary cotinine measurement for all children with persistent asthma: spit matters. Ann Allergy Asthma Immunol 2016; 116:463-5. [PMID: 27009437 DOI: 10.1016/j.anai.2016.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 02/09/2016] [Accepted: 02/19/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Arlene Butz
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Melissa H Bellin
- School of Social Work, University of Maryland, Baltimore, Maryland
| | | | - Joan Kub
- School of Nursing, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shawna S Mudd
- School of Nursing, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - C Jean Ogborn
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Cassia Lewis-Land
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Richard E Thompson
- Bloomberg School of Public Health, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mona Tsoukleris
- School of Pharmacy, University of Maryland, Baltimore, Maryland
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Farley JE, Stewart J, Kub J, Cumpsty-Fowler C, Lowensen K, Becker K. Development of The Johns Hopkins University School of Nursing Adult/Geriatric Primary Care Nurse Practitioner Program in HIV Prevention, Treatment, and Care. J Assoc Nurses AIDS Care 2015; 27:223-33. [PMID: 26852319 DOI: 10.1016/j.jana.2015.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 12/17/2015] [Indexed: 11/16/2022]
Abstract
In response to the call to create an AIDS Education and Training Center for Nurse Practitioner Education by the Health Resources and Services Administration, The Johns Hopkins University School of Nursing embarked on a transformative curriculum overhaul to integrate HIV prevention, treatment, and care into the Adult/Geriatric Nurse Practitioner Program. A six-step process outlined in the Curriculum Development for Medical Education was followed. A pilot cohort of Adult/Geriatric Nurse Practitioner students were enrolled, including 50% primary care setting and 50% HIV-focused primary care through a 12-month HIV continuity clinic experience. Through this pilot, substantive changes to the program were adopted. Programmatic outcomes were not compromised with the modification in clinical hours. The model of a 12-month HIV continuity clinical experience reduced the number of required preceptors. This model has important implications for the HIV workforce by demonstrating successful integration of HIV and primary care training for nurse practitioners.
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Bellin MH, Osteen P, Kub J, Bollinger ME, Tsoukleris M, Chaikind L, Butz AM. Stress and Quality of Life in Urban Caregivers of Children With Poorly Controlled Asthma: A Longitudinal Analysis. J Pediatr Health Care 2015; 29:536-46. [PMID: 26036621 PMCID: PMC4624025 DOI: 10.1016/j.pedhc.2015.04.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 04/28/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The intent of this analysis was to examine the longitudinal effects of risk and protective factors on quality of life (QOL) in caregivers of minority children with asthma. METHOD Caregivers (n = 300) reported on demographics, child asthma characteristics, daily asthma caregiving stress, general life stress, social support, and QOL. Latent growth curve modeling examined changes in QOL across 12 months as a function of stress, asthma control, and social support. RESULTS Caregivers were primarily the biological mother (92%), single (71%), unemployed (55%), and living in poverty. Children were African American (96%), Medicaid eligible (92%), and had poorly controlled asthma (93%). Lower QOL was associated with higher life stress, greater asthma caregiving stress, and lower asthma control over time. DISCUSSION Findings underscore the importance of assessing objective and subjective measures of asthma burden and daily life stress in clinical encounters with urban, low-income caregivers of children with poorly controlled asthma.
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Abshire M, Xu J, Dennison Himmelfarb C, Davidson P, Sulmasy D, Kub J, Hughes M, Nolan M. Symptoms and fear in heart failure patients approaching end of life: a mixed methods study. J Clin Nurs 2015; 24:3215-23. [PMID: 26404121 DOI: 10.1111/jocn.12973] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2015] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES The purpose of this study was to consider how fear and symptom experience are perceived in patients with heart failure at the end of life. BACKGROUND Heart failure is a burdensome condition and mortality rates are high globally. There is substantive literature describing suffering and unmet needs but description of the experience of fear and the relationship with symptom burden is limited. DESIGN A convergent mixed methods design was used. METHODS Data from the McGill Quality of Life Questionnaire (n = 55) were compared to data from in-depth interviews (n = 5). RESULTS Patients denied fear when asked directly, but frequently referred to moments of being afraid when they were experiencing symptoms. In addition, patients reported few troublesome symptoms on the survey, but mentioned many more symptoms during interviews. CONCLUSIONS These data not only identify the relationship between psychological issues and symptom experience but also elucidate the benefit of a mixed method approach in describing such experiences from the perspective of the patient. Future research should examine relationships between and among symptom experience, fear and other psychological constructs across the illness trajectory. RELEVANCE TO CLINICAL PRACTICE Conversations about the interaction of symptom burden and fear can lead to both a more robust assessment of symptoms and lead to patient centred interventions.
