The relationship between psychosocial state and exercise behavior of older women 2 months after hip fracture.

Despite the potential benefits associated with exercise after hip fracture, those who have sustained hip fractures are among the least likely to engage in regular exercise (resistive or aerobic). This article describes the psychosocial state, specifically the self-efficacy expectations and outcome expectations related to exercise, mood, fear of falling, pain, and health status of older women who enrolled in either of two Baltimore Hip Studies (BHS), BHS-4 and BHS-5, and to test a self-efficacy-based model to explain exercise behavior after hip fracture. A total of 389 older women with hip fractures participated in these studies. The participants reported moderate confidence in their ability to exercise and a general belief in the benefits of exercise, high perceived health status, limited depressive symptoms, and some pain and fear of falling. Consistently across these two samples, age and mental status or depressive symptoms influenced outcome expectations, such that older women with more depressive symptoms or lower mental health status had weaker outcome expectations for exercise. Self-efficacy expectations consistently influenced exercise behavior across both samples. It was also consistent across both models that age, cognitive status, physical and mental health status, pain, fear, outcome expectations, and depressive symptoms did not directly influence exercise behavior.     

Development of an exercise self-efficacy questionnaire for older Mexican American women

The purpose of this study was to develop a reliable and culturally meaningful exercise self-efficacy questionnaire for older Mexican American women. Items were derived from a 5-item exercise self-efficacy instrument (Laffrey, 2000; Marcus, Selby, Niaura, & Rossi, 1992) and from focus groups with women in the target population. Content validity of the Spanish-language items was supported by three Mexican American professional women and by five Mexican American nurses. A factor analysis of the 11-item questionnaire revealed one major factor. Internal consistency was shown by an alpha reliability coefficient of .86. Item:corrected scale correlation coefficients ranged from .30 to .70. The mean exercise self-efficacy score was significantly higher for 38 regular exercisers than for 37 non-exercisers. The exercise self-efficacy questionnaire can be used in research with older Mexican American women and should be tested with men and with younger men and women to explore its usefulness with these populations.     

Perceptions and experiences of heart disease: a literature review and identification of a research agenda in older women.

BACKGROUND: Following diagnosis of heart disease women have poorer health related outcomes compared with men. Nursing science lacks well-evaluated interventions to address the specific rehabilitative needs of older women with heart disease.This paper seeks to inform the development of nursing intervention studies by a review of published studies on the experiences and rehabilitative needs of older women with heart disease. METHODS: The CINAHL, MEDLINE, FAMILY and PsychINFO databases were searched, identifying literature published from 1982 and written in English. Keywords used were women, old* (old, older) women, elderly women and: heart disease, heart failure, cardiac and rehabilitation. Hand searching of nursing and medical textbooks also occurred. These searches resulted in over 120 articles that met the criteria of describing experiences, perceptions, psychological responses and support rehabilitative needs of older women. RESULTS: Older women present with symptoms that are different from those derived from a male-dominated research agenda and further there is a paucity of data related to evaluation of interventions tailored to the needs of women. Key themes emerging from the literature review include not only that older women compared with men have a poorer prognosis and experience greater disability moreover they: (1). are at a higher risk of psychosocial distress; (2). have a greater need for instrumental support and social support; (3). have an altered perception of risk; and (4). demonstrate the need for specific rehabilitation programs, tailored to their needs. CONCLUSION: Future research should develop and evaluate intervention studies that better meet the unique needs of older women with heart disease. Particular emphasis needs to be on psychosocial aspects, given evidence that identify these are major concerns for women.     

A pilot phase II RCT of a home-based exercise intervention for survivors of AML

Background

Fatigue is the most common and disabling symptom affecting quality of life (QOL) and daily function in patients who have completed treatment for acute myeloid leukemia (AML). Although trials in patients with various solid tumors have reported improved fatigue and QOL following exercise interventions, there have been no studies in AML patients post treatment.

Methods

Forty patients aged ≥40 years who had completed treatment for AML were enrolled in a 12-week randomized phase II exercise intervention to determine feasibility (recruitment, retention, and adherence), efficacy, and safety of the intervention. Patients assigned to the exercise group received an individualized, moderate-intensity, 12-week home-based exercise program with weekly telephone support from a certified exercise physiologist. QOL, fatigue, and fitness outcomes were measured at baseline, 6 weeks, and 12 weeks. Between-group differences in 12-week change scores were calculated using linear regression adjusting for age and baseline function.

