The relationships between coping, occupational stress, and emotional intelligence in newly hired oncology nurses

OBJECTIVES

Associations between the varying levels of emotional intelligence in newly hired oncology nurses and their responses to stress and coping were examined. The secondary aim was to analyze whether emotional intelligence could moderate their choice of problem-focused or emotion-focused coping strategies.

METHODS

Newly hired nurses (n = 114) were recruited from a national cancer institute. Data were collected through surveys using the Ways of Coping Questionnaire, the Nursing Stress Scale, and the Emotional Quotient Inventory between the eighth and twelfth weeks post-hire date. Descriptive and bivariate statistical analyses were conducted on all variables. Regression models determined whether emotional intelligence moderated the choice of coping strategies.

RESULTS

Emotional intelligence had a mean value of M = 105.24, SD = 13.02, and occupational stress scores were M = 65.57, SD = 15.68. Significant negative correlations were found for occupational stress and problem-focused coping (r = -.189, P = .022), emotional intelligence and emotion-focused coping (r = -.340, P = .000), and emotional intelligence and occupational stress (r = -.428, P < 0.001). Positive correlations were noted between occupational stress and emotion-focused coping (r = .189, P = .022) and emotional intelligence and problem-focused coping (r = .340, P = .000). Emotional intelligence did not predict the choice of coping strategies.

CONCLUSIONS

Although emotional intelligence did not moderate coping strategies in newly hired nurses, using problem focused coping to address occupational stress during the initial employment period may be a protective factor for coping with stress in the oncology workplace.

A qualitative description of service providers' experiences of ethical issues in HIV care

BACKGROUND

Managing HIV treatment is a complex multi-dimensional task because of a combination of factors such as stigma and discrimination of some populations who frequently get infected with HIV. In addition, patient-provider encounters have become increasingly multicultural, making effective communication and provision of ethically sound care a challenge.

PURPOSE

This article explores ethical issues that health service providers in the United States and Botswana encountered in their interaction with patients in HIV care.

RESEARCH DESIGN

A descriptive qualitative design was used to collect data from health service providers and patients using focused group discussions. This article is based on responses from health service providers only.

PARTICIPANTS AND CONTEXT

This article is based on 11 focused group discussions with a total sample of 71 service providers in seven US sites and one Botswana site.

ETHICAL CONSIDERATIONS

Ethical review boards at all the study sites reviewed the study protocol and approved it. Ethical review boards of the study's coordinating centers, Rutgers University and the University of California at San Francisco, also approved it. The study participants provided a written informed consent to participate.

FINDINGS

HIV service providers encountered ethical challenges in all the four Beauchamp and Childress' biomedical ethics of respect for patients' autonomy, beneficence, justice, and nonmaleficence.

DISCUSSION

The finding that HIV service providers encounter ethical challenges in their interaction with patients is supported by prior studies. The ethical challenges are particularly prominent in multicultural care and resource-constrained care environments.

CONCLUSION

Provision of HIV care is fraught with ethical challenges that tend to pose different issues depending on a given care environment. It is important that strong partnerships are developed among key stakeholders in HIV care. In addition, health service providers need to be provided with resources so they can provide quality and ethically sound care.

A multinational qualitative investigation of the perspectives and drivers of exercise and dietary behaviors in people living with HIV

Globally, people living with HIV (PLWH) are at remarkably high risk for developing chronic comorbidities. While exercise and healthy eating reduce and mitigate chronic comorbidites, PLWH like many others, often fail to engage in recommended levels. We qualitatively examined the perspectives and contextual drivers of diet and exercise reported by PLWH and their health care providers. Two hundred and six participants across eight sites in the United States, Puerto Rico and Botswana described one overarching theme, Arranging Priorities, and four subthemes Defining Health, Perceived Importance of Diet and Exercise, Competing Needs, and Provider Influence. People living with HIV and their health care providers recognize the importance of eating a healthy diet and engaging in regular exercise. Yet there are HIV-specific factors limiting these behaviors that should be addressed. Health care providers have an important, and often underutilized opportunity to support PLWH to make improvements to their exercise and diet behavior.

90-90-90-Plus: Maintaining Adherence to Antiretroviral Therapies

Medication adherence is the "Plus" in the global challenge to have 90% of HIV-infected individuals tested, 90% of those who are HIV positive treated, and 90% of those treated achieve an undetectable viral load. The latter indicates viral suppression, the goal for clinicians treating people living with HIV (PLWH). The comparative importance of different psychosocial scales in predicting the level of antiretroviral adherence, however, has been little studied. Using data from a cross-sectional study of medication adherence with an international convenience sample of 1811 PLWH, we categorized respondent medication adherence as None (0%), Low (1-60%), Moderate (61-94%), and High (95-100%) adherence based on self-report. The survey contained 13 psychosocial scales/indices, all of which were correlated with one another (p < 0.05 or less) and had differing degrees of association with the levels of adherence. Controlling for the influence of race, gender, education, and ability to pay for care, all scales/indices were associated with adherence, with the exception of Berger's perceived stigma scale. Using forward selection stepwise regression, we found that adherence self-efficacy, depression, stressful life events, and perceived stigma were significant predictors of medication adherence. Among the demographic variables entered into the model, nonwhite race was associated with double the odds of being in the None rather than in the High adherence category, suggesting these individuals may require additional support. In addition, asking about self-efficacy, depression, stigma, and stressful life events also will be beneficial in identifying patients requiring greater adherence support. This support is essential to medication adherence, the Plus to 90-90-90.

Sexual transmission-risk behaviour among HIV-positive persons: a multisite study using social action theory

AIM

Sexual risk behaviour was explored and described using Social Action Theory.

BACKGROUND

The sexual transmission of HIV is complex and multi-factorial. Social Action Theory provides a framework for viewing self-regulation of modifiable behaviour such as condom use. Condom use is viewed within the context of social interaction and interdependence.

DESIGN

Cross-sectional survey.

METHODS

Self-report questionnaire administered to adults living with HIV/AIDS, recruited from clinics, service organizations and by active outreach, between 2010 - 2011.

