Predictors of adherence to a behavioral therapy sleep intervention during breast cancer chemotherapy

Background  

This study’s purpose was twofold: (1) to establish adherence rates to a behavioral therapy (BT) sleep intervention and (2) to identify psychological and physical symptom predictors of adherence to the intervention in women undergoing breast cancer chemotherapy.     

The long-term efficacy of a behavioral parent training intervention for families with 2-year-olds

The effectiveness of a behavioral parent training (BPT) intervention for improving maternal self-efficacy, maternal stress, and the quality of mother–toddler interactions has been demonstrated (Gross, Fogg, & Tucker, 1995). The 1-year follow-up of the 46 parents of toddlers (assigned to an intervention or comparison group) who participated in that study is reported. It was hypothesized that (a) BPT would lead to enduring positive changes in parenting self-efficacy, parenting stress, and parent–toddler interactions; and (b) the amount of parent participation in the intervention would be correlated with greater gains in parent–child outcomes at 1 year. All the families were retained and significant gains in maternal self-efficacy, maternal stress, and mother–child interactions were maintained. Minimal BPT effects were found for fathers. BPT dosage was related to reductions in mother critical statements and negative physical behaviors at 1-year postintervention. The findings are consistent with self-efficacy theory and support parenting self-efficacy as a target for BPT in families of young children. © 1998 John Wiley & Sons, Inc. Res Nurs Health 21:199–210, 1998     

Strategies for maintaining integrity of a behavioral intervention

The purpose of this article is to address issues in maintaining the integrity of a behavioral intervention. Examples are provided from a recently completed study on how to train research staff and monitor the integrity of the intervention. In this exemplar, the integrity of the behavioral intervention was addressed by the design of the study and research staff training. Throughout the study, the integrity of the behavioral intervention was monitored by delineating a checklist of topics that must be addressed, critiquing audiotapes of the intervention, and discussing incomplete or missing elements with the research staff.     

Predictors of post-release research retention and subsequent reenrollment for women recruited while incarcerated

Correctional facilities are prime targets for nursing interventions to decrease health disparities, but challenges to post-release follow-up limit use of the longitudinal research designs needed to fully examine intervention effects. Using an adapted version of the Behavioral Model for Vulnerable Populations, we determined predictors of 1-year post-release study retention and subsequent reenrollment an average of 3 years later in 88 mother and child dyads recruited from a state prison nursery. Predisposing characteristics and enabling factors emerged as strong predictors of loss to follow-up. Female research participants can be successfully retained years after release from a correctional facility. Understanding the barriers and facilitators to post-release follow-up supports the creation of theoretically informed strategies to retain formerly incarcerated populations.     

Effect of a behavioral nursing intervention on long-term lipid regulation

Reduction of dietary fat intake and increased physical activity are first-line interventions for elevated total serum cholesterol (TC) and low-density lipoprotein (LDL) serum cholesterol, which are major and modifiable risk factors for coronary heart disease. This retrospective study reports on the effects of a nurse-managed behavioral intervention (NMBI) program on TC and LDL levels in hyperlipidemic patients. Survival analysis indicated that NMBI patients had a significantly higher probability of attaining normal TC and LDL levels than did patients who received only standard nursing care. Additional analysis showed that actual TC and LDL values declined significantly across the study period with marginally significant group by time interactions. These findings provide preliminary evidence of the effectiveness of the behavioral intervention program with hyperlipidemic patients.     

Promoting interdisciplinary care of patients and families: a classroom project

Interdisciplinary educational experiences provide opportunities for nursing students to gain knowledge regarding the contributions of other healthcare providers in ensuring quality patient care. The project, part of a family health course, brought together students from 5 disciplines to heighten awareness of the necessity of, and the call for, interdisciplinary education. The authors discuss the project and its structure to provide ideas to other educators who may want to integrate an innovative interdisciplinary experience into their course.     

