RESUMEN
BACKGROUND: Bullying remains a troubling problem in the nursing profession. Nursing students may encounter bullying behavior in clinical settings. However, they may not be adequately prepared to recognize and handle bullying behavior when it occurs. This study's purpose was to gain a greater understanding of nursing students' experiences of bullying behaviors in the clinical setting. METHOD: Using a descriptive qualitative approach, eight focus groups were held with 56 undergraduate baccalaureate nursing students from four college campuses. Focus group data were coded and analyzed for themes. RESULTS: Four categories were identified: Bullying Behaviors, Rationale for Bullying, Response to Bullying, and Recommendations to Address Bullying. Each category and its corresponding themes are presented. CONCLUSION: Interventions for nurse educators to address the bullying of nursing students in clinical settings are presented. [J Nurs Educ. 2016;55(9):505-513.].
Asunto(s)
Acoso Escolar , Bachillerato en Enfermería , Estudiantes de Enfermería/psicología , Adulto , Femenino , Grupos Focales , Humanos , Relaciones Interprofesionales , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
BACKGROUND: Limited data exist regarding extended, long-term immunologic effects of immunotherapy in polysensitized individuals. To study possible long-term effects, skin tests and specific IgE levels were obtained from subjects who had previously received broad-spectrum aeroallergen immunotherapy years before. METHODS: Eighty-two subjects (78% male, mean age 23 years) previously enrolled in a randomized, placebo-controlled trial of immunotherapy for treatment of childhood allergic asthma were reevaluated in adulthood (mean follow-up interval, 10.8 years) by puncture skin tests and CAP-RAST levels for major aeroallergens. All completed at least 18 months (median 27 months) of maintenance active treatment or placebo injections without subsequent immunotherapy. RESULTS: At adult follow-up, 36% of all skin tests to treatment allergens among subjects who received immunotherapy (n = 41) had significantly reduced intensity versus 26% of skin tests among placebo recipients (n = 41; p = 0.03). No significant differences were noted for individual treatment allergens. No significant differences were observed in the long-term changes of serum-specific IgE antibody levels for all treatment allergens between immunotherapy treatment and placebo groups (p = 0.43). The treatment and placebo groups had a similar acquisition of new skin test sensitivities from time of randomization in the original childhood trial to debriefing (15 vs. 20%; p = 0.28) and to adult follow-up (30 vs. 31%; p = 0.75). CONCLUSIONS: Immunotherapy suppresses skin test sensitivity 8-16 years after discontinuation of treatment, but long-term effects on specific IgE levels in serum are not observed. Broad-spectrum immunotherapy does not appear to affect the acquisition of new inhalant sensitivities.
Asunto(s)
Alérgenos/inmunología , Asma/terapia , Desensibilización Inmunológica/métodos , Adolescente , Adulto , Asma/inmunología , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Inmunoglobulina E/sangre , Masculino , Prueba de Radioalergoadsorción , Pruebas Cutáneas , Estadísticas no ParamétricasRESUMEN
BACKGROUND: Asthma, traditionally characterized as reversible airway obstruction, might lead to structural changes and permanent impairment. OBJECTIVE: We sought to study the frequency, severity, and reversibility of pulmonary deficits in adults with a history of moderate-to-severe childhood allergic asthma. METHODS: Subjects (n = 121) previously enrolled in a randomized trial of immunotherapy for childhood asthma were recalled. Eighty-four young adults (age, 17-30 years; 78% male) were reevaluated by means of spirometry. Subjects with a postbronchodilator FEV1, forced vital capacity, or FEV1/forced vital capacity ratio less than or equal to the 5th percentile or 2 or more indices less than or equal to the 10th percentile (National Health and Nutrition Examination Survey III normative data) were invited to undergo complete pulmonary function testing, physical examination, and chest radiography after 1 week of 1 mg/kg daily prednisone. RESULTS: Of 84 subjects reevaluated, 40 (48%) had one or more spirometric indices less than or equal to the 5th and 10th percentiles (P < .0001). Twenty-eight of the 40 subjects were reassessed after prednisone treatment, of whom 21 (75%) did not improve. Adult and childhood (age 5-12 years) spirometric results were positively correlated (r = 0.49-0.72, P < .001). Abnormal adult spirometric results were associated with a longer duration of asthma at enrollment in the original trial (4.6 vs 6 years, P=.02), increased childhood methacholine sensitivity (PC20, 0.11 vs 0.18 mg/mL; P = .01), and birth prematurity (adjusted odds ratio, 10.7; 95% CI, 1.4-84.5). Immunotherapy status was unrelated to adult lung function. CONCLUSIONS: Many adults with a history of moderate-to-severe allergic asthma in childhood have irreversible lung function deficits. Childhood spirometry, duration of asthma, methacholine sensitivity, and birth prematurity might identify such individuals at a young age.
Asunto(s)
Asma/fisiopatología , Pulmón/fisiopatología , Adolescente , Adulto , Asma/terapia , Niño , Preescolar , Femenino , Volumen Espiratorio Forzado , Humanos , Inmunoterapia , Masculino , Espirometría , Capacidad VitalRESUMEN
BACKGROUND: Childhood asthma can have a range of outcomes in adulthood. OBJECTIVE: To identify clinical features and exposures associated with persistence and severity of childhood asthma in adulthood. METHODS: Eighty-five of 121 subjects previously enrolled in a study of immunotherapy for childhood allergic asthma (age 5-12 years) were re-evaluated with allergy skin testing, spirometry, and interviews about asthma symptoms and medications. These young adults (age 17-30 years; 74% male) all had moderate to severe childhood asthma. Adult asthma severity was scored by using a modified version of National Heart, Lung, and Blood Institute severity categories. RESULTS: Thirteen (15.3%) of 85 adult subjects were in remission despite persistent childhood asthma. Another 19 subjects (22.4%) had only intermittent asthma. The remaining 53 had persistent asthma, of whom 12 (14.1%) had mild asthma, 25 (29.4%) had moderate asthma, and 16 (18.8%) had severe asthma. Subjects in remission, compared with subjects with intermittent or persistent asthma, had lower total serum IgE in childhood (412 ng/mL vs 1136 ng/mL vs 968 ng/mL; P = .02) and fewer positive allergy skin tests (7 vs 9 vs 10 from panel of 18; P = .02). Subjects in remission also had milder childhood asthma, indicated by lower average daily medication usage scores (1.6 vs 3.5 vs 4.4; P = .005) and lower percentage of days on inhaled corticosteroids (13.7% vs 24.7% vs 40.9%; P = .008). No significant association was found between current asthma severity and childhood immunotherapy ( P = .46). CONCLUSION: The prognosis of childhood allergic asthma in adulthood is largely determined early in life. The degree of atopy appears to be a critical determinant of asthma persistence.