FINDINGS

Having multiple sex partners with inconsistent condom use during a 3-month recall period was associated with being male, younger age, having more years of education,substance use frequency and men having sex with men being a mode of acquiring HIV. In addition, lower self-efficacy for condom use scores were associated with having multiple sex partners and inconsistent condom use.

CONCLUSION

Social Action Theory provided a framework for organizing data from an international sample of seropositive persons. Interventions for sexually active, younger, HIV positive men who have sex with men, that strengthen perceived efficacy for condom use, and reduce the frequency of substance use, may contribute to reducing HIV-transmission risk.

Language and Culture in Health Literacy for People Living with HIV: Perspectives of Health Care Providers and Professional Care Team Members

Low health literacy has been linked to inadequate engagement in care and may serve as a contributor to poor health outcomes among people living with HIV and AIDS. The purpose of this paper was to examine the perspectives of health care providers and professional care team members regarding health literacy in HIV disease. A secondary data analysis was conducted from a qualitative study aimed at understanding factors that help an HIV positive person to manage their HIV disease. Data were collected from sites in Botswana, the US, and Puerto Rico. In the parent study, data were collected through focus group discussions with 135 people living with HIV, 32 HIV health care providers (HCPs), and 39 HIV professional care team members (PCTMs). SPSS was used to analyze quantitative data while ATLAS.ti was used to analyze qualitative data. The findings from analyses of the perspectives of HCPs/PCTMs suggested that linguistic and cultural factors were important themes in the exchange of HIV information between health care providers and PLHIV. These themes included ineffective communication, health seeking behavior, cultural facilitators, and complementary and alternative/traditional healing methods. Thus, this study suggests that language and culture have a major role in health literacy for PLHIV.

Building Trust and Relationships Between Patients and Providers: An Essential Complement to Health Literacy in HIV Care

Health literacy is important for access to and quality of HIV care. While most models of health literacy acknowledge the importance of the patient-provider relationship to disease management, a more nuanced understanding of this relationship is needed. Thematic analysis from 28 focus groups with HIV-experienced patients (n = 135) and providers (n = 71) identified a long-term and trusting relationship as an essential part of HIV treatment over the continuum of HIV care. We found that trust and relationship building over time were important for patients with HIV as well as for their providers. An expanded definition of health literacy that includes gaining a patient's trust and engaging in a process of health education and information sharing over time could improve HIV care. Expanding clinical perspectives to include trust and the importance of the patient-provider relationship to a shared understanding of health literacy may improve patient experiences and engagement in care.

A Cross-Sectional Relationship Between Social Capital, Self-Compassion, and Perceived HIV Symptoms

CONTEXT

Individual resources of social capital and self-compassion are associated with health behaviors and perceived symptoms, suggesting that both are positive resources that can be modified to improve a person's symptom experience.

OBJECTIVES

The aim was to examine the relationship between self-compassion and social capital and its impact on current HIV symptom experience in adult people living with HIV (PLWH). We further explored the impact of age on this relationship.

METHODS

We conducted a cross-sectional analysis of 2182 PLWH at 20 sites in five countries. Social capital, self-compassion, and HIV symptom experience were evaluated using valid and reliable scales. To account for inflated significance associated with a large sample size, we took a random sample of 28% of subjects (n = 615) and conducted correlation analyses and zero-inflated Poisson regression, controlling for known medical and demographic variables impacting HIV symptom experience.

RESULTS

Controlling for age, sex at birth, year of HIV diagnosis, comorbid health conditions, employment, and income, our model significantly predicted HIV symptom experience (overall model z = 5.77, P < 0.001). Employment status and social capital were consistent, negative, and significant predictors of HIV symptom experience. Self-compassion did not significantly predict HIV symptom experience. For those reporting symptoms, an increase in age was significantly associated with an increase in symptoms.

CONCLUSION

Employment and social capital modestly predicted current HIV symptom experience. Social capital can be incorporated into symptom management interventions, possibly as a way to reframe a person's symptom appraisal. This may be increasingly important as PLWH age. The relationship between employment status and HIV symptom experience was significant and should be explored further.

Key components of an effective mentoring relationship: a qualitative study

BACKGROUND

Despite the recognized importance of mentoring, little is known about specific mentoring behaviors that result in positive outcomes.

OBJECTIVE

To identify key components of an effective mentoring relationship identified by protégés-mentor dyads in an academic setting.

METHODS

In this qualitative study, purposive sampling resulted in geographic diversity and representation of a range of academic disciplines. Participants were from 12 universities in three regions of the U.S. (South, n=5; Northeast, n=4; Midwest, n=2) and Puerto Rico (n=1). Academic disciplines included natural sciences (51%), nursing/health sciences (31%), engineering (8%), and technology (1%). Twelve workshops using the Technology of Participation method were held with 117 mentor-protégé dyads. Consensus was reached regarding the key components of an effective mentoring relationship.

RESULTS

Conventional content analysis, in which coding categories were informed by the literature and derived directly from the data, was employed. Eight themes described key components of an effective mentoring relationship: (1) open communication and accessibility; (2) goals and challenges; (3) passion and inspiration; (4) caring personal relationship; (5) mutual respect and trust; (6) exchange of knowledge; (7) independence and collaboration; and (8) role modeling. Described within each theme are specific mentor-protégé behaviors and interactions, identified needs of both protégé and mentor in the relationship, and desirable personal qualities of mentor and protégé.

CONCLUSIONS

Findings can inform a dialog between existing nurse mentor-protégé dyads as well as student nurses and faculty members considering a mentoring relationship. Nurse educators can evaluate and modify their mentoring behaviors as needed, thereby strengthening the mentor-protégé relationship to ensure positive outcomes of the learning process.