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Affiliation(s)
- Martha Abshire
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Jiayun Xu
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Cheryl Dennison Himmelfarb
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA.,School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | - Daniel Sulmasy
- School of Medicine, University of Chicago, Chicago, IL, USA.,Divinity School, University of Chicago, Chicago, IL, USA
| | - Joan Kub
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA.,School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Mark Hughes
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Marie Nolan
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA.,Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
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Affiliation(s)
- Joan Kub
- Johns Hopkins University School of Nursing
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Kub J, Kulbok PA, Glick D. Cornerstone Documents, Milestones, and Policies: Shaping the Direction of Public Health Nursing 1890-1950. Online J Issues Nurs 2015; 20:3. [PMID: 26882422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The interplay of policy, milestone events, and cornerstone documents was critical in the evolution of the specialty of public health nursing (PHN) from 1890-1950. Using our contemporary lens, this article examines PHN development from an historical perspective, including events and milestones driving growth in the early 20th century. Some of the challenges faced by our founding public health nursing leadership are not unlike challenges we face today. In 1950, Ruth Hubbard, a former leader in the National Organization of Public Health Nurses and Director of the Visiting Nurse Society of Philadelphia, spoke of the value of examining the past to forge a new future. This article calls for contemporary public health nurses to act upon the lessons learned from the past, to strengthen the renewed focus on prevention, to develop policies that impact population health, and to foster a vision that will guide us into the future.
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Butz AM, Ogborn J, Mudd S, Ballreich J, Tsoukleris M, Kub J, Bellin M, Bollinger ME. Factors associated with high short-acting β2-agonist use in urban children with asthma. Ann Allergy Asthma Immunol 2015; 114:385-92. [PMID: 25840499 DOI: 10.1016/j.anai.2015.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 02/10/2015] [Accepted: 03/03/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND One goal of guideline-based asthma therapy is minimal use of short-acting β₂ agonist (SABA) medications. Inner-city children with asthma are known to have high SABA use. OBJECTIVE To examine factors associated with high SABA use in inner-city children with asthma. METHODS One hundred inner-city children with persistent asthma were enrolled into a randomized controlled trial of an emergency department (ED) and home intervention. All children underwent serologic allergen specific IgE and salivary cotinine testing at the ED enrollment visit. Pharmacy records for the past 12 months were obtained. Number of SABA fills during the past 12 months was categorized into low- to moderate- vs high-use groups. SABA groups were compared by the number of symptom days and nights, allergen sensitization, and exposures. Regression models were used to predict high SABA use. RESULTS Mean number of SABA fills over 12 months was 3.12. Unadjusted bivariate analysis showed that high SABA users were more than 5 times more likely to have an asthma hospitalization, almost 3 times more likely to have an asthma intensive care unit admission, and more than 3 times more likely to have prior specialty asthma care or positive cockroach sensitization than low to moderate SABA users. In the final regression model, for every additional inhaled corticosteroid fill, a child was 1.4 times more likely and a child with positive cockroach sensitization was almost 7 times more likely to have high SABA use when controlling for prior intensive care unit admission, receipt of specialty care, child age, and income. CONCLUSION Providers should closely monitor SABA and controller medication use, allergen sensitization, and exposures in children with persistent asthma. TRIAL REGISTRATION ClinicalTrials.gov, identifier NCT01981564.
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Affiliation(s)
- Arlene M Butz
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Jean Ogborn
- Department of Pediatric Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shawna Mudd
- The Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Jeromie Ballreich
- The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Mona Tsoukleris
- The University of Maryland School of Pharmacy, Baltimore, Maryland
| | - Joan Kub
- The Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Melissa Bellin
- The University of Maryland School of Social Work, Baltimore, Maryland
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Xu J, Nolan MT, Heinze K, Yenokyan G, Hughes MT, Johnson J, Kub J, Tudor C, Sulmasy DP, Lehmann LS, Gallo JJ, Rockko F, Lee MC. Symptom frequency, severity, and quality of life among persons with three disease trajectories: cancer, ALS, and CHF. Appl Nurs Res 2015; 28:311-5. [PMID: 26608431 DOI: 10.1016/j.apnr.2015.03.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 12/30/2014] [Accepted: 03/05/2015] [Indexed: 12/14/2022]
Abstract
PURPOSE National reports on end-of-life symptom management reveal a gap in the evidence regarding symptoms other than pain and studies of diseases other than cancer. This study examines the frequency and severity of symptoms and quality of life (QOL) in persons with advanced cancer, amyotrophic lateral sclerosis (ALS), and congestive heart failure (CHF). METHODS The present study is a cross-sectional examination of symptoms and QOL measured using the McGill QOL Questionnaire, among 147 participants. RESULTS Forty one percent of participants had advanced cancer, 22% had ALS, and 37% had advanced CHF. A total of 266 symptoms were reported, with the common symptom categories being discomfort/pain, weakness/fatigue/sleep, and respiratory. Participants with CHF had the highest mean symptom severity and the lowest QOL. CONCLUSION Clinicians should be aware and attentive for symptoms other than pain in patients with advanced illness. Studies on diseases other than cancer, such as CHF and ALS, are important to improve symptom management in all disease groups.
