• An Identification of Nursing Activities of Value in Assisting the Aphasic Patient to Develop Increased Self Dependency

      Kreider, Mildred Sherk, 1936-; Hosfeld, Carol M. (1968)
      The problem of this study was to identify the nursing activities of value in assisting aphasic patients to develop increased self dependency. Action research was utilized to collect the data. The nurse-investigator administered nursing care to two adult aphasic patients, attempting to direct care toward developing increased self dependency. Nursing activities were of value in assisting the patients to develop increased ability to care for their physical needs, to communicate, and to understand the implications of the disease process and plan of therapy. Activities of value in assisting the patient to increase communication included coordinating verbal communication with the use of objects and activities in the environment; reflecting the patient's attempts to verbalize; pronouncing words for the patient; encouraging expression of feelings; and verbalizing feelings which the nurse surmised the patient experienced. Activities which were of value in assisting the patient to care for her physical needs included the administration of immediate physical assistance; demonstration of activities; offering assistance to the patient; and suggesting an activity or approach to a problem. Activities which were of value in assisting patients to develop an increased understanding of the implications of the disease process and plan of therapy were providing the patient with factual information; offering assistance; and suggesting an activity.
    • Pain, coping, and depression following burn injury

      Ulmer, Janice Fitzgerald; Gift, Audrey G. (1991)
      Pain, coping, and depression were examined in a convenience sample of 32 burn injured men and women. Subjects were interviewed 3 times at approximately weekly intervals. The first and third interviews focused on coping, the second interview focused on how burn pain is described and rated by burn injured subjects and their care providers. Three criterion variables, pain intensity, pain distress, and depression were used to measure coping outcome. Five variables, severity of injury, surgical intensity, baseline depression, duration of pain, and level of analgesic drug were predicted to influence coping. Although the burn wound was identified as the source of worst pain, when subjects were asked to rate wound, donor, and skin graft pain using the short form McGill Pain Questionnaire (MPQ-SF), no significant differences were found. Average pain intensity, average pain distress, and level of depression decreased significantly over time. Pain with routine activity and pain worst continued to be rated moderate to severe by most patients at the third interview. No changes were noted in coping strategy use when coping was measured using the Coping Strategies Questionnaire. Subjects' perceptions of their ability to control pain increased significantly over the three measurement sessions. Subjects' perceptions of their ability to decrease their pain increased but did not achieve significance. Significant correlations between predictor and criterion variables were found for severity of injury, duration of pain, level of analgesic drug, baseline depression, and perceptions of ability to control and decrease pain. Significant correlations were also found between the criterion variables and beliefs related to personal control and the tendency to catastrophize. A significant positive correlation was found between care provider estimates of pain distress today and the average self-reported pain distress score. Care provider estimates of pain intensity today did not correlate with the average self-reported pain intensity score. When t-test comparisons were made between care provider and patient ratings no significant differences were found.
    • A study of family life education experiences among Chewa grandmothers, mothers, and daughters in Malawi

      Banda, Eta Elizabeth; Ruth, M. Virginia; Kreider, Mildred Sherk, 1936- (1991)
      A significant problem in adolescent health care in Malawi is a lack of information about family life education. The purpose of this descriptive and correlational study was to describe family life education experiences of Chewa grandmothers, mothers and daughters as a means of identifying the nature of the organization and type of educational programme/learning experiences that traditionally have been offered for developmental task readiness for adult life. The subjects for preliminary interviews were limited to three sets of grandmothers, mothers and daughters, i.e. nine participants. This data was used to develop the tool utilized for data collection in the study. The sample size for this study was 300. Data analysis was carried out using descriptive statistics, chi-square, analysis of variance and content analysis. Family life education organization was primarily perceived to be either the responsibility of the family or a shared responsibility between the family, village and other social organizations. Family life education was mainly informally conducted within the family, although multiple resources were utilized for teaching. Music in combination with verbal communication played an important role in instruction and reading was observed to be almost absent as a method of teaching across all generations. Although mostly of the teaching was done didactically there was some practical experience in the sex education component where a female adolescent was given a male partner to learn and this male was called a 'fisi'. Significant differences were found in virtually all organizational variables, by generation and area of residence. Ten categories of family life education learning experiences were identified and tested for differences on the basis of generation and area of residence. The results revealed statistically significant intergenerational as well as geographic differences in learning experiences in sex education, menstruation and sanitary towel care, anatomy and physiology of the female reproductive system, socialization into adulthood, relationships with parents, elders, peers of the same and opposite sex, and disabled persons, traditional practices, psychological and spiritual issues. In addition analysis of variance to examine differences in traditional values between grandmothers, mothers and daughters revealed a statistically significant main effect for generation on traditional family values. (Abstract shortened with permission of author.)
    • Minority student success in predominantly white schools of nursing: Cognitive and noncognitive factors

