Management of lymphoedema: a community-based approach.

Lymphoedema causes considerable physical, emotional and social problems. This article describes the establishment of a community lymphoedema service in one district health authority. The proposal won the Queen's Nursing Institute Innovation Award in 1991. A second article will review the first year of the clinical service.     

Evaluating a community-based exercise program for women cancer survivors.

Approximately 8.9 million cancer survivors live in communities across the United States. As advances in cancer therapy continue to improve survival rates, this number will increase. Nurses in community, ambulatory, and rehabilitative settings are challenged to meet the rehabilitative needs of this population. Research indicates that exercise interventions can improve survivors' quality of life (QOL). This pilot study examined a community-based exercise program and its impact on women cancer survivors' QOL. By using a pretest, posttest one-group design, data were collected from two groups on demographics, psychosocial adjustment to illness, mood states, fatigue, symptom distress, and overall QOL. Findings suggested that for some women exercise improved psychological and social well-being. Future research and community-based nursing practice were addressed.     

Stigma: a health barrier for women with HIV/AIDS.

The stigma experienced by women with HIV/AIDS is much like that of Hester Prynne in The Scarlet Letter. At the time of diagnosis with HIV/AIDS, women already are aware of the stigma associated with the disease. They immediately see themselves differently and believe others do also. The purpose of this article is to explore the multidimensional effect of stigma on women's efforts to promote, maintain, and enhance their health. The experiences of the women in this study tell of rejection by family members, friends, health care providers, employers, and church members. This rejection caused by stigma affects access to health care, medication adherence, social interaction, and social support. Interventions are needed to decrease the impact of stigma on women with HIV/AIDS so they can achieve a higher level of wellness, increase their life span, continue in the workforce, and improve their quality of life.     

Controlling teenagers' drinking: Effects of a community-based prevention project

Aims: The study presents the evaluation results of the age-limit component of a community-based prevention project called PAKKA. The project aimed to reduce alcohol availability among those under 18, which is the legal age for purchasing alcohol. The interventions consisted of law enforcement, community coalitions and community mobilization.

Data and methods: The effects of the interventions were measured in a quasi-experimental research-setting with a matched control area before (2004) and after (2006/7) the interventions. The data included under-age purchase trials, a population survey and a school-based survey.

Results: According to the purchase trials, the age limit control in the shops improved between the measuring points, and the young people reported in surveys that it had become more difficult to obtain alcohol. However, changes in the intervention and the control areas were similar. This can partly be explained by increased surveillance in addition to spill-over effects of PAKKA-interventions into the control areas.

Conclusions: Local coalitions can be important tools in reducing alcohol availability among minors. The quasi-experimental research-setting has its methodological limitations in assessing the intervention's impact given the overlap in local and national processes seen in the case of the PAKKA project.     

Role of women in prevention and control of AIDS

Women in India and AIDS prevention and control are discussed in terms of vulnerability, victimization, required knowledge, reproductive impact, care and prevention after birth, and the demands of the prevailing situation. A WHO world estimate is that 3 million women of childbearing age are infected with HIV out of 8-10 million. Indian women are vulnerable because of their reduced status and lack of power in private and marital life. Also, pregnant women receive blood transfusions, which may be inadequately screened, for anemia. The use of oral contraceptives with estrogen reduces immunity. The use of IUDs may cause inflammation or injury which provides a point of entry for HIV into the bloodstream. Prostitution is an outlet for lack of money, education, and skills, and places women at risk. The transmission from men to women is higher than the reverse. Every women should know their risks and modes of transmission. Women need to know that the risk of fetal infection from an HIV-positive mother is 20-40%, and that the risk is highest if HIV infection occurs or AIDS symptoms occur during pregnancy. Infant mortality from HIV may occur within the 1st several years. The following needs to be understood about reproduction and HIV: the risk of infection is very high when impregnated by an HIV male partner, and if children are desired, artificial insemination should be the preferred method. The reverse holds true, because penetrative sex without a condom allows transmission of the virus. The best option is for avoidance of childbearing if a partner has HIV. Abortion should be provided. Women need to develop the skills in language and confidence to negotiate safer sex, should be particular about choosing a loyal partner, and protect themselves by urging male condom use. The mode of transmission to babies is not from cuddling or handling. Breast feeding carries a meager risk of transmission, and should be continued if HIV infection occurs; the baby should be immunized. All health workers should receive training in order to provide support and care to mother and child in a private and confidential manner. Traditional healers have a role in providing advice on AIDS and condoms, spiritual support, and in changing behavior. Peer counseling is an important strategy for teenagers. There is a great need from society,husbands, and family to change the views of women and sex and to support women. Testing and screening of pregnant women in whom HIV infection is suspected is recommended.     

