Social Support in Cyberspace for Women with Chronic Illness

The Women to Women Project is designed to implement health promotion strategies delivered in a social context via a computer‐based system to isolated rural women who have a chronic health condition. The purposes of this article are to describe the context and methodology of the program, to examine the women's reactions to participation, and to demonstrate domains of social support exhibited in the computer‐based support group interactions. The participants are rural women, between the ages of 35 and 60, with a chronic condition (e.g., multiple sclerosis, cancer). The findings indicate that women can easily use the computer program and that few technical difficulties have been encountered. Support domains are clearly evident in the support group interactions. The women have been overwhelmingly positive about the project and share freely, giving advice and providing support.     

Educating for Wellness: A Wellness Education Group Intervention for Adults with Chronic Severe Mental Illness Living in the Community

Chronic severe mental illness (CSMI) is a common disorder in the United States associated with numerous adverse health effects. Health promotion educational interventions can be beneficial. The purpose of this project was to implement and evaluate a community-based educational program for adults with CSMI. Analyses of quantitative and qualitative data showed overall satisfaction with the program and achievement of some specific consumer health modifications. Three primary areas of interest and benefit included socialization and support, education and information, and motivation to change. The Wellness Education Group Intervention (WEGI) can serve as a model for wellness education with adults in similar communities.     

Wellness: The Dialectic of Illness

From a review of empirical and theoretical work, a model of wellness-illness evolved. The unfolding of events associated with wellness-illness is depicted as a generic paradigm with health, disease, wellness and illness existing in a dialectical relationship. Although distinct, health-disease and wellness-illness are neither mutually exclusive nor polar opposites. Rather, they are one in the same process, acknowledging the changing person in the changing world. Wellness-illness is the human experience of actual or perceived function-dysfunction through the interaction of cognitive-affective dimensions. This experience arises out of intrapersonal, interpersonal, health-disease-related and extra-personal factors.     

Interpersonal Violence is Associated with Depression and Chronic Physical Health Problems in Midlife Women

This research describes interpersonal violence (IPV) exposure in a community-based sample of midlife women from three ethnic groups and explores relationships among these exposures and variables associated with health outcomes. IPV, physical health, depression, and social support were measured by self-report questionnaires. More than 33% reported a history of physical abuse or sexual abuse and at least 20% reported both. Approximately 20% experienced sexual harassment in the past year. IPV exposure was associated with more chronic health problems and depressive symptoms. IPV, whenever it occurs, is detrimental to women's health regardless of socioeconomic status or ethnicity.     

青壮年女性四肢瘫痪患者的血脂紊乱特点

目的:通过流行病学调查了解青壮年四肢瘫痪女性血脂浓度的特点,探讨绝对缺乏运动的生活方式对青壮年女性血脂浓度的影响。方法:对中国康复研究中心因脊髓损伤致四肢瘫痪入院进行康复治疗的女性患者100例进行入院状态调查,对其血脂指标甘油三酯(TG),总胆固醇(TC),低密度脂蛋白胆固醇(LDL-C),高密度脂蛋白胆固醇(HDL-C)浓度进行分析。结果:100例患者TG浓度显著高于女性全国平均水平,HDL浓度显著低于女性全国平均水平;TC、LDL-C平均浓度与女性全国平均水平比较差异无统计学意义。年龄与TG、TC、LDL-C显著正相关(P0.05,0.01);与HDL无显著相关。血脂异常发生率68%,低HDL血症发生率58%。结论:青壮年四肢瘫痪女性患者血脂异常发生率高,与年龄正相关;与病程无相关性;患者均存在心血管健康隐患,有必要给予关注和早期干预。     