      Rodgers, Shielda Glover; Holt, Frieda M. (1991)
      The purpose of this study was to examine the nature of the relationship of selected cognitive and noncognitive factors to academic success of minority nursing students enrolled in predominantly white schools of nursing. In this study, the relationship between academic success (college grade point average) and the cognitive factors of high school grade point average and SAT score and the noncognitive factors of social isolation, self concept of ability, and self esteem was investigated. The theoretical framework for the study was based on Tracey and Sedlacek's model for predicting college success using noncognitive factors. Students from five NLN accredited baccalaureate schools of nursing in Virginia and Maryland participated in the study. A four part questionnaire was administered to the students which consisted of the Rosenberg Self Esteem Scale, the modified Brookover Self Concept of Ability Scale, the social isolation subscale of the UCLA Loneliness Scale and a demographic/academic data questionnaire. The student's cumulative grade point average at the end of the semester in which data collection occurred was obtained from university officials and all other academic data was self reported on the questionnaire. There were 40 black students, 33 other minority students and 117 white students in the study. Data were analyzed using regression analysis, discriminant analysis, frequency distributions, Chi Square and Pearson Product Moment Correlation. Results indicated that for the total sample of nursing students, those factors which were predictive of success were self concept of ability, self esteem, and SAT scores. For black nursing students, those factors which were predictive of success were self concept of ability and high school grade point average. For other minority students the only factor predictive of success was high school grade point average. The three groups of students (Blacks, Whites, Other minorities) included in this study differed significantly on their scores on ratings of self esteem, social isolation and college grade point average. Black students had higher levels of self esteem and social isolation, but lower college grade point averages than either whites or other minorities. No demographic characteristic correlated significantly with college grade point average for either group of minority students. Black students were significantly older and more likely to be employed than either of the other two groups. The findings from this study suggest that a combination of cognitive and noncognitive factors should be explored when attempting to predict success for black students.
    • The relationships among psychological hardiness, faculty practice involvement, and perception of role stress of nurse educators

      Lambert, Clinton E., Jr.; Ruth, M. Virginia (1991)
      The primary purpose of this descriptive cross-sectional survey of nurse educators, employed full-time by a NLN accredited baccalaureate and higher degree granting school of nursing with both a graduate and an undergraduate program, was to identify if the variables, psychological hardiness, faculty practice involvement, and perceived role stress, were inter-related. An additional purpose was to determine whether there were differences between those involved in faculty practice and those not involved in faculty practice. It was predicted that: (1) the nurse educators perception of role stress would be negatively related to the level of psychological hardiness, (2) the perception of role stress by nurse educators involved in faculty practice would be greater than the perception of role stress by nurse educators not involved in faculty practice, and (3) the level of psychological hardiness of nurse educators involved in faculty practice would be greater than the level of psychological hardiness of nurse educators not involved in faculty practice. Each of 1345 identified nurse educators, whose name had been provided by the deans of 34 randomly selected schools of nursing, was requested to anonymously respond to a mailed, self-administered, pencil and paper questionnaire comprised of three instruments (Demographic Data Questionnaire, Personal Views Survey, and Role Conflict and Role Ambiguity Scale). A 66.5% subject response rate was obtained. Data from 871 of the respondents' questionnaires were analyzed using descriptive statistics and inferential statistics. The nurse educators perception of role stress was found to be significantly negatively correlated to the level of psychological hardiness. No significant difference was found between those involved in faculty practice and those not involved in faculty practice with respect to perception of role stress or to level of psychological hardiness. The results of this study suggest that faculty practice involvement of nurse educators in NLN accredited baccalaureate and higher degree granting schools of nursing with both a graduate and an undergraduate program is a self-selective process.
    • Detecting critical on-line information: The relationship between nurse characteristics, computer screen designs, and computer interaction measures during laboratory results retrieval tasks