Clinical research with community-based older women.

Subjects for research with community-based elderly women are best obtained by first establishing rapport with the manager of the retirement home or apartment complex for the elderly. The site for group research should be comfortable, private, and free of distractions; it should also be centrally located and easily accessible for subjects with impaired mobility. Verbal instructions and printed questionnaires must be appropriate for the elderly subject's hearing, visual acuity, and reading level. It is important to ensure that subjects are using functional hearing aids and glasses, to allow extra time to repeat or explain questions, and to plan sessions that are not lengthy or tiring.     

Staying Steady: A community-based exercise initiative for falls prevention

Over the past decade falls in the older population have become a priority in government policy. There is good evidence to suggest that tailored exercise effectively reduces falls; however, much of this evidence takes the form of randomized controlled trials that do not reflect the diversity of clinical practice. In response to emerging evidence, a community falls prevention program, called Staying Steady, was developed targeting older people at risk of falls. The program was evaluated using a mixed methods approach to capture both the personal experiences of the five participants, and any measurable clinical outcomes. The narrative accounts, supported by the measurable clinical outcomes, indicated that it was possible to replicate the results of large trials at a local level. The qualitative aspect of the evaluation enabled detailed consideration of other issues important to falls prevention programs. A social cognitive model was used to explain the reasons why participants either did, or did not, adhere to the program. The acceptability of the program to the participants was also explored in detail. Recommendations have been made to develop the Staying Steady program for future service users.     

Focus groups: examining a community-based group intervention for depressed Puerto Rican women

Puerto Ricans manifest high rates of depression but avoid seeking treatment. The purpose of this pilot was to learn directly from Puerto Rican women how culturally appropriate they would consider a proposed community-based intervention for treating depression. Interactive activities were reviewed by two focus groups of women (N = 16), all working in community-based health programs. All activities (e.g., writing, role playing, and music) except individual drawing were deemed appropriate. Categories that emerged were family/community values, mainland/non-mainland cultural variances, communication style, religion, education/occupational variances, health beliefs, Puerto Rican traditions/customs, emotions, and coping skills. Categories provided guidance for refining a community-based intervention for treating depression in Puerto Rican women.     

Renegotiating HIV/AIDS prevention for adolescents.

According to the Centers for Disease Control in 1997, approximately 25% of the estimated new human immunodeficiency virus (HIV) infections in the United States may occur in youths under 20 years. Based on the research regarding adolescents and HIV disease, it is clear that several issues need to be addressed. This article reviews adolescent HIV risks, behaviors, and knowledge and discusses the implications for prevention.     

Falls prevention revisited: a call for a new approach

Background. Patient falls constitute a major threat to health services’ ability to provide care. Previous studies confirm that nurses can identify patients at risk and that a preventative programme can reduce the rate of falls but few studies have been evaluated over time. Aims and objectives. A study was undertaken to test a Falls Prevention Programme in an acute medical area that was re‐evaluated 5 years later to determine if the effects were sustainable. Design. The design included two groups of patients admitted before and after the programme. Variables such as staffing, equipment, environment and routines were controlled. However, because of ethical approval constraints, some variables such as age, mental status, mobility and gender were not. Methods. The programme included a risk assessment tool, a choice of interventions, a graphic that alerted others to ‘at risk patients’ and simple patient and staff education. Data were collected using incident forms and a formula was used to calculate a rate of falls. A non‐paired t‐test compared rates and anova examined the relationship of age, gender, mobility and mental status on the incidence of falls. Control graphs determined the stability of the process. Results. The falls rate was significantly reduced. Control graphs demonstrate that the process achieved greater control with less variation. In the next 5 years the falls rate increased to preprogramme levels and control graphs demonstrated that the process was no longer controlled. Compliance with the programme had deteriorated. Conclusions. The practice review considered skill mix, patient activity and acuity but provided no definitive answers to explain non‐compliance. The implications to nursing are discussed. Relevance to clinical practice. Clinicians are called to conduct more rigorous research into falls prevention but it may be more useful to direct research towards examining nursing work and increasing nurse autonomy in falls prevention.     