雌激素保护期成年截瘫女性血脂代谢研究

目的通过流行病学调查了解绝经前截瘫女性血脂水平,探讨截瘫致缺乏运动对雌激素保护期女性血脂代谢的影响。方法2004~2009 年中国康复研究中心截瘫女性住院患者183 例入院时行血脂状态调查。血脂观察指标：甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白(LDL)和高密度脂蛋白(HDL)。结果截瘫女性TG、TC 水平显著高于女性全国平均水平,分别达到1.44mmol/L 和4.45 mmol/L;HDL、LDL 平均水平均与女性全国平均水平无显著性差异。年龄与TG(r=0.158, P<0.05)、TC(r=0.271, P<0.01)、LDL(r=0.207, P<0.01)呈正相关;与HDL 无显著性相关。总体血脂异常发生率60%,依次为低HDL(33%)、高TC(25%)、高TG(24%)、高LDL(21%)。结论在雌激素保护作用下,HDL 代谢受缺乏运动的影响较小,但TG、TC代谢仍有一定程度紊乱,心血管疾病风险增加。     

Transitions in Chronic Illness: Rheumatoid Arthritis in Women

This article describes transition theory as it relates to a qualitative study of women with rheumatoid arthritis (RA) and the importance of this theory in nursing practice. Rheumatoid arthritis is prototypical of many chronic illnesses because it has a profound impact on activities of daily living. It frequently occurs during a person's most productive years and continues throughout life. Because a person with RA typically experiences a number of exacerbations and remissions over the course of many years, transition theory was chosen as a framework for this study. The study sample consisted of 30 women with RA, who were interviewed about their experiences of living with this chronic illness. The women described four distinct phases in learning to live with RA, which began with awareness and proceeded to mastery. These findings are consistent with the stages of transition described by other investigators.     

Divorce Transition Differences of Midlife Women

Divorce transition experienced by and its influence upon midlife women's health is not fully understood. Interviews were conducted with 24 divorced women who self-classified into decider status groups: initiator (who first decided to end marriage), non-initiator (recipient of end of marriage decision), and mutual decider (shared decision to end marriage). Interpretive content analysis involving pattern coding was conducted. The divorce transition by initiators (n = 8) included self-focused growth, optimism, and social support losses and opportunities, while the divorce transition by non-initiators (n = 8) included being left, ruminating, vulnerability, and spiritual comfort. No profile emerged for the mutual-decider group (n = 8). This study supports that differences in divorce transition exist for initiators and non-initiators.     

Measuring Physical Activity in Midlife Women

Women's risks for osteoporosis and cardiovascular disease are increasing. Although it is known that these risks decline with physical activity, it is difficult to associate specific risk levels with specific activity levels. Measuring activity levels is complex and problematic, especially in women. The present study explored the validity of a particular measure, the retrospective survey questionnaire, used with a female population to gauge physical activity, both occupational and leisure. To measure construct validity, four retrospective measures were administered to a sample of 43 middle-aged women representing three occupational groups (teachers, clerical workers, nurses) known to differ in activity levels. In addition, measurement approaches were triangulated by including a prospective measure, a beeper-cued record kept by subjects. A significant difference was noted among the groups on retrospective and prospective occupational activity measures, with clerical workers having the lowest levels of energy expenditure. The retrospective occupational measure correlated positively and significantly with the beeper-cued record kept during work; however, no correlation was found between the retrospective leisure measure and the beeper-cued record. These data suggest that the retrospective measure is appropriate for measuring the occupational dimension of physical activity. Additional study is required to identify women's leisure pursuits and the dimension of their household activities.     

Wellness and Illness Self-Management Skills in Community Corrections

Community corrections provide a readjustment venue for re-entry between incarceration and home for inmates in the US corrections system. Our goal was to determine how self-management skills, an important predictor of re-entry success, varied by demographic and risk factors. In this cross-sectional study, we analyzed responses of 675 clients from 57 community corrections programs run by the regional division of the Federal Bureau of Prisons. A self-administered survey collected data on self-management skills, demographics, and risk factors; significant associations were applied in four regression models: the overall self-management score and three self-management subscales: coping skills, goals, and drug use. Over one-quarter (27.2%/146) of participants had a mental health history. White race, no mental health history and high school education were associated with better overall self-management scores; mental health history and drug use in the past year were associated with lower coping scores; female gender and high school education were associated with better self-management goals; female gender was associated with better self-management drug use scores. Self-management programs may need to be individualized for different groups of clients. Lower scores for those with less education suggest an area for targeted, nurse-led interventions.     