Self-compassion and risk behavior among people living with HIV/AIDS

Sexual risk behavior and illicit drug use among people living with HIV/AIDS (PLWHA) contribute to poor health and onward transmission of HIV. The aim of this collaborative multi-site nursing research study was to explore the association between self-compassion and risk behaviors in PLWHA. As part of a larger project, nurse researchers in Canada, China, Namibia, Puerto Rico, Thailand and the US enrolled 1211 sexually active PLWHA using convenience sampling. The majority of the sample was male, middle-aged, and from the US. Illicit drug use was strongly associated with sexual risk behavior, but participants with higher self-compassion were less likely to report sexual risk behavior, even in the presence of illicit drug use. Self-compassion may be a novel area for behavioral intervention development for PLWHA.

Development and Testing of the Clinical Research Appraisal Inventory-Short Form

Background and Purpose: The National Academy of Sciences stressed the need for a doctorally prepared workforce and earlier entry into doctoral study in nursing and the behavioral, social, and basic sciences. Social Cognitive Career Theory (SCCT) suggests that self-efficacy for career related skills informs career choices. Thus, increasing clinical research self-efficacy early in students’ studies could increase their choice of a research career. To test interventions, a psychometrically sound measure of clinical research self-efficacy is needed. Methods: We examined the psychometrics of the Clinical Research Appraisal Inventory-Short Form (CRAI-SF) in undergraduate and first-year graduate students (N = 268). This scale is a modification of the Clinical Research Appraisal Inventory, which measures physician–scientists’ clinical research self-efficacy. Results: Content validity was supported by external review. Factor analysis revealed six factors explaining 75% of scale variance. Internal consistency of subscales and total scale ranged from .84 to .98. Differences in scores by gender (p = .016) and discipline of study (p = .000) supported construct validity. Conclusions: The CRAI-SF is a useful measure of undergraduate and first-year graduate students’ perceived clinical research self-efficacy.

Depressive symptoms, self-esteem, HIV symptom management self-efficacy and self-compassion in people living with HIV

The aims of this study were to examine differences in self-schemas between persons living with HIV/AIDS with and without depressive symptoms, and the degree to which these self-schemas predict depressive symptoms in this population. Self-schemas are beliefs about oneself and include self-esteem, HIV symptom management self-efficacy, and self-compassion. Beck's cognitive theory of depression guided the analysis of data from a sample of 1766 PLHIV from the USA and Puerto Rico. Sixty-five percent of the sample reported depressive symptoms. These symptoms were significantly (p ≤ 0.05), negatively correlated with age (r = -0.154), education (r = -0.106), work status (r = -0.132), income adequacy (r = -0.204, self-esteem (r = -0.617), HIV symptom self-efficacy (r = - 0.408), and self-kindness (r = - 0.284); they were significantly, positively correlated with gender (female/transgender) (r = 0.061), white or Hispanic race/ethnicity (r = 0.047) and self-judgment (r = 0.600). Fifty-one percent of the variance (F = 177.530 (df = 1524); p < 0.001) in depressive symptoms was predicted by the combination of age, education, work status, income adequacy, self-esteem, HIV symptom self-efficacy, and self-judgment. The strongest predictor of depressive symptoms was self-judgment. Results lend support to Beck's theory that those with negative self-schemas are more vulnerable to depression and suggest that clinicians should evaluate PLHIV for negative self-schemas. Tailored interventions for the treatment of depressive symptoms in PLHIV should be tested and future studies should evaluate whether alterations in negative self-schemas are the mechanism of action of these interventions and establish causality in the treatment of depressive symptoms in PLHIV.

Associations between the legal context of HIV, perceived social capital, and HIV antiretroviral adherence in North America

BACKGROUND

Human rights approaches to manage HIV and efforts to decriminalize HIV exposure/transmission globally offer hope to persons living with HIV (PLWH). However, among vulnerable populations of PLWH, substantial human rights and structural challenges (disadvantage and injustice that results from everyday practices of a well-intentioned liberal society) must be addressed. These challenges span all ecosocial context levels and in North America (Canada and the United States) can include prosecution for HIV nondisclosure and HIV exposure/transmission. Our aims were to: 1) Determine if there were associations between the social structural factor of criminalization of HIV exposure/transmission, the individual factor of perceived social capital (resources to support one's life chances and overcome life's challenges), and HIV antiretroviral therapy (ART) adherence among PLWH and 2) describe the nature of associations between the social structural factor of criminalization of HIV exposure/transmission, the individual factor of perceived social capital, and HIV ART adherence among PLWH.

METHODS

We used ecosocial theory and social epidemiology to guide our study. HIV related criminal law data were obtained from published literature. Perceived social capital and HIV ART adherence data were collected from adult PLWH. Correlation and logistic regression were used to identify and characterize observed associations.

RESULTS

Among a sample of adult PLWH (n = 1873), significant positive associations were observed between perceived social capital, HIV disclosure required by law, and self-reported HIV ART adherence. We observed that PLWH who have higher levels of perceived social capital and who live in areas where HIV disclosure is required by law reported better average adherence. In contrast, PLWH who live in areas where HIV transmission/exposure is a crime reported lower 30-day medication adherence. Among our North American participants, being of older age, of White or Hispanic ancestry, and having higher perceived social capital, were significant predictors of better HIV ART adherence.

CONCLUSIONS

Treatment approaches offer clear advantages in controlling HIV and reducing HIV transmission at the population level. These advantages, however, will have limited benefit for adherence to treatments without also addressing the social and structural challenges that allow HIV to continue to spread among society's most vulnerable populations.

Use of a brief version of the self-compassion inventory with an international sample of people with HIV/AIDS

The objective of this study was to extend the psychometric evaluation of a brief version of the Self-Compassion Scale (SCS). A secondary analysis of data from an international sample of 1967 English-speaking persons living with HIV disease was used to examine the factor structure, and reliability of the 12-item Brief Version Self-Compassion Inventory (BVSCI). A Maximum Likelihood factor analysis and Oblimin with Kaiser Normalization confirmed a two-factor solution, accounting for 42.58% of the variance. The BVSCI supported acceptable internal consistencies, with 0.714 for the total scale and 0.822 for Factor I and 0.774 for Factor II. Factor I (lower self-compassion) demonstrated strongly positive correlations with measures of anxiety and depression, while Factor II (high self-compassion) was inversely correlated with the measures. No significant differences were found in the BVSCI scores for gender, age, or having children. Levels of self-compassion were significantly higher in persons with HIV disease and other physical and psychological health conditions. The scale shows promise for the assessment of self-compassion in persons with HIV without taxing participants, and may prove essential in investigating future research aimed at examining correlates of self-compassion, as well as providing data for tailoring self-compassion interventions for persons with HIV.