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Affiliation(s)
- Jiayun Xu
- Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA.
| | - Marie T Nolan
- Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA.
| | - Katherine Heinze
- Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA.
| | - Gayane Yenokyan
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Mark T Hughes
- Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
| | - Julie Johnson
- The University of Chicago Medicine, Chicago, IL 60637, USA.
| | - Joan Kub
- Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA.
| | - Carrie Tudor
- Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA.
| | | | | | - Joseph J Gallo
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Felicia Rockko
- Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA.
| | - Mei Ching Lee
- Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA.
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Farley JE, Kelly AM, Reiser K, Brown M, Kub J, Davis JG, Walshe L, Van der Walt M. Development and evaluation of a pilot nurse case management model to address multidrug-resistant tuberculosis (MDR-TB) and HIV in South Africa. PLoS One 2014; 9:e111702. [PMID: 25405988 PMCID: PMC4236054 DOI: 10.1371/journal.pone.0111702] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 10/07/2014] [Indexed: 11/18/2022] Open
Abstract
Setting Multidrug-resistant tuberculosis (MDR-TB) unit in KwaZulu-Natal, South Africa. Objective To develop and evaluate a nurse case management model and intervention using the tenets of the Chronic Care Model to manage treatment for MDR-TB patients with a high prevalence of human immunodeficiency virus (HIV) co-infection. Design A quasi-experimental pilot programme utilizing a nurse case manager to manage care for 40 hospitalized MDR-TB patients, 70% HIV co-infected, during the intensive phase of MDR-TB treatment. Patients were followed for six months to compare proximal outcomes identified in the model between the pre- and post-intervention period. Results The greatest percent differences between baseline and six-month MDR-TB proximal outcomes were seen in the following three areas: baseline symptom evaluation on treatment initiation (95% improvement), baseline and monthly laboratory evaluations completed per guidelines (75% improvement), and adverse drug reactions acted upon by medical and/or nursing intervention (75% improvement). Conclusion Improvements were identified in guideline-based treatment and monitoring of adverse drug reactions following implementation of the nurse case management intervention. Further study is required to determine if the intervention introduced in this model will ultimately result in improvements in final MDR-TB treatment outcomes.
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Affiliation(s)
- Jason E. Farley
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, United States of America
- * E-mail:
| | - Ana M. Kelly
- College of Nursing, Michigan State University, East Lansing, Michigan, United States of America
| | - Katrina Reiser
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Maria Brown
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Joan Kub
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, United States of America
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Jeane G. Davis
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Louise Walshe
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Martie Van der Walt
- Tuberculosis Epidemiology and Intervention Research Unit, Medical Research Council, Pretoria, South Africa
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Bellin M, Osteen P, Collins K, Butz A, Land C, Kub J. The influence of community violence and protective factors on asthma morbidity and healthcare utilization in high-risk children. J Urban Health 2014; 91:677-89. [PMID: 24889008 PMCID: PMC4134443 DOI: 10.1007/s11524-014-9883-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We examined the longitudinal effects of community risk and protective factors on asthma morbidity and healthcare utilization. Three hundred urban caregivers of children with poorly controlled asthma were enrolled in a randomized controlled trial testing the effectiveness of a behavioral/educational intervention and completed measures of exposure to community violence (ECV), social cohesion (SC), informal social control (ISC), child asthma control, child asthma symptom days/nights, and healthcare utilization. Latent growth curve modeling examined the direct and interaction effects of ECV, SC, and ISC on the asthma outcomes over 12 months. Caregivers were primarily the biological mother (92 %), single (70 %), and poor (50 % earned less than $10,000). Children were African American (96 %) and young (mean age = 5.5 years, SD = 2.2). ECV at baseline was high, with 24.7 % of caregivers reporting more than two exposures to violence in the previous 6 months (M = 1.45, SD = 1.61). Caregiver ECV-predicted asthma-related healthcare utilization at baseline (b = 0.19, SE = 0.07, p = 0.003) and 2 months (b = 0.12, s.e. = 0.05, p = 0.04). ISC and SC moderated the effect of ECV on healthcare utilization. Our findings suggest that multifaceted interventions that include strategies to curb violence and foster feelings of cohesion among low-income urban residents may be needed to reduce asthma-related emergency services.