Results

Recruitment and retention rates were 38 % and 91 %, respectively. Adherence was low at 28 %. Analyses did not suggest statistically significant or clinically important benefits in QOL, fatigue, or physical fitness with the intervention. The level of adherence did not appear to impact outcomes. There were no adverse events.

Conclusion

A home-based exercise program for post-treatment AML patients age 40 years or older can be safely delivered with reasonable recruitment and high retention. However, feasibility was hampered by low adherence. Further research and program modification are needed to better understand and overcome barriers to exercise delivery and adherence in AML survivors.     

Gardening: a strategy for health promotion in older women

One of the goals of Healthy People 2010 is improved cognitive status of older adults. Preliminary research has identified gardening as an activity that may be cognitively protective. Clarification of gardening as a concept is a first step toward the development of theory that will enable nurses to develop interventions related to gardening. The purpose of this study was to describe the phenomenon of gardening. Using a phenomenological methodology, interviews with five older women were analyzed using Colaizzi's approach. Four themes emerged: "Gardening is challenge and work," "Gardening is connection," "Gardening is continuous learning," and "Gardening is sensory and aesthetic experience." The phenomenon of gardening is analogous to the relationship between a spider and its web, linking internal and external environments and providing support over a lifetime. It appears that the gardening experience, as an evolving lifelong process, sustains older women in their cognitive and spiritual development.     

Spirituality and health: perceptions of older women in a rural senior high rise

The purpose of this study was to examine the essence of spirituality and health in older women living in a rural senior high-rise apartment building. The researchers used a phenomenological research design and interviewed 10 women 65 years of age and older. Data analysis using Colaizzi's (1978) method for analysis revealed three themes-health is functional and provides a sense of wholeness; the relationship with God or a higher power is a personal one; and death is a part of life. The three themes create an essential structure, which influences the way the participants live. These findings provide information for nurses on the spiritual needs of older women and how the experiences of living in a high rise affect spirituality and health.     

Interventions on mealtime difficulties in older adults with dementia: A systematic review

Objectives

To evaluate the effects of interventions on mealtime difficulties in older adults with dementia.

Design

A systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA Statement.

Data sources

Pubmed, Medline (OVID), CINAHL (EBSCOHost), EBM Reviews (OVID) and PsychINFO (OVID) were searched between January 2004 and September 2012 by using keywords as dementia, Alzheimer, feed(ing), eat(ing), mealtime(s), oral intake, nutrition, intervention, experimental, quasi-experimental and any matched terms. Other sources included Google Scholar and relevant bibliographies.

Review methods

Eligibility criteria were established by defining the population, intervention, comparator, outcomes, timing and setting of interest. Studies were reviewed by title and abstract screening, and full-text assessing for eligibility. Data were abstracted from eligible studies using a self-made structured tool. Eligible studies were classified by intervention, accessed for quality using the Quality Assessment Tool for Quantitative Studies, and graded for evidence using the Grading of Recommendations, Assessment, Development and Evaluation Working Group criteria.

Results

Twenty-two intervention studies (9 RCTs), including a total of 2082 older adults with dementia and 95 professionals from more than 85 long-term care facilities, were selected, and classified into five types: nutritional supplements, training/education programs, environment/routine modification, feeding assistance and mixed interventions. Eight studies were strong, eleven moderate and three weak in quality. Limitations of body of research included lack of randomization and/or control group, small sample size without power analysis, lack of theory-based interventions and blinding, inadequate statistical analysis and plausible confounding bias. “Nutritional supplements” showed moderate evidence to increase food intake, body weight and BMI. “Training/education programs” demonstrated moderate evidence to increase eating time and decrease feeding difficulty. Both “training/education programs” and “feeding assistance” were insufficient to increase food intake. “Environment/routine modification” indicated low evidence to increase food intake, and insufficient to decrease agitation. Evidence was sparse on nutritional status, eating ability, behavior disturbance, behavioral and cognitive function, or level of dependence.

Conclusions

This review provides updated evidence for clinical practice and points out priorities for nursing research. Current evidence is based on a body of research with moderate quality and existing limitations, and needs to be further explored with more rigorous studies.     