综合性干预措施对某三级综合医院新入职医务人员手卫生的影响

摘要 目的 了解新入职医务人员干预前后手卫生变化情况,并根据调查结果提出针对性的管理措施。方法 通过问卷调查的方式对干预前后手卫生相关知识的掌握情况进行评估分析,利用现场演示法及观察法比较干预前后手卫生正确性及依从性,评价干预措施效果。结果 干预后医务人员手卫生知识掌握率不断提高,戴手套可以代替洗手的回答正确率由30.21%上升到86.98%;干预前后医疗(54% vs 85%)、护理(58% vs 89%)、医技人员(53% vs 81%)、其他工勤人员(51% vs 72%)的手卫生正确性变化情况,差异有统计学意义;干预后手卫生依从性较前有所提高。影响医务人员手卫生行为的因素主要有工作太忙顾不上、洗手设施不便、冬季洗手用水温度低等。结论 对手卫生的错误认知及消极态度会影响医务人员的手卫生行为,应根据其薄弱环节采取有针对性的措施。     

Impact of a psychoeducational intervention on caregiver response to behavioral problems

BACKGROUND: Eighty percent of persons with Alzheimer's disease and related disorders are cared for by family members who often lack adequate support and training for this all-consuming job. OBJECTIVE: To evaluate the efficacy of a longitudinal, multisite, community-based intervention designed to teach home caregivers to manage behavioral problems in persons with Alzheimer's disease. METHODS: Usable data were analyzed from 237 caregiver/care recipient dyads (n = 132 Experimental; n = 105 Comparison). The experimental group received a psychoeducational nursing intervention that was conceptually grounded in the Progressively Lowered Stress Threshold model (Hall & Buckwalter, 1987). The comparison group received routine information and referrals for case management, community-based services, and support groups. Although a variety of psychosocial outcomes were compared between caregivers in the two groups, this article focuses on frequency and response to behavioral problems and functional decline. RESULTS: The Progressively Lowered Stress Threshold intervention had a statistically significant effect on spousal response to memory/behavioral problems (p <.01) for all caregivers and on response to activities of daily living problems (p <.01) for spousal caregivers. In addition, nonspouses in the experimental group reported a reduction in the frequency of memory/behavioral problems (p <.01). No intervention effect on reports of activities of daily living frequencies was found for either spouses or nonspouses. CONCLUSIONS: This Progressively Lowered Stress Threshold-based intervention had a positive impact on both the frequency of and response to problem behaviors among spousal caregivers.     

Crisis intervention: a care plan for families of hospitalized children

Hospitalization of a child following a traumatic injury often precipitates a crisis for the patient's entire family. Although pediatric intensive care unit (PICU) nurses are in key positions to assist these families, time constraints, in addition to inadequate staff education regarding family assessment and counseling, often lead to the family being overlooked. Nurses need a quick and accurate method for assessing and intervening with families in crisis.     

对糖耐量异常人群行为干预的必要性和可行性探讨

[目的 ]探讨行为干预对糖耐量异常病人康复的影响。 [方法 ]把糖耐量异常病人分为行为干预组与对照组 ,比较 3年来在糖尿病发病率、并发症发生率、空腹及餐后血糖水平方面的差异。 [结果 ]两组病人在糖尿病发病率、并发症发生率及餐后血糖水平比较有统计学意义 (P <0 .0 5 )。 [结论 ]对糖耐量异常人群进行行为干预 ,能有效降低 2型糖尿病的发病率和与高血糖相关的晚期并发症 ,降低致残率。     

A holistic intervention programme for families with a child with a disability

BACKGROUND: The birth of a child with a disability may cause serious stress for the parents and affect each member of the family. Parents need support to deal with such a situation; however, health care professionals themselves are not always well equipped to help them and often adopt an attitude of withdrawal. AIM: The aim of this paper is to describe a family intervention programme developed in collaboration with families who were adapting to the birth of a child with a disability. DISCUSSION: The primary purpose of the programme is to help family members adapt to the situation in which they suddenly find themselves, primarily by reducing stress. The family's autonomy and competencies in providing care for the child are promoted and called into action. The programme encompasses different aspects of family relations: the individual, marital, parental, family, extended family and non-family sub-systems. Its theoretical foundations, clinical experience with families of a child with a health problem, and our previous research have enabled a remodelled vision of the way individuals and families adapt to such a situation. CONCLUSION: The symbioses of the design of the programme, training in its application, and intervention itself have transformed families of a child with a disability as well as the nurses themselves. The key element of this transformation has been the mutual recognition of relevant skills and authority by families and health care professionals that has led to new competencies, self-determination and an individuality that may change their lives.     