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Butz AM, Halterman J, Bellin M, Kub J, Tsoukleris M, Frick KD, Thompson RE, Land C, Bollinger ME. Improving preventive care in high risk children with asthma: lessons learned. J Asthma 2014; 51:498-507. [PMID: 24517110 PMCID: PMC4428172 DOI: 10.3109/02770903.2014.892608] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Rates of preventive asthma care after an asthma emergency department (ED) visit are low among inner-city children. The objective of this study was to test the efficacy of a clinician and caregiver feedback intervention (INT) on improving preventive asthma care following an asthma ED visit compared to an attention control group (CON). METHODS Children with persistent asthma and recent asthma ED visits (N = 300) were enrolled and randomized into a feedback intervention or an attention control group and followed for 12 months. All children received nurse visits. Data were obtained from interviews, child salivary cotinine levels and pharmacy records. Standard t-test, chi-square and multiple logistic regression tests were used to test for differences between the groups for reporting greater than or equal to two primary care provider (PCP) preventive care visits for asthma over 12 months. RESULTS Children were primarily male, young (3-5 years), African American and Medicaid insured. Mean ED visits over 12 months was high (2.29 visits). No difference by group was noted for attending two or more PCP visits/12 months or having an asthma action plan (AAP). Children having an AAP at baseline were almost twice as likely to attend two or more PCP visits over 12 months while controlling for asthma control, group status, child age and number of asthma ED visits. CONCLUSIONS A clinician and caregiver feedback intervention was unsuccessful in increasing asthma preventive care compared to an attention control group. Further research is needed to develop interventions to effectively prevent morbidity in high risk inner-city children with frequent ED utilization.
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Affiliation(s)
- Arlene M. Butz
- Department of Pediatrics, School of Medicine, Baltimore, MD, USA
- School of Nursing, The Johns Hopkins University, Baltimore, MD, USA
| | - Jill Halterman
- Department of Pediatrics, School of Medicine and Dentistry, The University of Rochester, Rochester, NY, USA
| | - Melissa Bellin
- School of Social Work, The University of Maryland, Baltimore, MD, USA
| | - Joan Kub
- School of Nursing, The Johns Hopkins University, Baltimore, MD, USA
| | - Mona Tsoukleris
- School of Pharmacy, The University of Maryland, Baltimore, MD, USA
| | - Kevin D. Frick
- Department of Health Policy and Management and Carey Business School, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD, USA
| | - Richard E. Thompson
- Department of Biostatistics, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD, USA
| | - Cassia Land
- Department of Pediatrics, School of Medicine, Baltimore, MD, USA
| | - Mary E. Bollinger
- Department Pediatrics, School of Medicine, The University of Maryland, Baltimore, MD, USA
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Sabri B, St Vil NM, Campbell JC, Fitzgerald S, Kub J, Agnew J. Racial and ethnic differences in factors related to workplace violence victimization. West J Nurs Res 2014; 37:180-96. [PMID: 24658287 DOI: 10.1177/0193945914527177] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Workplace violence (WPV) is a significant public health concern affecting all racial or ethnic groups. This study examined whether different racial/ethnic groups differed in vulnerability to WPV exposure and utilization of resources at the workplace. This cross-sectional research focused on White, Black, and Asian nursing employees (N = 2,033) employed in four health care institutions in a mid-Atlantic U.S. metropolitan area. Whereas childhood physical abuse was significantly related to risk of WPV among workers from all racial/ethnic backgrounds, intimate partner abuse was a significant factor for Asians and Whites. Blacks and Asians were found to be less likely than Whites to be knowledgeable about WPV resources or use resources to address WPV. Services to address past trauma, and education and training opportunities for new workers may reduce risk of WPV and promote resource utilization among minority workers.
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Affiliation(s)
| | | | | | | | - Joan Kub
- Johns Hopkins University, Baltimore, MD, USA
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Abstract
PURPOSE The purpose of this study was to explore the experiences of volunteer nurses after the Haiti earthquake, January 2010. DESIGN A descriptive qualitative study design using in-depth interviews focuses on experiences of 12 American nurse volunteers who served in Haiti following the 2010 earthquake. METHODS Semistructured interviews were conducted in person or by phone using an interview guide. The interviews were audio-taped, transcribed, and checked for accuracy. Data analysis was assisted using NVivo9. FINDINGS Six themes emerged: initial shock, relentless work, substituting and making do, questioning, systems building, and transitioning back. CONCLUSIONS AND IMPLICATIONS Nurses who are interested in volunteering after a disaster can expect the experience to be overwhelming and will require them to exercise great flexibility, creativity, and strength in their nursing practice. Nurse volunteers can expect a rewarding experience that will likely change their perspective on nursing work and personal life.
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Affiliation(s)
- Elizabeth Sloand
- School of Nursing, Johns Hopkins University, Baltimore, Maryland 21205, USA.