Nursing research on physical activity: a feminist critique

Studies on physical activity have rarely included women as research participants, and have been mainly conducted among Western populations. In this paper, nursing research on women's physical activity is analyzed and critiqued using a feminist perspective that respects and values women's own experiences and their diversities. An extensive literature search was conducted using computerized data retrieval systems and 47 empirical studies published in nursing literature were selected and analyzed. The critique is presented with three main themes emerged from the analysis: (a) "without considering women's own experiences"; (b) "implicit androcentric and ethnocentric assumptions"; (c) "without meaningful interactions". Based on the analysis, future directions for nursing research on physical activity are proposed.     

Recruitment and retention of African American elders into community-based research: lessons learned

Factors influencing the recruitment and retention of African Americans into research studies are not well understood. Studies show that their numbers continue to be low in clinical trials and other nursing studies. However, African Americans have disproportionately high incidences of disease, illness, and death, an important reason for their inclusion in ongoing research. Two urban, community-based intervention studies with elderly African American participants are used to show different issues and strategies in recruitment and retention. The sample selection and attrition experiences in the studies are examined using 3 theoretical approaches. Six concepts emerge as fundamental to successful recruitment and retention of diverse population groups: (1) historical cognizance; (2) sanctioning; (3) trust-building; (4) mutuality; (5) recognition of heterogeneity; and (6) researcher self-reflection and introspection.     

An intervention program to promote health‐related physical fitness in nurses

Aims. To assess the effects of exercise intervention on nurses’ health‐related physical fitness. Background. Regular exercise that includes gymnastics or aerobics has a positive effect on fitness. In Taiwan, there are not much data which assess the effects of exercise intervention on nurses’ health‐related physical fitness. Many studies have reported the high incidence of musculoskeletal disorders (MSDs) in nurses However, there has been limited research on intervention programs that are designed to improve the general physical fitness of nurses. Design. A quasi‐experimental study was conducted at a medical centre in central Taiwan. Methods. Ninety nurses from five different units of a hospital volunteered to participate in this study and participated in an experimental group and a control group. The experimental group engaged in a three‐month intervention program consisting of treadmill exercise. Indicators of the health‐related physical fitness of both groups were established and assessed before and after the intervention. Results. Before intervention, the control group had significantly better grasp strength, flexibility and durability of abdominal muscles than the experimental group (p < 0·05). After the intervention, logistic regression was used to adjust for marital status, work duration, regular exercise and workload and found that the experimental group performed significantly better (p < 0·05) on body mass index, grasp strength, flexibility, durability of abdominal and back muscles and cardiopulmonary function. Conclusions. This study demonstrates that the development and implementation of an intervention program can promote and improve the health‐related physical fitness of nurses. Relevance to clinical practice. It is suggested that nurses engage in an exercise program while in the workplace to lower the risk of MSDs and to promote working efficiency.     

Motivation for physical activity and exercise in severe mental illness: A systematic review of intervention studies

There has been increasing interest for research on motivation for physical activity (PA) and exercise among individuals with severe mental illness (SMI). The aim of this systematic review is to summarize findings from all intervention studies on PA or exercise that either include empirical data on motivational constructs or apply motivational techniques/theories in their intervention. Systematic searches of seven databases were conducted from database inception to February 2015. Studies were eligible if they: (i) included participants with SMI, (ii) had PA as part of the intervention, and (iii) reported empirical data on motivational constructs related to PA or incorporated motivational techniques/theory in their intervention. Of the 79 studies that met the inclusion criteria only one had motivation for PA as its main outcome. Nine additional interventions reported empirical data on motivational constructs. Altogether these studies yielded mixed results with respect to change in motivational constructs. Only one of those examined the association between motivation and PA, but found none. Sixty‐four studies reported using motivational techniques/theory in their intervention. Motivational interviewing and goal‐setting were the most popular techniques. Due to the exploratory nature of most of these studies, findings from intervention studies do not so far give very clear directions for motivational work with the patients. There is an urgent need for a more systematic theory based approach when developing strategies that target to increase engagement in PA among people with SMI.     