Mediators of antiretroviral adherence: a multisite international study

The purpose of this study was to investigate the effects of stressful life events (SLE) on medication adherence (3 days, 30 days) as mediated by sense of coherence (SOC), self-compassion (SCS), and engagement with the healthcare provider (eHCP) and whether this differed by international site. Data were obtained from a cross-sectional sample of 2082 HIV positive adults between September 2009 and January 2011 from sites in Canada, China, Namibia, Puerto Rico, Thailand, and US. Statistical tests to explore the effects of stressful life events on antiretroviral medication adherence included descriptive statistics, multivariate analysis of variance, analysis of variance with Bonferroni post-hoc analysis, and path analysis. An examination by international site of the relationships between SLE, SCS, SOC, and eHCP with adherence (3 days and 30 days) indicated these combined variables were related to adherence whether 3 days or 30 days to different degrees at the various sites. SLE, SCS, SOC, and eHCP were significant predictors of adherence past 3 days for the United States (p = < 0.001), Canada (p = 0.006), and Namibia (p = 0.019). The combined independent variables were significant predictors of adherence past 30 days only in the United States and Canada. Engagement with the provider was a significant correlate for antiretroviral adherence in most, but not all, of these countries. Thus, the importance of eHCP cannot be overstated. Nonetheless, our findings need to be accompanied by the caveat that research on variables of interest, while enriched by a sample obtained from international sites, may not have the same relationships in each country.

Self-care behaviors and activities for managing HIV-related anxiety

The goal of this study was to identify the baseline prevalence and effectiveness of anxiety self-management strategies in a convenience sample of persons living with HIV (PLWH; n = 343) in the United States, Puerto Rico, Kenya, and South Africa who reported HIV-related anxiety symptoms. Relationships between demographics and anxiety characteristics were determined, as was the effectiveness of self-care activities/behaviors to reduce anxiety. We found that the use of anxiety self-management strategies varied by gender and that ratings of effectiveness varied by country. Highest anxiety intensity scores were found in participants who were taking antiretroviral medications and who had undetectable viral loads. Forty-five percent of the persons with a diagnosis of AIDS reported anxiety symptoms. As HIV increases in areas of the world where self-care is the primary approach to managing HIV, additional research will be needed to address the effectiveness of cross-cultural differences in strategies for self-managing HIV-related anxiety.

Prevalence, correlates, and self-management of HIV-related depressive symptoms

Depressive symptoms are highly prevalent yet undertreated in people living with HIV/AIDS (PLHAs). As part of a larger study of symptom self-management (N=1217), this study examined the prevalence, correlates, and characteristics (intensity, distress, and impact) of depressive symptoms, and the self-care strategies used to manage those symptoms in PLHAs in five countries. The proportion of respondents from each country in the total sample reporting depressive symptoms in the past week varied and included Colombia (44%), Norway (66%), Puerto Rico (57%), Taiwan (35%), and the USA (56%). Fifty-four percent (n=655) of the total sample reported experiencing depressive symptoms in the past week, with a mean of 4.1 (SD 2.1) days of depression. Mean depression intensity 5.4 (SD 2.7), distressfulness 5.5 (SD 2.86), and impact 5.5 (SD 3.0) were rated on a 1-10 scale. The mean Center for Epidemiologic Studies Depression Scale score for those reporting depressive symptoms was 27 (SD 11; range 3-58), and varied significantly by country. Respondents identified 19 self-care behaviors for depressive symptoms, which fell into six categories: complementary therapies, talking to others, distraction techniques, physical activity, medications, and denial/avoidant coping. The most frequently used strategies varied by country. In the US sample, 33% of the variance in depressive symptoms was predicted by the combination of education, HIV symptoms, psychological and social support, and perceived consequences of HIV disease.

HIV/AIDS and universal precautions: knowledge and attitudes of Nepalese nursing students

AIM

This paper is a report of a study exploring Nepalese nursing students' knowledge and attitudes about HIV/AIDS and universal precautions.

BACKGROUND

Nepal is facing an HIV epidemic, and nurses are primary caregivers for people living with HIV/AIDS. Insufficient knowledge and negative attitudes on the part of nursing students translate into fear, stigmatization and unwillingness to care for patients with HIV/AIDS.

METHOD

Data were collected in 2005 for this cross-sectional study in which we examined HIV/AIDS-related knowledge, attitudes and universal precautions in three levels of Nepalese nursing students (N = 127). Instruments included the HIV/AIDS Knowledge Questionnaire, HIV/AIDS Attitudes Questionnaire, HIV/AIDS Transmission Attitudes Questionnaire and Universal Precautions Questionnaire. Descriptive statistics and chi-square analyses were employed to examine socio-demographic data. One-way anova, with level in school as the between-groups factor, were calculated to examine students' knowledge and attitudes.

FINDINGS

Nepalese nursing students have a large knowledge gap and negative attitudes, regardless of level of education. Their HIV/AIDS knowledge differed statistically significantly by group but there were no statistically significant group differences in general attitudes towards HIV/AIDS. Although knowledge of universal precaution improved with year of education, overall universal precautions knowledge was poor among all students, regardless of level of education.

CONCLUSION

Nursing curricula must include adequate and culturally relevant content on HIV/AIDS, attitudes towards people living with AIDS, and universal precautions.

Marijuana effectiveness as an HIV self-care strategy

Persons living with HIV/AIDS use self-care for symptom management. This study assesses the use of marijuana as a symptom management approach for six common symptoms for persons living with HIV/AIDS--anxiety, depression, fatigue, diarrhea, nausea, and peripheral neuropathy. This sub-analysis of the efficacy of a symptom management manual encompasses the experiences of participants from sites in the U.S., Africa, and Puerto Rico. Baseline data are analyzed to examine differences in the use and efficacy of marijuana as compared with prescribed and over-the-counter medications as well as the impact on adherence and quality of life.