| | - Grace Ho
- School of Nursing, Johns Hopkins University, Baltimore, Maryland 21205, USA
| | - Joan Kub
- School of Nursing, Johns Hopkins University, Baltimore, Maryland 21205, USA
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Bellin MH, Kub J, Frick KD, Bollinger ME, Tsoukleris M, Walker J, Land C, Butz AM. Stress and quality of life in caregivers of inner-city minority children with poorly controlled asthma. J Pediatr Health Care 2013; 27:127-34. [PMID: 23414978 PMCID: PMC3575578 DOI: 10.1016/j.pedhc.2011.09.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 09/21/2011] [Accepted: 09/30/2011] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Caregiver quality of life (QOL) is known to influence asthma management behaviors. Risk factors for low caregiver QOL in families of inner-city children with asthma remain unclear. This study evaluated the interrelationships of asthma control, stress, and caregiver QOL. METHOD Data were analyzed from a home-based behavioral intervention for children with persistent asthma after treatment for asthma in the emergency department. Caregivers reported on baseline demographics, asthma control, asthma management stress, life stress, and QOL. Hierarchical regression analysis examined the contributions of sociodemographic factors, asthma control, asthma management stress, and life stress in explaining caregiver QOL. RESULTS Children (N = 300) were primarily African American (96%) and young (mean age, 5.5 years). Caregivers were predominantly the biological mother (92%), single (70%), and unemployed (54%). Poor QOL was associated with higher caregiver education and number of children in the home, low asthma control, and increased asthma management stress and life stress. The model accounted for 28% of variance in caregiver QOL. DISCUSSION Findings underscore the need for multifaceted interventions to provide tools to caregivers of children with asthma to help them cope with asthma management demands and contemporary life stressors.
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Affiliation(s)
- Melissa H Bellin
- Health Specialization, School of Social Work, University of Maryland, Baltimore, MD 21201, USA.
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Abstract
Although the scientific understanding of the pathophysiology of asthma and the quality of asthma therapies have significantly improved over the past 30 years, asthma morbidity remains high and preventive care low for inner-city children. This article focuses on 4 major challenges to providing preventive care (family and patient attitudes and beliefs, lack of access to quality medical care, psychosocial factors, environmental factors) based on prior evidence and the authors' observation of these challenges in research with inner-city children with asthma over the past decade. Cost issues related to preventive care are addressed, and recommendations provide for pediatric nurses.
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Affiliation(s)
- Arlene M Butz
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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Abstract
We examine current perceptions and constraints surrounding condom use among young adults in the Philippines to garner a deeper contextual understanding of this aspect of HIV prevention within Filipino society. Through thematic analysis of focus group data, we found three broad themes, all of which include societal and individual barriers to using condoms. The findings may provide insight for similar settings in which religion has a strong influence on society. To strengthen HIV prevention efforts in such settings, we suggest that the development of strategies to address these constraints and promote healthy sexuality in young adults is essential.
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Butz AM, Halterman JS, Bellin M, Kub J, Frick KD, Lewis-Land C, Walker J, Donithan M, Tsoukleris M, Bollinger ME. Factors associated with completion of a behavioral intervention for caregivers of urban children with asthma. J Asthma 2012; 49:977-88. [PMID: 22991952 PMCID: PMC3773483 DOI: 10.3109/02770903.2012.721435] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Rates of preventive follow-up asthma care after an acute emergency department (ED) visit are low among inner-city children. We implemented a novel behavioral asthma intervention, Pediatric Asthma Alert (PAAL) intervention, to improve outpatient follow-up and preventive care for urban children with a recent ED visit for asthma. OBJECTIVE The objective of this article is to describe the PAAL intervention and examine factors associated with intervention completers and noncompleters. METHODS Children with persistent asthma and recurrent ED visits (N = 300) were enrolled in a randomized controlled trial of the PAAL intervention that included two home visits and a facilitated follow-up visit with the child's primary care provider (PCP). Children were categorized as intervention completers, that is, completed home and PCP visits compared with noncompleters, who completed at least one home visit but did not complete the PCP visit. Using chi-square test of independence, analysis of variance, and multiple logistic regression, the intervention completion status was examined by several sociodemographic, health, and caregiver psychological variables. RESULTS Children were African-American (95%), Medicaid insured (91%), and young (aged 3-5 years, 56%). Overall, 71% of children randomized to the intervention successfully completed all home and PCP visits (completers). Factors significantly associated with completing the intervention included younger age (age 3-5 years: completers, 65.4%; noncompleters, 34.1%; p < .001) and having an asthma action plan in the home at baseline (completers: 40%; noncompleters: 21%; p = .02). In a logistic regression model, younger child age, having an asthma action plan, and lower caregiver daily asthma stress were significantly associated with successful completion of the intervention. CONCLUSIONS The majority of caregivers of high-risk children with asthma were successfully engaged in this home and PCP-based intervention. Caregivers of older children with asthma and those with high stress may need additional support for program completion. Further, the lack of an asthma action plan may be a marker of preexisting barriers to preventive care.
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Affiliation(s)
- Arlene M Butz
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Šourek Z, Kopecký M, Kub J, Fábry J, Hlinka J. Atomic ordering in PbMgTaO recovered from the anomalous X-ray scattering. Acta Crystallogr A 2012. [DOI: 10.1107/s0108767312095414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Sloand E, Ho G, Klimmek R, Pho A, Kub J. Nursing children after a disaster: a qualitative study of nurse volunteers and children after the Haiti earthquake. J SPEC PEDIATR NURS 2012; 17:242-53. [PMID: 22734877 DOI: 10.1111/j.1744-6155.2012.00338.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to explore the experiences of nurse volunteers caring for children after the Haiti earthquake in January 2010. DESIGN AND METHODS This descriptive qualitative study using in-depth interviews focuses on the experiences of 10 nurse volunteers. RESULTS Four themes emerged: hope amid devastation, professional compromises, universality of children, and emotional impact on nurses. PRACTICE IMPLICATIONS Nurses who volunteer after natural disasters have rich personal and professional experiences, including extremes of sadness and joy. Nurse volunteers will likely need to care for children. Nurses and humanitarian agencies should prepare for the unique challenges of pediatric care.
