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Becker's (1974) Health Belief Model has been used successfully to address behavior change in chronic diseases, including smoking and alcohol dependence. This project applies the Health Belief Model to opiate addiction treatment, specifically medication-assisted treatment (MAT). The purpose of this study was to measure the relationship between self-efficacy and treatment outcomes for opiate-dependent clients on MAT. A convenience sample of 50 persons with addiction to opiates was admitted to an outpatient substance abuse treatment program for MAT and followed for a period of 6 months. Pretreatment and posttreatment self-efficacy scores were obtained using a modified General Self-Efficacy Scale (GSE). Treatment outcomes were measured by the number of negative random monthly urine screens, attendance at group and individual counseling sessions, and retention in treatment for at least 6 months. Pretreatment and posttreatment self-efficacy scores were compared using a t test, and self-efficacy scores were compared with client outcomes using Pearson's correlation. GSE scores showed improvement after 6 months in treatment (p ≤ .01). However, no statistically significant relationship was found between GSE scores and treatment outcomes.

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The interplay of policy, milestone events, and cornerstone documents was critical in the evolution of the specialty of public health nursing (PHN) from 1890-1950. Using our contemporary lens, this article examines PHN development from an historical perspective, including events and milestones driving growth in the early 20th century. Some of the challenges faced by our founding public health nursing leadership are not unlike challenges we face today. In 1950, Ruth Hubbard, a former leader in the National Organization of Public Health Nurses and Director of the Visiting Nurse Society of Philadelphia, spoke of the value of examining the past to forge a new future. This article calls for contemporary public health nurses to act upon the lessons learned from the past, to strengthen the renewed focus on prevention, to develop policies that impact population health, and to foster a vision that will guide us into the future.

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Rural health disparities are due in part to access barriers to health care providers. Nursing education has been extended into rural areas, yet a limited rural research and practice literature informs the content and delivery of these educational programs. The University Of Virginia School of Nursing through a grant from the Health Resources and Services Administration developed the Nursing Leadership in Rural Health Care (NLRHC) Program. The transformational nursing leadership in rural health care (TNLRHC) model guided the development of NLRHC program content and teaching methods. This article describes the TNLRHC model and how it has steered the integration of rural content into advanced practice nursing (APN) education. The capacity of the TNLRHC model for promoting innovation in APN education is described. Recommendations regarding the future development of APN education are presented.

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This article examines public health nursing (PHN) education in the United States from 1900 to 1950. Following establishment of district nursing and the Henry Street Settlement in the late 1800s, nurses worked with families and communities in schools, homes, and with immigrant populations in tenements of industrialized cities. By the early 1900s, PHN leaders recognized that graduates needed broader education than provided by hospital training schools to prepare nurses to address social conditions and promote health and hygiene for populations. Current themes in professional nursing, such as social determinants of health, have their roots in early discourse about PHN education.

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Children diagnosed with cancer experience many invasive procedures throughout diagnosis and treatment of their disease. These procedures, oftentimes a source of distress in children, can elicit a variety of anticipatory symptoms prior to the actual procedure. Although there have been efforts to develop approaches to alleviate this distress through use of distraction, relaxation, sedation, guided imagery, and hypnosis, there has not been a combination treatment that merged relaxation techniques and biofeedback within a pediatric framework. A group of 12 children diagnosed with cancer participated in a 4-session intervention combining relaxation and biofeedback. This feasibility study suggests that the combination intervention offered in a clinical setting may be beneficial to children experiencing procedural distress as a novel coping strategy.

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The purpose of this study is to describe the characteristics and health status of a sample of migrant farmworkers in the Shenandoah Valley. The methodology for this study is a retrospective record review and analysis of data on 390 male migrant farmworkers. The group included men from Mexico (57. 2%), Jamaica (26. 9%), and Haiti (13. 0%) with a mean age of 38.5 years. The most common health problems reported were work-related and included musculoskeletal pain, irritated eyes, and respiratory symptoms. This study identifies areas for community and public health nurses to target interventions to address health promotion/disease prevention efforts.

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Service learning and study abroad opportunities have become increasingly popular in nursing education in the past decade. The purpose of this systematic review was to explore existing literature concerning global health experiences in nursing education. Twenty-three empirical articles from 2003 to 2010 were reviewed, building upon existing reviews of international nursing education literature. Research on two-way exchange experiences and models for best practice were found to be lacking. While an array of countries were represented as the visiting or hosting side of the experience, few co-authors from host countries were found, particularly in literature originating from the U.S. The authors recommend that two-way exchange programs be evaluated to identify successful strategies and barriers to success. Ongoing evaluation of exchanges is necessary to ensure continued sustainable partnership and exchange in immersion experiences for nursing students.