Does "asymptomatic" mean without symptoms for those living with HIV infection?

Throughout the history of the HIV epidemic, HIV-positive patients with relatively high CD4 counts and no clinical features of opportunistic infections have been classified as "asymptomatic" by definition and treatment guidelines. This classification, however, does not take into consideration the array of symptoms that an HIV-positive person can experience long before progressing to AIDS. This short report describes two international multi-site studies conducted in 2003-2005 and 2005-2007. The results from the studies show that HIV-positive people may experience symptoms throughout the trajectory of their disease, regardless of CD4 count or classification. Providers should discuss symptoms and symptom management with their clients at all stages of the disease.

Unhealthy behaviours for self-management of HIV-related peripheral neuropathy

The prevalence of peripheral neuropathy is frequent in HIV disease and is often associated with antiretroviral therapy. Unhealthy behaviours, particularly substance-use behaviours, are utilized by many HIV-positive individuals to manage neuropathic symptoms. As part of a larger study on self-care for symptoms in HIV disease, this study analyzed the prevalence and characteristics of unhealthy behaviours to self-manage peripheral neuropathy in HIV disease. Sociodemographic and disease-related correlates and unhealthy behaviours were examined in a convenience sample of 1,217 respondents who were recruited from data collection sites in several US cities, Puerto Rico, Colombia, and Taiwan. Results of the study indicated that respondents with peripheral neuropathy (n=450) identified a variety of unhealthy self-care behaviours including injection drug use, oral drug use, smoking cigarettes and alcohol ingestion. Specific unhealthy behaviours that participants reported to alleviate peripheral neuropathy included use of marijuana (n=67), smoking cigarettes (n=139), drinking alcohol (n=81) and street drugs (n=30). A subset of those individuals (n=160), who identified high levels of neuropathy (greater than five on a scale of 1-10), indicated significantly higher use of amphetamines and injection drug use in addition to alcohol use and cigarette smoking. For participants from Norway, substance use (using alcohol: 56%) was one of the most frequent self-management strategies. Implications for clinical practice include assessment and education of persons with HIV for self-care management of the complex symptom of peripheral neuropathy.

Predictors of Life Satisfaction in HIV-Positive Nepali Women

In a cross-sectional design, the authors examined the degree to which indicators of physical, mental, and social domains and perceived health predicted life satisfaction in 98 HIV-positive women who were former commercial sex workers in Nepal. Measures included the Quality of Life Inventory, Medical Outcomes Study 36-Item Short-Form Survey, Center for Epidemiologic Studies Depression Scale, and the anxiety subscale of the Symptom Checklist-90-Revised. Life satisfaction was significantly associated with physical functioning (r = .32), role-physical (r = .31), bodily pain (r = .32), mental health (r = .39), anxiety (r = -.66), depression (r = -.47), social functioning (r = .47), and health transition (r = .49). Anxiety (beta = -.75), health transition, (beta = .45), role-physical (beta = -.43), physical function (beta = .24), and mental health (beta = -.23) explained 60% of the variance in life satisfaction. The authors discuss the challenges of international studies, including salience of the concept of quality of life, conceptual and cultural equivalence of instruments, identification of culturally relevant concerns, disclosure of private information, and instrument format.

Exploratory factor analysis: strategies used by patients to promote health

Strategies used by patients to promote health (SUPPH) was used to measure self-care self-efficacy in patients with cancer. The objectives of this study were (1) to determine the extent to which self-efficacy theory explained the factor structure of the SUPPH and (2) to determine the relationship of demographic data with factors of the SUPPH. Subjects were diagnosed with prostate cancer (PCa) and treated with either: (a) radical prostatectomy, (b) intensity modulated radiation therapy (IMRT) + radioactive seed implantation, or (c) IMRT + high dose rate. Subjects completed a demographic questionnaire and the SUPPH. Exploratory factor analysis of the SUPPH was performed using a varimax rotation. Subjects (n = 265) were predominately white and averaged 68 years of age. The model explained 81.3% of the total sum of eigenvalues. Two factors of the SUPPH were identified: physiological efficacy information and performance efficacy information. Younger subjects who were fully employed and earning more money had significantly higher performance self-efficacy than older subjects who were working part time and earning less money. Results are congruent with Bandura's (1997) description of self-efficacy. Use of the SUPPH may facilitate research validating Bandura's (1997) assertion that an individual's self-efficacy is related to quality of life (QOL) during chronic illness. Additional research focusing on self-efficacy and PCa patients' QOL may lead to efficacy enhancing interventions that will improve QOL of patients with PCa.

Strategies for self-management of HIV-related anxiety

This study examines the frequency and effectiveness of commonly used strategies for self management of anxiety in an international sample of 502 participants from Norway (n=42, 8%), Taiwan (n=35, 7%), and the US (n=426, 85%). An activities checklist summarized into five categories of self-care behaviours including activities/thoughts, exercise, medications, complementary therapies, and substance use determined self-care behaviours. Ratings of frequency and effectiveness for each self-care activity were also included. Praying received the highest overall rating of effectiveness of any self-management strategies included in this study at 8.10 (scale 1 to 10), followed by meditation (7.37), exercising (7.32), using relaxation techniques (7.22), cooking (6.98), and walking (6.90). An analysis of effectiveness scores for each self-care strategy by country reflected a wide variation. The three most effective anxiety self-care strategies reported by participants from Norway included exercise (7.31), walking (6.96), and reading (6.44). Highest ratings of effectiveness by participants from Taiwan included talking with others with HIV (6.0), attending support groups (6.0), and exercising (6.0). US participants allocated highest ratings of effectiveness to complementary/alternative therapies, including praying (8.10), meditating (7.43), and using relaxation techniques (7.35). Regardless of the country, watching television and talking with family and friends were the two most frequently reported strategies. These strategies for self-management of HIV-related anxiety are important for clinicians to be aware of in the care of persons with HIV/AIDS.