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Affiliation(s)
- Elizabeth Sloand
- Johns Hopkins University, School of Nursing, Baltimore, Maryland, USA.
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Lucea MB, Hindin MJ, Kub J, Campbell JC. HIV risk, partner violence, and relationship power among Filipino young women: testing a structural model. Health Care Women Int 2012; 33:302-20. [PMID: 22420674 DOI: 10.1080/07399332.2011.646369] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
A person's ability to minimize HIV risk is embedded in a complex, multidimensional context. In this study, we tested a model of how relationship power impacts IPV victimization, which in turn impacts HIV risk behaviors. We analyzed data from 474 young adult women (aged 15-31) in Cebu Province, Philippines, using structural equation modeling, and demonstrated good fit for the models. High relationship power is directly associated with increased IPV victimization, and IPV victimization is positively associated with increased HIV risk. We highlight in this article the complex dynamics to consider in HIV risk prevention among these young women.
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Cavanaugh CE, Messing JT, Petras H, Fowler B, La Flair L, Kub J, Agnew J, Fitzgerald S, Bolyard R, Campbell JC. Patterns of Violence Against Women: A Latent Class Analysis. Psychol Trauma 2012; 4:169-176. [PMID: 22662284 PMCID: PMC3362828 DOI: 10.1037/a0023314] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study examined patterns of nine types of violence against women (VAW) and associated mental health problems. The following self-reported, lifetime violence victimization was examined among 1424 employed women: (1) childhood physical abuse, (2) childhood sexual abuse, (3) physical abuse between parents/guardians during childhood, (4) psychological intimate partner violence (IPV), (5) physical IPV, (6) sexual IPV, (7) adult physical or sexual assault by a non-intimate partner, (8) physical workplace violence, and (9) psychological workplace violence. Latent class analysis was used to identify homogenous patterns, called "classes," of women's "yes/no" responses to experiencing these types of violence. The best model consisted of 4-classes characterized by the following probabilities: low violence (class 1: 63.1%), high psychological and physical IPV (class 2: 15.6%), high physical and psychological workplace violence (class 3: 12.4%), and moderate to high childhood abuse (class 4: 9.0%). When compared to class 1 (low violence), membership in classes 2 (IPV) and 4 (childhood abuse) was associated with screening positive for depression in the past week at baseline after controlling for the influence of demographic characteristics on class membership. Also, when compared to class 1 (low all), membership in class 2 (IPV) was associated with greater odds of screening positive for posttraumatic stress disorder in the past month at the six month follow-up assessment. Findings document distinct patterns of VAW and associated proximal and distal mental health outcomes. Implications for interventions aimed to improve employed women's health are discussed.
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Affiliation(s)
| | | | | | | | | | - Joan Kub
- Johns Hopkins University School of Nursing
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Šourek Z, Kopecký M, Kub J, Fábry J, Novák V, Cukr M. Real-structure anisotropy in GaMnAs layers. Acta Crystallogr A 2011. [DOI: 10.1107/s0108767311088866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Sharma RK, Hughes MT, Nolan MT, Tudor C, Kub J, Terry PB, Sulmasy DP. Family understanding of seriously-ill patient preferences for family involvement in healthcare decision making. J Gen Intern Med 2011; 26:881-6. [PMID: 21499822 PMCID: PMC3138973 DOI: 10.1007/s11606-011-1717-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Revised: 03/25/2011] [Accepted: 03/28/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Surrogate accuracy in predicting patient treatment preferences (i.e., what patients want) has been studied extensively, but it is not known whether surrogates can predict how patients want loved ones to make end-of-life decisions on their behalf. OBJECTIVE To evaluate the ability of family members to correctly identify the preferences of seriously-ill patients regarding family involvement in decision making. DESIGN Cross-sectional survey. PARTICIPANTS Twenty-five pancreatic cancer and 27 amyotrophic lateral sclerosis (ALS) patients and their family members (52 dyads total). MAIN MEASURES Patients and family members completed the Decision Control Preferences (DCP) scale regarding patient preferences for family involvement in health care decisions using conscious and unconscious scenarios. KEY RESULTS Patient and family member agreement was 56% (29/52 dyads) for the conscious scenario (kappa 0.29) and 46% (24/52 dyads) for the unconscious scenario (kappa 0.15). Twenty-four family members identified the patient's preference as independent in the unconscious scenario, but six of these patients actually preferred shared decision making and six preferred reliant decision making. In the conscious scenario, preference for independent decision making was associated with higher odds of patient-family agreement (AOR 5.28, 1.07-26.06). In the unconscious scenario, cancer patients had a higher odds of agreement than ALS patients (AOR 3.86; 95% CI 1.02-14.54). CONCLUSION Family members were often unable to correctly identify patient preferences for family involvement in end-of-life decision making, especially when patients desired that decisions be made using the best-interest standard. Clinicians and family members should consider explicitly eliciting patient preferences for family involvement in decision making. Additional research is still needed to identify interventions to improve family member understanding of patient preferences regarding the decision-making process itself.