Issues concerning women and AIDS: sexuality.

In the US and globally women are contracting the human immunodeficiency virus (HIV) and developing the acquired immunodeficiency syndrome (AIDS) the fastest. Worldwide, HIV is transmitted primarily through heterosexual intercourse. In the US, the proportion of women who have contracted AIDS by heterosexual transmission has increased from 11% in 1984 to 34% in 1990. Women are at a greater risk than men for transmission by heterosexual intercourse as the ratio of women to men who acquire AIDS by heterosexual transmission is 3 to 1. Furthermore, 25% of AIDS cases caused by heterosexual transmission or iv drug use occurs in women. Although women often develop HIV-related serious gynecologic problems, including cervical cancer and refractory vaginal candidiasis, these conditions do not fall within the Centers for Disease Control definition of AIDS. Women who have gynecologic symptoms are not diagnosed as having AIDS, are not eligible for AIDS benefits, and live half as long as men do once they are diagnosed as being HIV infected. Little is known about the characteristics of HIV infection or AIDS in women. Sexually transmitted diseases (STDs) seem to act as cofactors for HIV infection. The human papilloma virus or genital warts, the herpes simplex virus, syphilis, chancroid, recurrent vaginal candidiasis, abnormal Pap smears, cervical neoplasias, and pelvic inflammatory disease have been associated with HIV infection in women. HIV infection should be considered in all women with symptoms of any of these disorders. Nurses must first become aware of the clinical manifestations of HIV infection specific to women. Nursing interventions should educate about safer-sex including condom use with nonoxynol 9, and the risks of sharing needles. Strategies must be developed that provide empowerment skills and are sensitive to the women's cultural, religious, and ethnic background, beliefs, and values.     

Community health, media, and policy in sub-Saharan Africa: a primary prevention approach to the AIDS crisis.

Availability, access and utilization of essential health services present challenges to community health services in Sub-Saharan Africa. HIV/AIDS infection has added yet another dimension to a continent already experiencing economic crises. A primary prevention approach is emphasized as a means of addressing sexual behaviors that decrease risk of transmission. Educating the sexually active to use condom and also HIV/AIDS testing and counseling can be effective in curbing transmission of the virus. Community forums such as the local schools and churches, together with the political leadership need to coordinate primary prevention efforts against HIV/AIDS transmission. The media can be powerful in raising awareness, community activism, and mobilization of the masses at grass-roots level by advocating behaviors that promote health. African leaders must indicate a strong political will by shaping policies that address HIV/AIDS. These leaders need resources (both internally and externally) to fund primary prevention programs that are community-based and outcome-oriented.     

Critical care education: experience with a community-based consortium approach

A continuous cycle of new orientees, cost-containment issues related to orientation, and conflicting job priorities prove to be challenging adversaries for critical care educators. The San Diego Chapter of the American Association of Critical Care Nurses (AACN) has met some of these educational challenges by providing a community-wide, consortium-based Critical Care Nursing Internship Program (CCIP) for novice critical care nurses. Over the last 15 years this CCIP has been instrumental in providing comprehensive education for more than 2,200 novice critical care nurses in San Diego County. This article discusses the background, rewards, and current challenges of the program. It also addresses a comparison between consortium-based education and the National AACN Essentials of Critical Care Orientation (ECCO) Program.     

Impact of support services provided by a community-based AIDS service organization on persons living with HIV/AIDS.

This study examined demographic, health-related, social support, and service utilization characteristics of clients with high and low use of a community-based AIDS service organization in Canada. The study confirmed that the organizations' services were reaching the most vulnerable persons living with HIV/AIDS. It found that a significantly greater number of high users compared with low users were single, lived alone, and reported poorer health. The similarity in functional health status and depression between user groups, despite high users' poorer health and greater social vulnerability, supports client reports that services have reduced client isolation and improved health-related quality of life. Finally, high users had lower expenditures for government-provided health and social services overall, particularly HIV specialists and AIDS medication, but significantly more expenditures for emergency room services and complementary therapies. The results suggest community-based services can enhance health-related quality of life for persons living with HIV/AIDS by increasing providers' capacity to identify and address client depression and its consequences.