Depressive symptoms in HIV disease

Although depressive symptoms are common in people living with HIV/AIDS, their reported prevalence varies greatly across HIV-positive populations, ranging from 21% to 97%. Comparing these rates is complicated by the varied conceptualization of depression as a major depressive disorder (clinical depression) or depressive symptoms, and by the use of multiple methods of measurement. Knowledge of predictors of depressive symptoms can assist health care providers in the identification of those who are most at risk. Appropriate diagnosis, treatment, and referral are critical, because depressive symptoms have been associated with poorer disease outcomes. Additionally, self-management symptoms can be used to supplement more traditional treatment methods.

Gender differences in use of prayer as a self-care strategy for managing symptoms in African Americans living with HIV/AIDS

The objective of this study was to explore the association of gender to use of prayer as a self-care strategy for managing the HIV-related symptoms of fatigue, nausea, depression, and anxiety among African American men and women who are HIV-seropositive. To accomplish this, data were determined using convenience sampling from a sample of 448 African American men and women from the United States who were participants in a national study on self-care symptom management of HIV/AIDS. Chi-square analyses were used to examine the potential relationships between gender and the use of prayer for managing the four symptoms. The mean age of the sample was 42.69 +/- 7.93 years (range, 20-66). Results showed the following gender differences in the use of prayer as a self-care strategy: fatigue-men 46% (n = 62), women 54% (n = 74); nausea-men 52% (n = 33), women 48% (n = 30); depression-men 55% (n = 90), women 45% (n = 73); and anxiety-men 77% (n = 83), women 87% (n = 73). Chi-square analyses determined that significant differences exist between African American men and women in the frequency of the use of prayer for managing HIV-related fatigue (chi(2) = 14.81, 1 df, p = .000), nausea (chi(2) = 4.10, 1 df, p =.043), and depression (chi(2) = 5.21, 1 df, p = .022). There was no gender difference in the use of prayer to manage anxiety. Prayer was reported as a self-care strategy by over 50% of the respondents for three of the four symptoms and was rated highly efficacious. The authors conclude that the African American men and women differed in their selection of prayer as a self-care strategy for managing HIV-related depression, fatigue, and nausea. A higher proportion of women than men used prayer to manage fatigue, and more men than women reported using prayer to manage nausea and depression.

Prospective study of quality of life of patients receiving treatment for prostate cancer

BACKGROUND

No research was found that compared quality of life (QOL) outcomes of prostate cancer patients receiving intensity-modulated radiation therapies with prostate cancer patients receiving radical prostatectomy.

OBJECTIVES

To (a) describe differences in QOL before and after three types of treatment for prostate cancer: radical prostatectomy, intensity-modulated radiation therapy + seed implantation (permanent brachytherapy), or intensity-modulated radiation therapy + high dose rate radiotherapy (temporary brachytherapy); and (b) investigate demographic, physical, and psychosocial variables that impact QOL of men with prostate cancer.

METHODS

Data were collected on three occasions: baseline (prior to treatment), 1 month, and 3 months after beginning treatment. Measures included biographic data, physiological, and psychological measures. Analysis of variance and hierarchical regression were used to examine patterns, describe differences, and identify predictors of QOL in the three treatment groups. QOL was conceptualized as a multidimensional construct that included physical, psychological, social, and functional well-being and prostate cancer concerns.

RESULTS

Groups differed significantly in bowel and urinary symptom scores and prostate cancer concerns at baseline, and in urinary and depressive symptoms at 3 months. There were no significant group differences at 1 month.

DISCUSSION

Significant differences were found in QOL as measured with the Functional Assessment of Cancer Treatment-Prostate after treatment with radical prostatectomy, intensity-modulated radiation therapy + seed implantation, or intensity-modulated radiation therapy + high dose rate radiotherapy. Findings may provide healthcare providers with knowledge about treatment sequelae for prostate cancer, enable healthcare providers to educate patients about QOL outcomes of treatment for prostate cancer, and enable patients to make more informed treatment decisions.

Self-care strategies for depressive symptoms in people with HIV disease

AIM

This paper reports a study with people living with HIV to examine the experience of depressive symptoms, self-care symptom management strategies, symptom outcomes in response to those strategies, and sources from which the strategies were learned.

BACKGROUND

Depressive symptoms are common, under-diagnosed and under-treated in people living with HIV. These symptoms have been associated with lower medication adherence, risky behaviours and poorer health outcomes.

METHODS

The study was based on the model of symptom management developed by the University of California San Francisco School of Nursing Symptom Management Faculty. Thirty-four HIV+ men and women from a larger study of symptom self-care strategies (n = 422) reported experiencing depressive symptoms. Data were collected from this subset on the Web, by mail and in-person using the critical incident technique.

RESULTS

Depressive symptoms were described using 80 words and phrases clustered into eight categories: futility, sadness, loneliness/isolation, fatigue, fear/worry, lack of motivation, suicidal thoughts and other. A total of 111 self-care strategies were coded into six categories: practising complementary/alternative therapies, talking to others, using distraction techniques, using antidepressants, engaging in physical activity, and using denial/avoidant coping. Sources of information for strategies used were trial and error (31%), healthcare providers (28%), family and friends (20%), classes/reading (8%), clergy (8%), support groups (4%) and other (3%). Overall, 92% of the self-care strategies used were reported as helpful, 4% were sometimes helpful and 4% were not helpful.

CONCLUSIONS

People living with HIV use numerous effective self-care strategies to manage depressive symptoms. Further study is needed to validate the use of these strategies across populations, to standardize dose, duration and frequency, and to measure their effectiveness.

Quality of life of men treated with brachytherapies for prostate cancer

Background

Most studies of men undergoing treatment for prostate cancer examine physical symptoms as predictors of Quality of Life (QOL). However, symptoms vary by treatment modality in this population, and psychosocial variables, shown to be important to QOL, have rarely been examined. Litwin noted a need for analysis of QOL data in men treated for prostate cancer with different modes of therapy, as studies focusing on specific treatments will increase the homogeneity of research findings.