Effectiveness of a behavioral change intervention in Thai elders after knee replacement

BACKGROUND: After total knee replacement, elders need an effective intervention to change exercise and physical activity behavior. OBJECTIVES: This study examined the effects of a behavioral change intervention (BCI) on self-efficacy and outcome expectations for exercise and functional activity, physical activity participation, and physical performance of older adults. METHODS: The study was based on the social cognitive theory (SCT), with a longitudinal quasi-experimental, pretest-posttest control group design. Sixty-three Thai elders undergoing knee replacement surgery were studied. The experimental group received a BCI based on SCT given by the investigator. Outcome measures were the Self-Efficacy for Exercise Scale (SEES) and Self-Efficacy for Functional Activity Scale (SEFAS), the Outcome Expectations for Exercise Scale (OEES) and Outcome Expectations for Functional Activity Scale (OEFAS), the Physical Performance Test (PPT), and the Physical Activity Diary (PAD). RESULTS: The experimental group had significantly greater improvements in self-efficacy for exercise, outcome expectations for exercise, and functional activity, significantly more participation in exercise and walking, and significantly greater improvement in physical performance than did the control group at postoperative weeks 2 and 6. DISCUSSION: The BCI based on SCT was effective in changing the outcomes in the expected direction. This BCI may be applicable, with modifications, to elders in other situations in which changing behavior is the key to recovery.     

Evaluation of a nursing intervention project to promote patient medication education

Aim and objective. The purpose of this study was to evaluate patients’ knowledge regarding their medication regime following a nursing interventional project in patient medication education. Design. Evaluation. Background. Educating patients during their hospital stay regarding their medical treatment is an issue which the medical staff deals with on a daily basis. The hospitalisation period is a known critical point in the provision of influential information to the patient and related family members, probably because the hospitalised patient and family members have unique learning needs that cannot be postponed. Methods. The study was conducted in three internal medicine wards in a large university tertiary hospital in Jerusalem, Israel. The intervention project used structured written materials and verbal patient education related to highly potent drugs. The study evaluated patients’ knowledge regarding their medication as the main interventional outcome. In addition, the rate of patients receiving verbal and written education, rate of patient intention to take the medication and adequacy of nursing interventions according to the patients’ educational needs were also assessed. Data collection was carried out by a short structured tool that examined patient knowledge. With this tool, the nurse interviewed the patients and recorded the patient’s response and her recommended intervention. Results. Two hundred and fifty‐one patients participated in the study. Most of the patients (71–93%) reported that they had received instructions from nurses. The majority of the patients demonstrated a high level of knowledge regarding their medications and planned on taking their medications on a regular basis. Lack of knowledge was observed mostly on issues related to dietary recommendations. In these cases, the nurses’ intervention was not always documented and did not necessarily match the problem identified. Conclusions. The findings show that patients, who received medication education, demonstrated satisfactory level of knowledge and intended to take their medication. Patients’ knowledge feedback enables the nurse to assess her intervention. Relevance to clinical practice. Patient medication education in the hospital is a challenging task. This article suggests an applicable tool to assure that patients receive appropriate medication education, while assessing the effectiveness of this education. This tool also enables the nurses to modify their intervention according to patient response.     

Student-generated behavioral guidelines to inform ethical practice: a quality improvement project

Nursing faculty members have become increasingly concerned with student incidences of cheating and the associated lack of commitment to ethical conduct. Our faculty believed that actively engaging students in the development of specific behavioral guidelines would result in improved ethical conduct and provide a bridge to future professional ethical practice. The authors discuss the use of focus groups to establish clear behavioral guidelines that align with the American Nurses Association Code of Ethics.     

Mobile diabetes intervention study: Testing a personalized treatment/behavioral communication intervention for blood glucose control

Background:National data find glycemic control is within target (A1c < 7.0%) for 37% of patients with diabetes, and only 7% meet recommended glycemic, lipid, and blood pressure goals.Objectives:To compare active interventions and usual care for glucose control in a randomized clinical trial (RCT) among persons with diabetes cared for by primary care physicians (PCPs) over the course of 1 year.Methods:Physician practices (n = 36) in 4 geographic areas are randomly assigned to 1 of 4 study groups. The intervention is a diabetes communication system, using mobile phones and patient/physician portals to allow patient-specific treatment and communication. All physicians receive American Diabetes Association (ADA) Guidelines for diabetes care. Patients with poor diabetes control (A1c ≥ 7.5%) at baseline (n = 260) are enrolled in study groups based on PCP randomization. All study patients receive blood glucose (BG) meters and a year's supply of testing materials. Patients in three treatment groups select one of two mobile phone models, receive one-year unlimited mobile phone data and service plan, register on the web-based individual patient portal and receive study treatment phone software based on study assignment. Control group patients receive usual care from their PCP. The primary outcome is mean change in A1c over a 12-month intervention period.Conclusion:Traditional methods of disease management have not achieved adequate control for BG and other conditions important to persons with diabetes. Tools to improve communication between patients and PCPs may improve patient outcomes and be satisfactory to patients and physicians. This RCT is ongoing.