抑郁症患者运动干预的证据图谱

目的 通过证据图谱方法系统识别、描述和评价抑郁症患者运动干预相关研究证据。方法 计算机检索建库至2021年7月中国知网、万方数据、中国生物医学文献数据库、维普、Web of Science、EMBASE、Cochrane library和PubMed,获取抑郁症患者运动干预的随机对照试验和系统综述/Meta分析。采用Cochrane手册5.1.0推荐的偏倚风险评估工具和AMSTAR-2对纳入的研究进行质量评估。基于世界卫生组织国际健康分类家族(WHO-FICs)架构,建立证据图谱研究框架,利用EPPI软件和Microsoft Excel 2019工具进行数据提取和编码,采用气泡图综合呈现研究人群、干预类别、原始研究样本量及系统综述/Meta分析纳入研究数量、结论分类等信息。结果 最终纳入101篇随机对照试验和52篇系统综述/Meta分析。101篇随机对照试验中,共涉及3类干预策略,15种不同的干预措施,主要包括未特指的运动干预(28篇,27.72%)和瑜伽干预(19篇,18.81%)。主要研究结局包括b1.精神功能(92篇,91.09%)和d9.社区、社会和公民生活(19篇,18.81%)。3类干预策略中康复类占比最高,共计47篇(46.53%),主要研究人群为其他特指的抑郁症患者(19篇,40.42%),如重度抑郁症及老年抑郁症患者,46篇(97.87%)结论被归类为“有益”或“可能有益”。52篇系统综述/Meta分析中,共涉及9项干预措施,主要包括未特指的运动干预(17篇,32.69%)和瑜伽干预(12篇,23.08%)。主要研究结局包括b1.精神功能(41篇,78.85%)和不良反应(12篇,23.08%)。3类干预策略中治疗类占比最高,共计34篇(65.38%),其中,研究人群主要为其他特指的抑郁症患者(27篇,79.41%),如成年抑郁症和抑郁症孕产妇,28篇(82.35%)的研究结论被归类为“有益”或“可能有益”。同时,干预环境/背景主要为门诊和住院环境。结论 证据图谱结果显示运动干预策略主要聚焦于抑郁症患者的治疗和康复,主要研究患者的身体功能与结构(精神功能),且有效性显著。对于步行、自行车、气功、阻力训练和运动游戏干预的有效性,以及干预时间、干预的不良反应等方面,仍需未来高质量的研究进一步探讨。     

Caring for female patients: The experiences of male nurses

This article presents the results of two small qualitative studies, which examined the experiences of six male registered psychiatric nurses (RPN) and five male registered general nurses (RGN) when caring for patients of the opposite sex. Semi-structured interviews were used to collect the data. The focus of the interviews was an attempt to describe the male nurses' experiences of caring for women with a particular emphasis on interventions that involved physical touch. Themes were generated from both studies and the common themes are presented here. Male nurses in this study were often apprehensive about using physical touch and they used coping strategies in response to their fears of being accused of using touch inappropriately. Several factors also influenced the male nurses when using physical touch as an intervention. These findings suggest that learning about caring for female patients needs to be included in the undergraduate curriculum and that further research on the experience of men as nurses is required.     

Canadian cancer nurses' views on recruitment and retention

bakker d., butler l., fitch m., green e., olson k. & cummings g. (2009) Journal of Nursing Management  18, 205–214
Canadian cancer nurses' views on recruitment and retention Aim The purpose of this study was to explore oncology nurses’ perceptions about recruitment and retention. Background Competition among healthcare organizations to recruit and retain qualified nurses is a real-life challenge. Focusing attention on human resource planning in oncology is highlighted by both the worsening nursing shortage and cancer incidence. Methods A participatory action research approach was used and 12 focus groups with 91 cancer nurses were conducted across Canada to collect data about strategies that could improve recruitment and retention. Results Four themes emerged reflecting oncology nurses’ beliefs and values about organizational practices that attract and retain nurses and they are as follows: (1) recognizing oncology as a specialty, (2) tacit knowledge no longer enough, (3) gratification as a retaining factor, and (4) relationship dependent on environment. Conclusions Participants highlighted leadership, recognition and professional and continuing education opportunities as critical to job satisfaction and organizational commitment. Implications for nursing management Recruitment and retention were viewed as a continuum where organizational investment begins with a well-developed orientation and ongoing mentorship to ensure knowledge development. The challenge for nurse leaders is to use the evidence generated from this study and previous studies to develop professional practice environments that facilitate the cultural changes needed to build and sustain a quality nursing workforce.     