      Staggers, Nancy; Mills, Mary Etta C. (1991)
      This study focused on the match between nurse characteristics and computer interface designs during critical information detection tasks and examined: (1) which of three computer screen density levels promoted the fastest, most accurate target detection performance and greatest subjective screen satisfaction among clinical nurses, and (2) which of a set of selected cognitive and demographic nurse characteristics were related to nurses' practiced performance speed, accuracy, and subjective screen satisfaction. A conceptual framework for research in nurse-computer interaction was developed by integrating concepts from human-computer interaction, nursing informatics, and developmental psychology. The study sample was 110 randomly selected clinical nurses from an East-coast university medical center. A two-factor within subjects repeated measures analysis was used for the study's screen design section. Overall and for practiced tasks, nurses found information targets significantly more quickly on high density than moderate or low density screens during practiced tasks. Also, nurses found information more quickly on moderate versus low density screens. Nurses' mean accuracy and subjective screen satisfaction scores were essentially the same for all screen types. These results suggest increases in screen information density can result in faster performance speeds without sacrificing nurses' accuracy or screen satisfaction. Using step-wise multiple regression analyses, nurses' age, spatial memory, and spatial visualization explained 35.9% of overall performance speed and 21.5% of accuracy variance. Younger nurses with higher spatial memory and visualization abilities had faster performance speeds and higher accuracy rates. Nurses' previous computer experience represented a basement effect. Nurse characteristic predictors explained 27.8% of high density screen performance speed, 10.9% for moderate, and 22.5% for low density screens. During step-wise regression, age emerged as a significant predictor for all three screen types, and spatial memory was a significant predictor for high and low density screens. Spatial visualization emerged as a significant predictor for performance speed on high and moderate screens but not low. The set of predictors explained little accuracy during practiced tasks, 12.4%, and virtually none of the screen design satisfaction variance, 6%. These results suggest nurse educators and system designers may need to design visual aids and/or computer training to accommodate nurses' age and cognitive individual differences.
    • The relationship between the rewards, costs, and coping strategies of black family caregivers

      Picot, Sandra J.; Baldwin, Beverly Ann, 1941-; Rasin, Joyce (1991)
      This study was designed to describe the relationship between perceived rewards, costs, and coping strategies of black family caregivers who provided care to an elderly demented relative. Selection of coping strategies is predicated on a continuous transaction between the caregiver's appraisal of what is at stake for the caregiver in the caregiving situation and her personal resources (Folkman & Lazarus, 1980). However, research studies have suggested the caregiver's ethnicity, household income, relationship to the carereceiver, carereceiver's geographic area of residence, and the caregiving demands may serve as confounding variables. Most caregiver studies have either used predominantly white samples or treated black subjects as a homogeneous group. Therefore, the relationship of rewards, costs, and coping strategy selection with controls for the above confounding variables in an all black sample has not been done. Face-to-face interviews of 83 black female caregivers of elderly demented relatives were conducted. Coping was measured by the Jalowiec Coping Scale, rewards from the Picot Caregiver Rewards Scale, and costs from the Cost of Care Index. The demographics form included caregiver-carereceiver relationship, caregiver household income, and carereceiver geographic area of residence. The Modified Wood's Social Support Questionnaire measured the perceived quality of social support; and the Texas Research Institute of Mental Sciences Behavioral Problem Checklist evaluated caregiving demands. The seven major predictors (together) accounted for a significant amount of the overall variance in selected coping strategies, palliative emotive, confrontive active, positive thinking, problem analysis, and social support use coping. When the influences of all of the variables were removed except rewards and costs, the overall variance in palliative emotive coping, positive thinking, and problem analysis was significantly explained by rewards and costs. Caregiving demands and perceived quality of social support emerged as major predictors of total coping and social support use. Caregiver household income was a major predictor of both confrontive active and palliative emotive coping. Costs, also, predicted palliative emotive coping. Rewards were the most influential predictors of both positive thinking and problem analysis. Neither caregiver-carereceiver relationship nor carereceiver geographic area of residence emerged as significant predictors of either total coping score or individual coping strategies.
    • A study of maternal employment and family contexts: Influences on maternal health and mother-infant interaction