Methods

This cross-sectional study explored physical and psychosocial predictors of QOL in men receiving one of two types of radiation treatment for prostate cancer: Intensity Modulated Radiation Therapy (IMRT) + High Dose Rate (HDR) Brachytherapy or IMRT + seed implantation. Subjects completed a biographic questionnaire; quality of life measures, which were the eight subscales of the Medical Outcome Study Short Form Health Survey (SF-36); measures of physical symptoms including the Radiation Therapy Oncology Group and the European Organization for Research and Treatment of Cancer (RTOG/EORTC) and the Prostate Symptom Self-Report (PSSR); and measures of psychological factors, the Ways of Coping Scale (WOC), Perceived Stress Scale, the Anxiety Subscale of the SCL-90, and Strategies Used by Patients to Promote Health (SUPPH). Eight regression models including both physical and psychosocial variables were used to predict quality of life.

Results

Sixty-three subjects with complete data on all variables were studied. Treatment effect sizes were medium to large in predicting each of the quality of life subscales of the SF-36. Psychosocial variables were related to physical function, role function, bodily pain, general health, social function, emotional role, and mental health. Physical symptoms were related to subjects' perceived general health and mental health.

Discussion

The number of significant relationships among psychosocial variables and indicators of QOL exceeded the number of relationships among symptoms and QOL suggesting that psychosocial variables associate strongly with prostate cancer patients' reports of quality of life. Findings of the study may provide patients and families with knowledge that contributes to their understanding of quality of life outcomes of IMRT+ HDR and IMRT + seed implantation and their ability to make more informed treatment choices.

Spiritual perspectives, needs and nursing interventions of Christian African-Americans

BACKGROUND

Although the amount of literature on spiritual needs and care has increased, in practice there has been little change in how nurses assess spiritual need. This suggests that not all spiritual needs of patients are being addressed. Based on the assumption that spiritual needs vary by culture, this study focused on one subgroup, namely Christian African-Americans.

AIMS

The aim of this paper is to report a study examining spiritual perspectives, spiritual needs and desired nursing interventions during hospitalization identified by Christian African-Americans.

METHODS

A descriptive correlational design was employed. A convenience sample (n = 44) was recruited from three African-American churches. Descriptive statistics were calculated, and one-way anovas used to examine spiritual perspectives and spiritual values. Content analysis was used to analyse and summarize qualitative data. Instruments included the Spiritual Perspective Scale (SPS) and two open-ended questions.

RESULTS

The mean age of participants was 56 years (range 19-84). The majority was female (86%); 71% of respondents strongly agreed that they had spiritual needs to be met during hospitalization. Mean score for the SPS was 5.7 (sd = 0.36). Respondents used a total of 103 phrases to describe spiritual needs, based on three dimensions of connectedness: connectedness to God (50 phrases), connectedness to others (37 phrases) and connectedness to self (16 phrases). Desired nursing interventions included: participating in spiritual activities (n = 41); demonstrating caring qualities (n = 27); providing comforting measures (n = 13); providing reassurance (n = 9); recognizing the spiritual caregiver role (n = 7); and incorporating diversity in care (n = 3).

CONCLUSIONS

The findings provide information for nurses to facilitate development of culturally appropriate spiritual nursing interventions.

Psychological factors in Nepali former commercial sex workers with HIV

PURPOSE

To examine perceived stress, coping style, and symptoms of anxiety and depression in HIV-positive Nepali women who were formerly commercial sex workers (CSWs).

DESIGN

Descriptive, correlational study with a convenience sample of 98 Nepali women with HIV recruited from a nongovernmental organization (NGO) in Nepal.

METHODS

Investigator-administered questionnaires included a sociodemographic questionnaire, the Perceived Stress Scale (PSS), the Ways of Coping Questionnaire (WOC), the Center for Epidemiologic Studies Depression Scale (CES-D), and the Symptoms Checklist-90 (SCL-90) Anxiety Subscale. Analytical methods included descriptive statistics and hierarchical regression analysis.

FINDINGS

The level of perceived stress was similar to that observed in a healthy female population of similar age. The primary coping style was problem-focused, with the strategy of seeking social support used most. Depression measured with the entire CES-D was 3% but is was 18% on the somatic subscale. Twenty-two percent of the variance in depression was predicted by the combination of perceived stress and the coping strategy of escape avoidance. Twenty-four percent of the variance in anxiety was predicted by the combination of perceived stress and three coping strategies: problem solving, accepting responsibility, and distancing.

CONCLUSIONS

This sample had a low prevalence of psychological symptoms. Somatic symptoms, which may be more relevant than affective symptoms in non-Western populations, were the best indicator of depression. Future studies are needed to examine culturally relevant appraisals, coping style, and psychological symptoms. Knowledge of psychological factors can be used to develop interventions for this population that has no access to treatment for HIV disease.

Self-care management of anxiety and fear in HIV disease

The purpose of this study is to describe the frequency and correlates of self-reported anxiety and fear and the self-care behaviors used to manage these symptoms. Data were collected in a convenience sample (N = 422) of HIV-positive subjects. Demographic and disease-related variables were compared for those who did and did not report anxiety and fear. Anxiety and fear were the most frequently reported symptoms (17.3%, n = 73). There were significant differences on gender, level of education, and the use of antiretroviral medications. Self-care behaviors (n = 212) for anxiety and fear were grouped into seven categories: using activities for distraction = 25%, talking to others = 21%, using alternative/complementary therapies = 18%, taking prescribed medications = 10%, using self-talk = 9%, using substances = 9%, and using avoidance behaviors = 7%. Anxiety and fear are commonly experienced by people with HIV/AIDS. Self-care strategies are imperative in the management of these clinical manifestations.

