• Concepts and protective factors related to positive mental health from Thai adolescents' perspectives: An ethnonursing study

      Suttharangsee, Wandee; Arnold, Elizabeth (1997)
      The purpose of this Ethnonursing study was to describe characteristics of a mentally healthy person and to identify protective factors associated with positive mental health from Thai adolescents' perspectives. Three orienting questions were addressed: (1) What do Thai adolescents define as characteristics of being a mentally healthy person? (2) What do Thai adolescents do to maintain their mental health? and (3) What factors do Thai adolescents believe facilitate their mental health? Data consisted of transcriptions from individual and group interviews and participant observations of 23 high school students from a co-educational school in southern Thailand, during a three and a half month period. Data were analyzed using Leininger's Phases of Ethnonursing Analysis for Qualitative Data. Ethical issues and the rigor were considered in the study. Emerging themes were validated by informants, an expert in qualitative approaches and two experts in psychiatric/mental health. The findings were translated into English and validated by a bilingual Thai professor. Characteristics of a mentally healthy person were identified as (1) having a good mood: smiling, being cheerful and polite, and being worry-free, (2) positive thinking: a good attitude towards one's self and focusing on the positive aspects of others and of situations, and (3) good social relationships: being friends with others and having the ability to manage problems. Five methods the Thai adolescents used to maintain mental health included expressing feelings through actions and in words, distracting themselves from problems, seeking help, using a cognitive strategy, and religious practices. Eight protective factors for mental health included peers, family, school, mass media, religion, physical environment, economics, and physical health. The findings showed that traditional Thai values of social network and religion strongly influenced informants' ideas even though Thailand is becoming more westernized and it is experiencing a new industrialized period. Implications for culturally congruent nursing interventions in clinical practice, education, research, and recommendations for future studies are presented.
    • Ethical conflict situations of nursing staff development educators

      Cummings, Charmaine Jo; Arnold, Elizabeth (1995)
      Nursing Staff Development Educators (NSDEs) teach, mentor, consult with health care staff, and conduct educational research in varied health care settings. These role functions demand professional ethical conduct and skill in ethical decision-making. No available data exist concerning the ethical conflict situations these nursing professionals encounter in their practice. Hence, the major purposes of this study were to: (1) identify and categorize the themes in the ethical conflict situations reported by a sample of nursing staff development educators; (2) categorize the types of ethical conflict situations using Jameton's (1984) categories of moral conflict; (3) identify and categorize the modes of moral reasoning used by the NSDEs; (4) measure "how often" NSDEs are directly involved in and "how troubled" they are by the reported ethical conflict situations; and (5) describe the sample in terms of selected demographic variables, type and level of academic preparation (including ethics education), work history, and time spent in NSDE roles in their practice. The theoretical framework guiding this study was ethical theory and an adaptation of Rest's (1979) Four-Component Model Of Morality. Component 1 is the identification of the salient ethical aspects of an ethical conflict. Principled and care ethics modes of reasoning were proposed in Component 2 followed by moral intent (Component 3) and moral behavior or action as Component 4. The sample consisted of 102 NSDEs who represent a 35% return rate for the mailed survey of 300 randomly selected from the mailing list of the major professional organization for NSDEs. The NSDEs responded to a three-part questionnaire which asked for a description of an ethical conflict situation they were "directly involved in", how they responded, and demographic/background information. For coding of open-ended material, evidence of intrarater and interrater reliability was obtained, with percentages of agreement in the 80s and 90s. Thematic content analysis, a qualitative methodology, was used to code the responses to the open-ended questions provided by the 79 participants. (The remaining 23 NSDEs were unable to describe an ethical conflict situation, although they completed the rest of the questionnaire. The modified Zablow (1984) coding scheme revealed nine categories of ethical conflict situations which are: competence testing of staff and educators (14); resource allocation vs. quality (14); the triangle: manager/NSDE/staff (14); professional values (10); educator role functions (8); business/legal issues (8); patient care issues (7) confidentiality (4); and no stated conflict (23). Use of Jameton's typology of moral conflicts (1984) to categorize the described situations yielded an almost bimodal distribution, with 48% involving moral distress and 41% involving moral dilemma. In terms of Lyon's (1984) coding scheme for modes of moral reasoning, the 79 NSDEs predominantly (60%) used principled ethics moral reasoning, with 13% using care ethics moral reasoning. Study results provide evidence that NSDEs are directly involved in ethical conflict situations specific to their practice of adult education and staff development. The majority of the NSDEs (89%) perceived these situations as either a moral dilemma or distress. NSDEs predominantly (60%) use principled ethics mode of moral reasoning to resolve the conflicts. Implications for staff development, ethics education for NSDEs, and future research are explored.
    • The relationship of illness, psychosocial, and cognitive factors to perceived uncertainty among women with endometriosis

      Lemaire, Gail Schoen; Arnold, Elizabeth (1996)
      The primary purpose of this study was to explore illness, psychosocial, and cognitive characteristics of women with endometriosis and identify predictors of uncertainty among a convenience sample of 298 women attending an educational program on the disease. A descriptive, cross-sectional design was used. Analysis of an author-developed survey revealed that women experienced multiple symptoms; minimal success from treatment; and relatively infrequent psychological distress and disrupted social support. Participants tended to be undecided about the adequacy of their knowledge about endometriosis and had a high preference for information about the disease as measured by the author-developed instrument and the Krantz Health Opinion Survey. Uncertainty, measured by the Mishel Uncertainty in Illness Scale-Community Form, was relatively high (M=65.03, (SD) = 15.90) when compared to previously studied individuals with chronic illness. (For example, reported mean scores were in the 40s for cancer patients and post myocardial infarction patients.) Principal components factor analysis with varimax rotation was used to determine underlying factors within the illness, psychosocial, and cognitive domains. Uncertainty was negatively correlated with age (r=-.18, p<.01), and perceived knowledge (r=-.53, p<.001), and positively correlated with the factors of psychological distress and perceived nonreproductive symptoms (r=.46, p<.0001), and the treatment factor of medications taken and perceived hormonal/surgical treatment success (r=.30, p<.0001). Two factors (psychological distress and perceived nonreproductive symptom effect) and the variables perceived knowledge and subject age predicted 28% of the variance in perceived uncertainty (F (4, 196) = 19.19, p<.0001), for the stepwise equation). This study represents the first exploration of women's experiences with endometriosis and provides empirical evidence for the complexity of the disease and its treatment. Further research is needed to determine other variables relevant to women's experience of endometriosis-related uncertainty. Findings suggest the need for information, support, and intervention to assist women in making informed treatment choices.