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The purpose of this study was to describe the experiences of rural community-dwelling older adults with heart failure who required assistance with activities of daily living (ADLs) and instrumental ADLs (IADLs). The context of the study was a rural area in a southern U.S. state. Twenty older adults with ADL/IADL needs living in the rural area were recruited during hospitalization and interviewed in their homes after discharge. The semi-structured interview focused on ADLs/IADLs and community resources. This qualitative descriptive study used hermeneutic methods for analysis. Four themes were identified: Accepting Limitations, Disappointments and Unmet Expectations, Figure It Out, and Complex Connections. The findings indicate that despite the older adults' medical conditions, they were able to set up complex arrangements, which allowed them to remain in their homes. Understanding the help older adults require after discharge will assist nurses in developing programs that are available, accessible, and acceptable to older adults who live in rural areas.

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The purpose of this systematic literature review was to determine the relationship between the diagnosis of diabetes and depression and missed appointments in a low-income, uninsured, racially heterogeneous, adult population. Research demonstrates that individuals with diabetes have an increased incidence of depression across socioeconomic and racial groups. Low-income individuals have an increased prevalence of depression. The cost and burden of diabetes are greatly increased among individuals with both diabetes and depression versus diabetes alone. The prevalence and effects of diabetes and depression in a low-income, uninsured, racially heterogeneous population have not been determined. Further research to explore the relationship of diabetes, depression, and missed appointments in this vulnerable population is needed before effective treatment models can be developed. Longitudinal studies are also needed to determine the cause and effect between diabetes and depression among all populations.

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Hospitals as research environments are crucial in advancing evidence-based practice and translational research. The authors discuss issues related to hospital-based nursing research such as institutional review board approval, the HIPAA, structure, unit characteristics, and nurse staffing as well as research-related issues such as study purpose and design, participant recruitment, and research personnel. Strategies and suggestions for nurse executives to assist researchers in overcoming recruitment challenges are presented.

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Elders with chronic diseases frequently have problems with activities of daily living and instrumental activities of daily living. This article describes a holistic, elder-friendly community model. The review of the nursing, healthcare, and social science literature offers insight into the complexity of community resources for elders.

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OBJECTIVES: The purpose of this study was to translate and psychometrically assess the Breastfeeding Self-Efficacy Scale (BSES) among women living in Fortaleza, CE, Brazil, and examine the relationship between breastfeeding self-efficacy (BSE) and maternal demographic variables. DESIGN AND SAMPLE: This methodological study is the first translation of BSES conducted in South America. The psychometric assessment of the original study was replicated. This methodological study enrolled a group (sample of judgment) of 117 pregnant women. MEASURES: BSES and maternal sociodemographic variables were studied. RESULTS: The Cronbach's alpha coefficient for the translated BSES was .88. Significant differences in BSES scores were found among mothers with a previous satisfactory breastfeeding experience (M = 145.81; SD = + or - 6.82, p = .0001). Significant relationships were found among prenatal BSE and maternal age (r = .228; p = .01), educational level (r = .234; p = .01), and marital status (r = .183; p = .04). No relationship was found among BSE and maternal occupation, family income, or number of pregnancies. CONCLUSIONS: Altogether, our findings suggest that BSES translated into Portuguese may be a reliable and valid measure to assess maternal BSE in Brazilian culture. Minor changes may be needed to use it in other Portuguese-speaking countries, such as Portugal and Mozambique.

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PURPOSE: The purpose of this project is to identify rates of depression and document mental health needs of adults with diabetes who obtained care in free clinics. Data were collected to determine if there is a relationship between diabetes and depression and missed appointments in a sample of patients who were low-income, uninsured, and represented a variety of racial groups. METHODS: A sample of 183 adults with diabetes participated by completing paper and computerized questionnaires. Instruments included the Patient Health Questionnaire 9 (to measure prevalence of depression), the RAND 36 Health Survey (to measure quality of health), the Audit of Diabetes Dependent Quality of Life (to measure diabetes-dependent quality of life), and the Diabetes Empowerment Scale (to measure self-efficacy). RESULTS: The prevalence of depression at a moderate or greater level in the sample was found to be 30.1%. Levels of quality of health and self-efficacy were found to be reduced among those with the presence of depression. A significant increase in the rate of depression was found among those who had attended the free clinic for a longer period. No significant differences were found in diabetes-dependent quality of life and missed appointments among those with depression compared with those without. CONCLUSIONS: Rates of depression among adults with diabetes in a free clinic setting were found to be comparable with the highest rates reported by other studies of insured populations. Results of this study support the need to develop mental health treatment programs for free clinic settings.