      Wendt, Linda Elaine; Parks, Peggy L. (1991)
      The purpose of this study was to examine relationships between selected employment, family, mother and infant characteristics, and mother-infant interaction in a sample of 81 mothers who were employed by three-months postpartum. The goal of the study was to identify family and employment variables that indirectly predicted mother- infant interaction through maternal health. A longitudinal design was used to test the Lerner-Galambos model of maternal employment. Family context variables included family social support, spousal support, and child care arrangements. Employment context variables included reasons for working, employment incongruence, hours worked and employment changes. Maternal health variables included depressive symptomatology, general health status, and number of health conditions. Mother-Infant interaction was measured by the Clark ERA dyad subscales. Variables were measured at three times: in the hospital following birth, at three-months postpartum, and at six-months postpartum. Employment context, family context, and mother and infant health variables were factor analyzed for purposes of data reduction. The factor scores were entered into hierarchical regressions. Neither employment context, nor family context, nor a combination of employment context and family context variables predicted mother-infant interaction through maternal health at six months. Maternal and infant health did not predict mother-infant interaction at six months. Family context at three months and at six months predicted maternal employment at three and six months. Exploratory analyses indicated that family context factors at three months predicted maternal health at six months. Employment context at three months predicted maternal health at six months. These findings are important for nurses who work with employed mothers during the perinatal period.
    • Correlates of nursing faculty scholarly productivity in colleges and universities in Taiwan, Republic of China

      Hsu, Man-Ying Fang; Holt, Frieda M. (1991)
      The purpose of this exploratory-descriptive study was to determine and to describe predictors of nursing faculty scholarly productivity (NFSP) in higher education in Taiwan of Republic of China. A systems model was developed based on the Andreoli & Musser's (1984) systems model of nursing faculty productivity to determine selected variables of the study. Cultural impacts on NFSP are considered. The Nursing Faculty Scholarly Productivity (NFSP) Inventory was developed to measure the phenomena of nursing faculty scholarly productivity in Taiwan. A weighting scheme used as a standard index was established by nursing committee members to increase the reliability of the measurement of NFSP. Test-retest reliability and content validity were tested and are acceptable at a predetermined level. A nationwide sample of 242 respondents (all female) had a response rate of 52.4%. All subjects worked full-time in one of sixteen colleges and universities across the northern, middle and southern regions in Taiwan, republic of China. The survey was done by mail. The deans/directors of the subjects were invited to provide organizational data. Two hundred twenty-eight usable questionnaires were included in the data analysis. Data analysis procedures included descriptive statistics, oneway ANOVA, and multiple regression analysis. Findings suggested that the systems model was a useful framework to determine variables of the NFSP. Significant predictors of NFSP in three subsystems were identified. Both teaching and research role are preferred with teaching as their primary concern, length of nursing teaching career, associate professor, teaching assistant, and aged 46-50 in human subsystem are significant predictors of NFSP. Resource support match, printed policy and being employed at a private senior college in organizational subsystem are significant predictors of NFSP. Number of persons cared for in family subsystem is a significant predictor of NFSP. Of three subsystems, the human subsystem predictors were found to have the most explanatory power of variance in NFSP in this study. Methodological issues in this study are discussed, recommendations are made for future research, and implications for improving nursing faculty scholarly productivity are also addressed.
    • The relationship between recurrent placental pathology and recurrent poor pregnancy outcome

      Krulewitch, Cara Joy; Kohler, Helen (1992)
      Poor pregnancy outcome (PPO) is a top agenda item in health and political arenas. Most prominent PPOs are low birth weight (LBW) and preterm delivery (PTD). Effective interventions to maximize pregnancy outcome will diminish their negative impact. The placenta is a diary of the infant's prenatal experiences. Changes in the placenta provide clues to the uterine environment during the pregnancy. Each placental pathology represents a different insult, including severity, duration and type. The Collaborative Perinatal Project of the National Institute of Neurological and Communicative Disorders and Stroke was a longitudinal study of obstetric outcomes in women. The study was conducted from 1959 to 1966 and contains information for 53,518 pregnancies from 10,699 women, including examination of 31,494 placentas (59%). A nested case control study was conducted on this dataset. A sample of 7653 women of black and white races who had two pregnancies during the study period were examined to determine if a relationship existed between the recurrence of PPO and a recurrence of placental pathology. Analysis used several statistical techniques including linear logistic regression and an experimental causal modelling program, TETRAD II. TETRAD II analysis indicated a relationship between marital status and educational incongruity and PPO along with a relationship between recurrent chronic hypoxia and LBW and recurrent infection and PTD. This was the first time TETRAD II was used on real data. Linear logistic regression confirmed these relationships. The risk of repeating LBW or PTD was 1.6 times greater if the woman was unmarried and was 10% greater for each year of greater educational incongruity between the mother and father of the baby. Cigarette smoking in both pregnancies represented 2.1 (1.5-2.9) times greater risk of repeating LBW. There was a 4.2 (1.4-12) times greater risk of repeating PTD if placental chorionic villitis repeated, remaining significant after adjustment for cigarette smoking and social class. There was a 6.5 (1.4-31) times greater risk of repeating LBW if decidual necrosis repeated, remaining significant after adjustment for social class, but becoming marginal when cigarette smoking was included. The main implication of these findings involves the area of preconceptual care for women. This includes preconceptual treatment of infection and nursing support to women at high risk for repeating a PPO.
    • Aggression in psychiatrically disordered children and adolescents