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Affiliation(s)
- Rashmi K Sharma
- Division of Hospital Medicine, Northwestern University, Chicago, IL 60611, USA.
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Butz AM, Halterman JS, Bellin M, Tsoukleris M, Donithan M, Kub J, Thompson RE, Land CL, Walker J, Bollinger ME. Factors associated with second-hand smoke exposure in young inner-city children with asthma. J Asthma 2011; 48:449-57. [PMID: 21545248 DOI: 10.3109/02770903.2011.576742] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To examine the association of social and environmental factors with levels of second-hand smoke (SHS) exposure, as measured by salivary cotinine, in young inner-city children with asthma. METHODS We used data drawn from a home-based behavioral intervention for young high-risk children with persistent asthma post-emergency department (ED) treatment (N = 198). SHS exposure was measured by salivary cotinine and caregiver reports. Caregiver demographic and psychological functioning, household smoking behavior, and asthma morbidity were compared with child cotinine concentrations. Chi-square and ANOVA tests and multivariate regression models were used to determine the association of cotinine concentrations with household smoking behavior and asthma morbidity. RESULTS Over half (53%) of the children had cotinine levels compatible with SHS exposure and mean cotinine concentrations were high at 2.42 ng/ml (SD 3.2). The caregiver was the predominant smoker in the home (57%) and 63% reported a total home smoking ban. Preschool aged children and those with caregivers reporting depressive symptoms and high stress had higher cotinine concentrations than their counterparts. Among children living in a home with a total home smoking ban, younger children had significantly higher mean cotinine concentrations than older children (cotinine: 3-5 year olds, 2.24 ng/ml (SD 3.5); 6-10 year olds, 0.63 ng/ml (SD 1.0); p < .05). In multivariate models, the factors most strongly associated with high child cotinine concentrations were increased number of household smokers (β = 0.24) and younger child age (3-5 years) (β = 0.23; p < .001, R(2) = 0.35). CONCLUSION Over half of the young inner-city children with asthma were exposed to SHS, and caregivers are the predominant household smokers. Younger children and children with depressed and stressed caregivers are at significant risk of smoke exposures, even when a household smoking ban is reported. Further advocacy for these high-risk children is needed to help caregivers quit and to mitigate smoke exposure.
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Affiliation(s)
- Arlene M Butz
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
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Butz A, Kub J, Donithan M, James NT, Thompson RE, Bellin M, Tsoukleris M, Bollinger ME. Influence of caregiver and provider communication on symptom days and medication use for inner-city children with asthma. J Asthma 2010; 47:478-85. [PMID: 20528605 DOI: 10.3109/02770901003692793] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Effective pediatric guideline-based asthma care requires the caregiver to accurately relay the child's symptom frequency, pattern of rescue and controller medication use, and level of asthma control to the child's primary care clinician. OBJECTIVE This study evaluated the longitudinal effects of a caregiver-clinician asthma communication education intervention (ACE) relative to an asthma education control group (CON) on symptom days and controller medication use in inner-city children with asthma. PARTICIPANTS AND METHODS 231 inner-city children with asthma, recruited from urban pediatric emergency departments (EDs) and community practices, were followed for 12 months. Data included number of symptom days and nights, ED visits, hospitalizations, presence of limited activity, and controller medication use over 12 months. Pharmacy records were used to calculate controller to total asthma medication ratios as a proxy of appropriate controller medication use. Multivariate logistic regression models were used to identify factors associated with number of symptom days and nights over the past 30 days at the 12-month follow-up. RESULTS Most caregivers rated the communication with their child's clinician as high. Unadjusted and adjusted rates of symptom days and nights did not differ by group at follow-up. ACE children tended towards a higher controller to total medication ratio at 12 months as compared to CON children (mean ratio: ACE: 0.54, SD 0.3; CON, 0.45, SD 0.4; p = .07). Activity limitation due to asthma and persistent asthma severity were the only factors significantly associated with reporting any symptom day within the past 30 days, adjusting for treatment group, number of oral corticosteroid courses and number of clinician visits in the last 6 months, seasonality, insurance type, and controller to total asthma medication ratio covariates. CONCLUSION A home-based caregiver asthma communication educational intervention was not associated with decreased symptom days. However, a trend was noted in higher controller to total medication ratios in the intervention group. Inner-city caregivers of children with asthma may require a health systems approach to help convey the child's asthma health information to their clinician.