Complementary therapy use in persons with HIV/AIDS

The purpose of this study was to describe the frequency and correlates of complementary and alternative medicine (CAM) therapies used by people with HIV/AIDS to manage illness and treatment-related symptoms. Data were collected from a convenience sample (N = 422) of people living with HIV disease. Demographic variables (e.g., education, age, and gender) were compared for those who reported using at least one CAM therapy. There were significant differences for gender (chi2 = 4.003, df = 1, p = .045) and for ethnicity (chi2 = 6.042, df = 2, p = .049). Females and African Americans used CAM more frequently. More than one third of the participants used CAM, and there were a total of 246 critical incidents of nontraditional treatment use. It is possible that these nonallopathic interventions may positively affect health-related quality of life in persons with HIV by ameliorating or reducing the side effects associated with the disease and its treatments.

Self-care for fatigue in patients With HIV

PURPOSE/OBJECTIVES

To identify when fatigue is reported as a problem by people who are HIV positive, what the perception of fatigue is, and which self-care behaviors are used and with what efficacy.

DESIGN

Multisite descriptive study.

SETTING

University-based AIDS clinics, community-based organizations, and homecare agencies located in cities across the United States, in Norway, and through a university Web site.

SAMPLE

Convenience sample of 422 self-identified people who are HIV positive.

MAIN RESEARCH VARIABLES

Symptom description, symptom relief, symptom help, and self-care strategies.

FINDINGS

The sixth most reported symptom in this study, fatigue, was treated with a variety of self-designed strategies. In only three instances was consultation with a healthcare provider (i.e., physician) or an injection (medication not defined) mentioned. The most frequently used interventions were supplements, vitamins, and nutrition followed by sleep and rest; exercise; adjusting activities, approaches, and thoughts; distraction; and complementary and alternative therapies. In addition to self-designed strategies, the media and friends and family were sources of information.

CONCLUSIONS

Fatigue was reported less frequently in this study than in other HIV-, AIDS-, or cancer-related studies. This may be an artifact of the study design. The use of informal networks for assistance, let alone the prevalence of unrelieved fatigue, indicates the need for more attention to this problem among people with AIDS.

IMPLICATIONS FOR NURSING

Careful assessment of the pattern of fatigue and its onset, duration, intervention, and resolution is required if the varied types of fatigue are to be identified and treated successfully.

Quality of life in persons living with HIV

This study investigated the effects of selected variables on quality of life (QOL) in persons living with HIV. Eighty-one HIV-positive adults completed a demographic questionnaire, the Sickness Impact Profile, the Center for Epidemiologic Studies Depression Scale, and a fatigue visual analog scale. Blood samples were collected for CD4+, CD8+, and CD16+ Lymphocyte numbers. Based on an expanded psychoneuroimmunology model, hierarchical multiple regression analysis was used to determine the extent to which four blocks of variables predicted variance in quality of life. These included sociodemographics, depression, immune status, and fatigue. Findings revealed that work status, depression, and fatigue predicted 58% of the variance in QOL in persons with HIV Findings support the need for routine assessment and management of depression and fatigue in persons living with HIV.

Guided imagery interventions for symptom management

For the past several decades, papers in the nursing literature have advocated the use of cognitive interventions in clinical practice. Increasing consumer use of complementary therapies, a cost-driven health care system, and the need for evidence-based practice all lend urgency to the validation of the efficacy of these interventions. This review focuses specifically on guided imagery intervention studies identified in the nursing, medical and psychological literature published between 1966 and 1998. Included were 46 studies of the use of guided imagery for management of psychological and physiological symptoms. There is preliminary evidence for the effectiveness of guided imagery in the management of stress, anxiety and depression, and for the reduction of blood pressure, pain and the side effects of chemotherapy. Overall, results of this review demonstrated a need for systematic, well-designed studies, which explore several unanswered questions regarding the use of guided imagery. These include the effects of different imagery language, symptoms for which guided imagery is effective, appropriate and sensitive outcome measures, method of delivery of the intervention and optimum dose and duration of the intervention, and individual factors that influence its effectiveness.

Effects of cognitive-behavioral interventions on quality of life in persons with HIV

This study explored the effects of cognitive-behavioral interventions on quality of life in persons with HIV. In a randomized, 3 x 3 block design, 69 participants were assigned to a guided imagery, progressive muscle relaxation or control group. Following brief instruction, subjects practiced their respective intervention over six weeks. Post intervention, perceived health status, but not quality of life, was significantly different across treatment groups. Findings suggested differential effects for guided imagery and progressive muscle relaxation, with larger effects for those at mid-stage disease and for low frequency users of guided imagery.

Testing a model: effects of pain on immunity in HIV+ and HIV- participants

In this study, the cold pressor test (CPT) was used to test a model of the effects of acute pain on 10 HIV+ and 10 HIV- adults. Participants were exposed to the CPT for a maximum of 5 minutes. Blood samples were collected immediately before, immediately after, and 1 hour after the CPT. Variables included immune measures (CD4+, CD8+, and CD16+ 56+ lymphocyte number, CD4+ CD8+ lymphocyte ratio and NK cell cytotoxicity), cardiovascular reactivity (heart rate, systolic and diastolic blood pressure), anxiety, perceived pain intensity and perceived self-efficacy. Effects of pain were generally consistent across HIV+ and HIV- groups, with no between-group differences across time in immune responses, state anxiety and diastolic blood pressure. Within-subjects differences across time averaged over both groups were significant for NK cell cytotoxicity, CD8+ and CD16+ 56+ lymphocyte numbers, anxiety and heart rate. Significant nonlinear trends were observed for CD16+ 56+ lymphocyte numbers, NK cell cytotoxicity and state anxiety in both groups and for heart rate in the HIV+ group only. Perceived pain intensity was significantly associated with state anxiety (r = .65), systolic (r = -.56) and diastolic (-.52) blood pressure and CD4+ lymphocyte number (r = .48). Heart rate and trait anxiety were significantly associated with all immune variables. Associations were positive for CD4+ lymphocyte number and inverse for all other immune measures. Associations between perceived self-efficacy and both perceived pain intensity and anxiety were inverse, as predicted, but not significant. Overall, the direction and strength of observed relationships provided some support for the theoretical model on which the study was based. Generally, responses to acute pain were consistent and did not differ by HIV status.