      Harnett, Nancy Elizabeth; Robinson, Lisa, Ph.D., M.S. (1992)
      In light of the current emphasis on adolescent aggression and the lack of available measurement instruments to study this phenomenon, this research project was undertaken to (a) examine the nature, range, and frequency of aggressive behaviors in psychiatrically disordered children and adolescents, (b) assess the psychometric properties of research instruments purporting to measure aggression, and (c) examine the relationship between age, gender, socioeconomic status and aggression. A developmental framework was utilized to guide this research endeavor. The sample consisted of 32 inpatients hospitalized at a private psychiatric facility. The instruments employed in this study included: (a) The Child Behavior Checklist/Profile; (b) The Modified Overt Aggression Scale (MOAS); (c) The Children's Overt Aggression Tool (COAT); and (d) The Hollingshead Two Factor Measure of Socioeconomic Status (SES). Findings from the study indicated significant differences in overall aggression between different age groups. There were no significant differences in aggression based on gender or socioeconomic class. Regression analysis revealed age and the absence of legal involvement to be the two strongest predictors of aggression. The overall findings from the psychometric assessment of the instruments lent support for reliability and validity of the COAT and the MOAS, with the exception of the autoaggression subscales. Additional refinement of the autoaggression subscales and more extensive assessments of the COAT and MOAS are warranted.;The findings from this study are consistent with some aspects of developmental theory. The anticipated transient recrudescence of regressive expressions of aggression during adolescence was displayed by many of the subjects. However the degree and intensity of specific aggressive behaviors exhibited by some of the subjects were not associated with earlier stages of normal development.
    • Perceived ability for self-care: A measurement study

      Thompson, Kathleen O'Hara; Prescott, Patricia A. (1992)
      The psychometric assessment of a new measure of self-efficacy at discharge from an acute care hospital, The Ability for Self Care scale is reported. The study consisted of three phases: instrument development, reliability assessment, and validity assessment. The Ability for Self Care scale contains 22 items rated on a 5-point ordinal scale. Seven behaviors or tasks are represented including: activities of daily living, diet, medications, treatments/therapeutic regimens, physician/health care contacts, therapeutic exercise, and overall self care self-efficacy. A total of 350 patients being discharged from the hospital to a home setting participated. Substantial internal consistency was demonstrated. Validity testing included hypothesis testing. Ability for Self Care scores were significantly related to social support, previous ability, and functional status, and anxiety.
    • Life stress, distress symptoms, and social supports among Korean immigrants who own small retail businesses

      Shin, Yeonghee; Ruth, M. Virginia (1992)
      The purpose of this descriptive correlational survey was to describe the relationship between life stress, distress symptoms, social support among Korean immigrant businessmen. Korean small businessmen (N = 100) completed a questionnaire developed by the researcher consisting of measures of life stress, distress symptoms, and social support. Subjects were recruited from customers of a Korean owned wholesale store. The typical profile of the sample was a middle-aged married-man, with some college education, Christian, in this country about 8 years, and who worked 6 or 7 days a week and put in 12 or 13 hours a day. The subject's family helped in his store and his clientele were mostly African-Americans. The findings suggest that Korean businessmen in the United States experience low level of life stress and distress symptoms during their adjustment in the host country. Stepwise multiple regression and ANCOVA were used to answer the research questions relating to life stress, distress, and social support. Stepwise regression yield distress symptoms, English fluency, and weekly working hours as the best predictor variables for life stress. This set of predictor variables significantly predicted 41% of variance in life stress. With distress symptoms as the criterion variable, 28% of the variance in distress was explained by life stress and education. ANCOVA showed no support for either the direct or buffering models of social support among Korean immigrant businessmen. Content analysis of open-ended questions provided added support for these findings. When the Pearson Product-Moment correlation method was used for additional analyses, variables of education, length of residence in US, life satisfaction, self-evaluation of health, and social support were significantly associated with variables of life stress and distress symptoms.
    • Defining the situation: Family members cope with chronic mental illness