The Experiences of Midlife Women With Migraines

PURPOSE: To describe the experiences of midlife women with migraines. DESIGN AND METHODS: Qualitative data were collected in two consecutive studies, using open-ended interviews, focus groups, and online discussion boards. Interpretive methods were used for analysis. FINDINGS: Three patterns were identified: Changing Headache Patterns; Predicting, Preventing, and Controlling Headaches; and Keeping on the Move. These patterns indicated how women's headaches changed over time, how headaches were envisioned within the context of their lives, what strategies were used to meet work and home responsibilities, and how women controlled their headaches while maintaining a sense of perspective. CONCLUSIONS: Many midlife women with migraines receive inadequate or inappropriate treatment, and better dissemination of current diagnostic and treatment guidelines is necessary. Ongoing research is needed to increase understanding of how this problem affects midlife women's lives and of what interventions might prevent or alleviate migraine discomfort.     

The Meaning of Health Among Midlife Russian-Speaking Women

Purpose: To explore the meaning of health among midlife Russian-speaking women from the former Soviet Union.
Design and Methodology: A hermeneutic phenomenological design was used. Study participants included 12 Russian-speaking women ages 40–61, who also spoke English and had migrated to the United States after 1991.
Findings: These themes were identified: health as being highly valued, though less of a priority during immigration; being a stranger and seeking the familiar; grieving and loss and building a new life; experiencing changes and transitions; trusting self; and the importance of hope.
Conclusions: Although health was less of a priority during the immigration process, the women valued and were knowledgeable about health, participated in self-care practices, trusted their own abilities to make self-care decisions, and sought health-related information. This is a vulnerable population at risk for the onset of chronic medical conditions associated with the process of aging, past exposures, the tendency to avoid health screening, and current stressors related to immigration and family responsibilities. Implications include the need for interventions to build trust, assess self-care practices, and understand values and beliefs concerning health screening. Future research recommendations include replication with other samples within this population and exploring curative beliefs and practices more fully. Ultimately, this study design could be applied to other immigrant populations in Western cultures.
Clinical Relevance: Midlife Russian speaking women from the former Soviet Union are a vulnerable group at risk for the onset of chronic medical conditions associated with aging, past exposures, the tendency to avoid health screening, and current stressors related to immigration and family responsibilities.     

Helping the Client with Chronic Disability Achieve High-Level Wellness

Clients with chronic disability often define themselves in terms of their sick role. Today, many healthcare professionals and laypersons alike prefer to view the individual as a unified whole striving toward high-level wellness. Thus, a client may be diagnosed with a physical illness, a chronic illness, or a disability but may still work to attain high-level wellness by functioning in an integrated way with the environment. This article describes the client with chronic disability in relation to high-level wellness and provides techniques nurses can use to facilitate a client's positive adjustment.     

Spirituality and Chronic Illness

Purpose: To present a comprehensive overview of spirituality and identify strategies to support the spiritual dimensions of nursing care for people with chronic illness, focusing specifically on HIV-related illness and AIDS.
Significance and Scope: The AIDS crisis has brought new emphasis to the need to develop therapeutic interventions to support the coping resources of people living and dying with chronic illness. Conceptual, theoretical, and empirical knowledge related to spirituality was reviewed, integrated, and interpreted within the context of nursing care for this population, emphasizing the spiritual needs of people with HIV-related illness and AIDS.
Conclusions and Implications: Spirituality has evolved beyond religious considerations to encompass multidimensional and existential perspectives that are integral to maintaining well-being for the chronically ill. A deeper understanding of spirituality enhances the potential for nurses to identify spiritual needs and incorporate spiritual caring into practice.