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Affiliation(s)
- Arlene Butz
- School of Medicine, Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland 21287, USA.
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Bracken MI, Messing JT, Campbell JC, La Flair LN, Kub J. Intimate partner violence and abuse among female nurses and nursing personnel: prevalence and risk factors. Issues Ment Health Nurs 2010; 31:137-48. [PMID: 20070228 DOI: 10.3109/01612840903470609] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study examines the prevalence and risk factors for intimate partner violence (IPV) and intimate partner abuse (IPA) against female nurses and nursing personnel (n = 1981). Data were collected through online surveys conducted at three hospitals and one geriatric care center in a Mid-Atlantic US metropolitan area. Lifetime physical or sexual IPV was reported by 25% of participants and 22.8% reported experiencing lifetime emotional abuse by an intimate partner. Logistic regression analyses identified independent variables statistically related to IPV and IPA, including increased age, having children, not being married, and experiences of childhood abuse. Implications for women in the workplace are discussed.
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Affiliation(s)
- Michele Irene Bracken
- Salisbury University, School of Nursing, 1101 Camden Ave., Salisbury, MA 21801, USA.
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Abstract
The health of individuals occurs within the context of their environment and the other individuals they interact with in the communities they live in, work in and visit. Promoting the health of the public requires multiple strategies aimed at improving the environment, the health knowledge of groups and individuals, maintaining adequate food and water, and reducing the spread of disease. Many disciplines are needed to meet these goals, but the largest segment of the professional health work force required to meet these needs is nursing. Historically, nursing leaders in public health such as Florence Nightingale and Lillian Wald made significant inroads related to serious health issues because they were nurses. Today across the globe, nurses provide the key components of public health interventions including well baby care, health education, screening and immunization clinics, disaster management and emergency preparedness. With the growing nursing shortage in acute care settings, the brain drain of nurses from certain areas of the world, the shrinking public dollars for preventive health care, the nursing workforce needed to continue to provide these essential health care services is threatened. It is essential to put the spot light on nursing's role in public health with the hopes of attracting more public funds and more nurses to provide these essential services.
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Kub J, Jennings JM, Donithan M, Walker JM, Land CL, Butz A. Life events, chronic stressors, and depressive symptoms in low-income urban mothers with asthmatic children. Public Health Nurs 2009; 26:297-306. [PMID: 19573208 DOI: 10.1111/j.1525-1446.2009.00784.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This secondary data analysis study examines the relationship between maternal sociodemographic variables, life events, chronic stressors, including asthma control and management and environmental stressors, and maternal depression. DESIGN Cross-sectional descriptive design study consisting of baseline data from participants enrolled in a randomized asthma communication educational intervention trial. SAMPLE 201 mothers of children with asthma (ages 6-12), recruited from community pediatric practices and emergency departments of 2 urban university hospitals. MEASUREMENT Life events were measured using standardized items. Chronic stressors were measured using items from the International Asthma and Allergies in Childhood study and maternal and child exposure to violence. Depressive symptoms were assessed with the Center for Epidemiologic Studies-Depression scale. RESULTS Close to 25% of the mothers had high depressive symptoms. In separate multiple logistic regression models, education (adjusted odds ratio [AOR]=2.62; 95% confidence interval [CI]=1.07, 6.39) or unemployment (AOR=2.38; 95% CI=1.16, 4.90) and the use of quick relief medications (AOR=2.74; 95% CI=1.33, 5.66) for asthma were positively associated with depressive symptoms. CONCLUSIONS Implications include the need to assess maternal depressive symptoms of mothers of children with asthma, in order to improve asthma management for low-income urban children.
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Affiliation(s)
- Joan Kub
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA.
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Zemek J, Houdkova J, Jiricek P, Jablonski A, Jurka V, Kub J. Determination of electron inelastic mean free paths for poly[methyl(phenyl)silylene] films. POLYMER 2009. [DOI: 10.1016/j.polymer.2009.03.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Violence disproportionately affects low- and middle-income countries. Deeper understanding is needed in areas where little research has occurred. The objectives of the study were to: (a) ascertain rate of homicide death; (b) describe the victims and circumstances surrounding their deaths in Dar es Salaam, Tanzania in 2005. This study was developed by adapting the WHO/CDC Injury Surveillance Guidelines (Holder et al., 2001). Data on 12 variables were collected on all homicide deaths. Descriptive statistics and hypothesis tests were done when appropriate. Age standardised, age-specific and cause-specific mortality rates are presented. The overall homicide rate was 12.57 (males and females respectively: 22.26 and 2.64). Homicide deaths were 93.4% male, mostly unemployed, with a mean age of 28.2 years. Most deaths occurred in urban areas. Mob violence was the cause of 57% of deaths. The risk of homicide death for males was greater than the world average, but for females it was less. Most homicides were committed by community members policing against thieves.
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Affiliation(s)
- Anne H Outwater
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania.
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