      Rose, Linda Elizabeth; Lenz, Elizabeth R., 1943- (1992)
      Chronic mental illness impacts family members who experience burdens as they provide support and assistance to the patient. Family members respond in numerous ways, with some families coping more effectively than others. Little is known about this coping process and the contribution of personal and situational factors to selection of coping strategies. The study's purposes were to identify the process by which family members interpreted personal experiences of mental illness, to describe coping strategies they used and to investigate relationships among coping strategies and selected personal and situational factors. Based upon the stress and coping theory of Lazarus and Folkman and guided by the theoretical perspective of symbolic interactionism, definition of the situation was explored in indepth semi-structured interviews with 15 family members, representing 15 hospitalized psychiatric patients. Subjects also completed The Family Environment Scale, the Ways of Coping Checklist, and the Personal Resources Questionnaire. Interview data were analyzed using the Ethnograph computer program. The qualitative analysis followed interpretive approach based on grounded theory methodology. Quantitative and qualitative data were analyzed for congruence. The qualitative analysis suggested that the situation was defined in terms of two major components: identifying and responding to "patient as person" and using "power relating" to influence the impact and course of the illness. "Patient as person" included assessment of patient losses, and awareness of the essence of the patient that remained in spite of the losses. Specific actions by family members were: changing roles, patterning responses, adjusting attitudes, and making it worse/making it better. Mechanisms were: connectedness, motivation, mobilization and protection. Contexts and conditions that affected the power of relating were: personal values, social support, knowledge, and illness parameters. The components Patient as Person and Power of Relating were related in a conceptual model entitled, "Managing the Interpersonal Environment". The study expanded stress and coping theory as applied to the situation of chronic mental illness. It increased understanding of the process by which family members manage the situation. It provided insights into the importance of managing to family members in a chronic situation. Recommendations for practice and research were identified.
    • Developing a curriculum for professional nursing education in Swaziland: Views from Ministry of Health officials and nursing leaders

      Zwane, Thembi Isabel; Kavanagh, Kathryn Hopkins (1993)
      The purposes of this exploratory study were to learn about views held by Ministry of Health Officials and Nursing Leaders with regards to baccalaureate nursing graduates, and to ascertain content for baccalaureate nursing curriculum that is relevant and culturally acceptable in Swaziland. The theoretical framework for this study was based on literature on professional nursing education, curriculum development, role theory and the culture care theory. Eleven nursing Leaders and five Ministry of Health Officials acted as informants. They were selected on the basis that they are involved in decision-making for nursing education in Swaziland, have knowledge of the phenomenon studied, and were willing and able to share their views. Over a four-month period data were collected using semi-structured interviews. Interpretations of findings were related to existing literature. Validity of data was achieved through triangulation of multiple data sources. Content analysis was undertaken to inductively derive themes or patterns from data. Diverse descriptions of professional nursing education emerged from the data. Current and future nurses' roles in health care were identified. Baccalaureate and diploma nursing graduates were compared. Relevant and culturally acceptable courses for baccalaureate nursing curriculum were identified. Implications of the study for nursing education are discussed.
    • Self-efficacy in performing health education and knowledge of health teaching-learning principles in Jordanian baccalaureate nursing students.