Focus groups with African American adolescents: enhancing recruitment and retention in intervention studies

This study explores African American adolescents' perceptions about recruitment and retention strategies for intervention studies. Fifteen African American adolescents, ages 13 and 17 years, participated in this focus group study. Adolescents attended one of three groups which varied by size, gender, and the type of chronic condition: well adolescents (n = 7), adolescents with sickle cell disease (n = 5), and adolescents with diabetes (n = 3). Each group of adolescents participated in two group sessions. Content analyses of the two major categories in the study, recruitment and retention, yielded 10 themes. These themes included adolescents' (1) knowledge about their disease; (2) attitudes and expectations of self-care classes; (3) expectations about the research interventions; (4) instructor characteristics; (5) relationships with the researchers; (6) logistical considerations, such as time, location, and setting of interventions; (7) involvement and choice during the intervention; (8) relationships with other teens; (9) incentives for participation, such as food, fun, and money; and (10) the role of health care providers in recruitment and retention for research studies.     

Specialist breast care and research nurses’ attitudes to adjuvant chemotherapy in older women with breast cancer

Purpose

Breast cancer largely affects older women (≥70 y) who have historically been excluded from clinical trials; consequently, treatment is often not evidence-based. Older women may not be offered adjuvant chemotherapy due to assumptions that they would not benefit, cannot tolerate it or do not wish to have it. Specialist breast care nurses (BCN) and research nurses (RN) play an important role influencing decisions. We report the roles, attitudes and involvement of such nurses regarding adjuvant chemotherapy in older women.

Method

A questionnaire examined 259 UK BCN and RN’s views about efficacy and desirability of chemotherapy in older women, participation in decision-making in MDTs, and roles when chemotherapy was discussed with patients.

Results

72% of BCN and 48% of RN agreed that age should not be a factor influencing who is offered chemotherapy. BCNs indicated involvement in decision-making with older breast cancer patients, discussing chemotherapy with patients at different points following diagnosis and during treatment, and proposing chemotherapy in MDT meetings. RNs were involved to a lesser extent. 69% of all nurses had not received specific training in the area and 70% thought training would be beneficial. Nurses disagreed that older patients would not tolerate or did not want chemotherapy but 1/3 agreed or were uncertain that burdens of chemotherapy outweighed benefits. A third felt that older women had less control over treatment decisions than younger women.

Conclusions

This study suggests a need to develop the role of specialist nurses to facilitate treatment decision-making relating to chemotherapy in older women.     

Effect of therapeutic exercise on gait speed in community-dwelling elderly people: a meta-analysis

BACKGROUND AND PURPOSE: Inconsistent research findings make it unclear whether therapeutic exercise improves gait speed in community-dwelling elderly people. Using meta-analytical procedures, we examined the effect of therapeutic exercise on changing gait speed in community-dwelling older adults and the effect of type, intensity, and dose of therapeutic exercise on gait speed. METHOD: Studies were retrieved using a comprehensive database search. Two independent reviewers determined study eligibility based on inclusion criteria, rated study quality, and extracted information on study methods, design, intervention, and results. Data were combined to obtain an overall effect size, its 95% confidence interval, and a measure of significance. In addition, analyses to characterize the clinical relevance of the findings were performed. RESULTS: One hundred seventeen studies were evaluated, with 24 studies (n=1,302 subjects) meeting the inclusion criteria for habitual gait speed and 18 studies (n=752 subjects) meeting the inclusion criteria for fast gait speed. Therapeutic exercise--or, more specifically, strength training and combination training (aerobic plus other exercise)--had significant effects (r=.145, P=.017; r=.176, P=.002, respectively) on habitual gait speed. High-intensity (effort expended by subjects) exercise and high-dosage (frequency and duration of exercise sessions) intervention also had a significant effect (r=.184, P=.001; r=.190, P=.001, respectively) on gait speed, whereas there was no effect for moderate- and low-intensity exercise or for low-dosage exercise. No exercise intervention affected fast gait speed in this analysis. DISCUSSION AND CONCLUSION: The results provide support for the belief that therapeutic exercise can improve gait speed in community-dwelling elderly people and that intensity and dosage are important contributing factors. The relatively weak correlation found between therapeutic exercise and gait speed merits further study.