      Haddad, Linda Ghazi; Ruth, M. Virginia (1993)
      This study explored Jordanian baccalaureate senior nursing students' reported self-efficacy and knowledge that is associated with one of the primary health care components. The major purposes of this study were to (1) examine the students' perceived efficacy in providing health education tasks and role, and (2) to examine the students' reported cognitive knowledge, particularly the teaching and learning principles. Health education was selected because it is the first essential constituent of primary health care. The conceptual framework reflected the integration of primary health care concept as presented by the Alma-Ata declaration, elements of self-efficacy theory, and cognitive skills which have been deduced from Bloom's construct of competency construct. Furthermore, the literature suggested that cognitive competence and high self-efficacy can be described as indicators of successful performance of the expected role actions. An exploratory descriptive survey design was used. The study sample (n = 185) consisted of all senior nursing students in the two baccalaureate nursing programs in Jordan, with 81.8% response rate. Measures included: (1) knowledge of teaching-learning principles questionnaire developed by Murdaugh; and (2) self-efficacy in relation to health education questionnaire which is an amalgamation of the Milde and Heim teaching skills inventory to test students' competence in providing health education, and Lehman's self-efficacy scale, which is used to measure students' self-judged efficacy associated with specific primary health care tasks and role. The two instruments were pilot tested in Jordan; A process called Back-translation was used to translate the questionnaires into Arabic. The analysis included descriptive statistics, correlation, multiple regression, and discriminant analysis. The analysis suggested the following findings and conclusions: (1) Students demonstrated a weak level of knowledge, and judged themselves as uncertain about their efficacy in performing their future health education tasks and role. (2) As predictors, those who had previously taken the community health nursing course, engaged in health education activities outside the formal course work, age, and home background were found to show weak to moderate relationships with self-efficacy. Other associated factors that could explain the variance in self-efficacy, such as instructional inputs, motivation, and students' beliefs and values, were not explored in this study.
    • War and non-war stressors, family resources, coping and family adaptation among Lebanese families

      Farhood, Laila Faris; Lenz, Elizabeth R., 1943- (1993)
      The Lebanese war (1975-1991) represented a continuing source of difficulty and disruption for the people of Beirut. The negative impact on individuals mental health has been documented, but little is known about its impact on families. The study was undertaken to describe the objective stressors, perceived stress, coping and resources of families living in Beirut during the Lebanese war and to test a model based on McCubbin's double Abcx theory predicting the relationships of these variables to family adaptation. The study was a secondary analysis of cross-sectional data collected in Beirut in 1987. The cluster sample consisted of 438 families chosen at random. Independent variables included objective stressors and perceived stress. The mediating variables were family resources and coping strategies. The dependent variables were health and interactional indicators of the outcome family adaptation: physical and psychological health, depression, and interpersonal and marital relationships. Families reported a medium to low number of objective war and non-war events stressors but a more severe perceived stress and moderate level of physical and psychological symptoms, depression, a problematic pattern in their interpersonal relationships, and good quality of marital relations. Findings provided support for the theoretical framework. Multiple regression analyses revealed that perceived stress, rather than the objective occurrence of events that predicted family adaptation. However, the more objective events experienced, the greater their perception as stressful, which led, in turn, to less positive family adaptation. Family resources particularly social support, directly and positively impacted family adaptation, and was also associated with increased use of cognitive coping. Cognitive coping did not predict either health or interactional outcomes; however behavioral coping predicted poor family adaptation. Discriminant analysis indicated a high degree of consistency in the prediction and classification of high/low perceived stress groups. Families in the low perceived stress groups had a more positive adaptation than those in the high perceived stress groups. The findings provide a beginning theoretical model which, upon further testing, can serve as a basis for practice by nurses and other health professionals when working with traumatized families.
    • Predictors of nurse adoption of a computerized information system as an innovation

      Romano, Carol Ann; Mills, Mary Etta C. (1993)
      Computerized information systems are viewed as innovations in the health care delivery system and are used by nurses to support the management of clinical and administrative information. The development, implementation and use of computerized information systems are viewed as predictable activities in the future health care environment. Adoption of these innovations is critical to the achievement of improved information management. Nurses are challenged to direct these activities to achieve efficiency, effectiveness and productivity in the delivery of health care services. The adoption of information systems is envisioned as a vehicle to enhance and improve the quality of information and ultimately the quality of nursing practice. This study explored factors that influence the adoption of a computerized information system as an innovation after it is first introduced to members of a social system. Individual, technological and organizational characteristics were investigated as predictors of adoption using multiple regression analyses, and the effect of organizational position on adoption was analyzed. Findings evidenced that over one half of the variance in adoption was explained by all three sets of predictors; close to one half of the variance was explained by technological variables alone; and one third of the variance was explained by organizational variables alone. Factors related to an adopter's personality, socio-economic status and communication behavior were found not to influence nurse adoption. In addition, using analysis of covariance, a significantly lower level of adoption was found for managers compared to non-managers when either need, supervisor values or peer values was controlled. The results suggest that focus on the perceived advantages of an innovation, the perceived need, values held by peers regarding the innovation and use of communication mechanisms facilitate nurse adoption of a computerized information system as an innovation. A revised theoretical model for the study of innovation adoption was proposed based on the data analysis. The model asserts that a relationship exists among the categories of predictor variables and negates the hypothesized direct influence of adopter characteristics on adoption behavior. Recommendations for further research, replication and model testing are proposed to expand the body of knowledge in this field. Implications for nursing include the need to focus strategies for planning, development and implementation of computerized information systems on maximizing the significant predictors. Evaluations of the information management component of current nursing roles is also suggested.
    • Role model behaviors in the clinical setting

      Wiseman, Rebecca Fortune; Soeken, Karen (1993)
      The purpose of this study was to identify the role modeling behaviors of clinical nursing faculty which junior and senior baccalaureate students consider important. Bandura's Social Learning Theory provided the theoretical framework for the three research questions. The first question focused on whether junior and senior baccalaureate nursing students differed in their perceptions of the importance of selected role model behaviors demonstrated by their clinical faculty role models. The second question examined whether there were differences in the role model behaviors that senior and junior nursing students believed they were practicing in the clinical setting. The third question explored whether there were differences in the way junior and senior nursing students perceived rewards for practicing the selected role model behaviors in the clinical setting. A convenience sample of 207 junior and senior generic baccalaureate nursing students from three university schools of nursing responded to the questionnaire. The questionnaire consisted of a list of 28 role model behaviors repeated in three sections to correspond to the three research questions. Students responded using a five-point Likert scale appropriately worded for each section of the questionnaire. Using the 28 items on each section of the questionnaire as dependent variables a MANOVA was calculated for each section. No significant differences were found between the juniors and seniors based on the overall scores. To test whether the students rated the sections differently, a repeated measures analysis was computed. Tukey post hoc comparisons indicated that both the juniors and seniors perceived that they were inconsistently rewarded for performing the behaviors that they believed to be important in a faculty role model. The findings of this study indicate that clinical faculty are considered role models by their students. Students perceive themselves as practicing the role model behaviors but they also perceive that the clinical faculty are inconsistent in rewarding them for their attempts to emulate those behaviors considered important. There were no differences between the junior and senior nursing students in the overall ratings of the three sections of the questionnaire. Areas for future research are discussed.
    • Cultural aspects of moral actions and moral choices in nursing

      Rooks, Carol Ann; Fry, Sara T.; Kavanagh, Kathryn Hopkins (1994)
      Health care in America occurs in many different contexts including the use of nurses from a variety of cultural backgrounds and experience. With ever increasing complexities in health care occurring at rapid rates, nurses are frequently involved in moral dilemmas that provide additional challenges to the practicing nurse. The role of culture in the resolution of moral dilemmas in nursing is unclear. The presumption that foreign born nurses, licensed to practice in the United States, respond similarly to nurses who are native to America, when both are faced with a moral dilemma, has not been adequately explored. This descriptive study explored the responses of foreign-educated and domestic nurses on hypothetical ethical dilemmas in an instrument that purports to measure knowledge of the American Nurses' Association Code of Ethics. Using the Judgments About Nursing Decisions (JAND) developed by Ketefian (1982), 33 European American, 26 African American and 17 Filipino nurses completed the instrument. Moral choice was operationally defined as the responses to Column A of the JAND; moral action was operationally defined as responses to Column B of the JAND. Demographic and cultural data were obtained in an instrument developed by the author. The data were analyzed using one-way ANOVAs with ethno-cultural group as the independent variable, and post-hoc comparisons of significant differences using the Student-Newman-Keuls procedure. Significant differences were found among the groups in Column A (moral choice) responses (F(2,73) = 6.56; p =.002), with European Americans scoring significantly higher than Filipino nurses. No significant differences were found among the groups in Column B (moral action) responses. Seven subjects agreed to be interviewed after completing the questionnaire to determine additional cultural factors that might have influenced their responses to the JAND. Professional and personal value systems influenced the ways in which nurses attempted to resolve the dilemmas within each story. Professional value systems related to issues of trust, accountability and confidentiality while personal value systems related to the influence of ethnocultural heritage (e.g. Irish Catholic), ethnocultural traits (e.g. stoicism and pride) and ethnocultural ethics (e.g. influence of German truth).