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The CINAHL and MEDLINE databases were used to conduct a review of international rural nursing research published between 2003 and 2007. In total, 41 articles were reviewed and organized based on the United Nations Human Development Index, which categorizes countries based on development status. Critical review of international rural nursing research yielded three major organizational themes: clinical issues, aspects of nursing practice, and nursing and health policy research. Despite the variety in international locale of the research, these themes and other common findings emerged. The need for increased access to specialized nursing knowledge, resources, and support is an ongoing issue facing nurses in rural and remote settings.

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A infertilidade é um problema de saúde que vem acometendo pessoas na sociedade contemporânea. Esta investigação qualitativa utilizou o Interacionismo Simbólico como referencial teórico-metodológico para compreender os significados vivenciados pelas mulheres durante uma fertilização in vitro em Fortaleza-Ceará. Seis mulheres concordaram em participar deste estudo conduzido entre março/2002 e janeiro/2003. Os métodos incluíram observação participante, diário de campo e uma entrevista. A FIV foi considerada difícil pelas mulheres as quais experienciaram temor, dor física e emocional, ansiedade, e expuseram seus corpos para tentar gerar uma nova vida e satisfazer o desejo da maternidade. A experiência diária com o processo de FIV moldou os sentimentos, comportamentos e atitudes das mulheres. O suporte de enfermagem foi crucial para a habilidade da mulher de enfrentar a trajetória da FIV, especialmente durante os períodos críticos do tratamento.

This qualitative investigation uses Symbolic Interactionism as theoretical and methodological framework to understanding the experienced meanings created in women's lives by the in vitro fertilization process in Fortaleza-Ceara. Six women agreed to participate, and were enrolled in this study that was conducted between March/2002 and January/2003. Methods included participant observation, field diary, and an interview. In vitro fertilization was considered difficult by the women who experienced fear, physical and emotional pain, anxiety, and exposure of their bodies in an attempt to generate a new life and fulfilling the desire for motherhood. The daily experience with the overall in vitro fertilization process shaped the women' feelings, behaviors and attitudes. Nursing support was crucial for the women's ability to endure the in vitro fertilization trajectory, especially during critical periods of the treatment

La infertilidad es un problema de salud que ha acometido personas en la sociedad contemporánea. Esta investigación cualitativa utilizó el Interaccionismo Simbólico como referencial teórico-metodológico para comprender los significados probados por las mujeres durante una fertilización in vitro (FIV) en Fortaleza-Ceará. Seis mujeres concordaron en participar de este estudio conducido entre marzo/2002 y enero/2003. Los métodos incluyeron observación participante, diario de campo y una entrevista. La FIV fue considerada difícil por las mujeres que, a la vez, tuvieron temor, dolor físico y emocional, ansiedad, y además exhibieron sus cuerpos para intentar generar una nueva vida y satisfacer el deseo de la maternidad. La experiencia diaria con el proceso de FIV amoldó los sentimientos, comportamientos y actitudes de las mujeres. El soporte de enfermería fue crucial para la habilidad de la mujer de enfrentar la trayectoria de la FIV, especialmente durante los periodos críticos del tratamiento.

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Exclusive breastfeeding is acknowledged as important for survival, optimal growth, and development of infants. The current review presents a synthesis of research output by Brazilian nurses on breastfeeding over the last 20 years, analyzes the theoretical and methodological issues emerging from studies on breastfeeding in Brazil, and provides directions for future research and practice by nurses in the area breastfeeding. Studies included in this review were identified through LILACS searches of Portuguese-language sources. Articles were organized and analyzed chronologically by comparing the evolution of the Brazilian Breastfeeding Program. The incomplete research output of the Brazilian nursing profession in regard to breastfeeding research needs to be addressed. In addition, specific cultural, sociological, and anthropological characteristics of Brazilian regional settings remain to be explored. Emphasis on potential confounders and critical interrelations is warranted.

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Sabe-se que o aleitamento materno exclusivo é importante para a sobrevivência, crescimento e desenvolvimento infantil. Os objetivos desta revisão foram: apresentar uma síntese da produção intelectual da enfermagem brasileira na área do aleitamento materno nos últimos vinte anos, criticar questões teóricas e metodológicas dos estudos, e providenciar direções para futuras pesquisas e práticas de enfermagem em relação ao aleitamento materno. Os estudos incluídos nesta revisão foram identificados por meio de busca no LILACS para estudos publicados em português. Os artigos foram organizados e analisados cronologicamente, traçando uma comparação com a evolução do Programa Nacional de Aleitamento Materno. A lacuna da pesquisa em aleitamento materno pela enfermagem brasileira precisa ser preenchida como uma agenda prioritária. Além disso, as peculiaridades culturais, sociológicas e antropológicas que caracterizam cada região brasileira precisam ser exploradas. A ênfase em potenciais co-fatores e suas inter-relações críticas precisa ser melhor explorada.

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Since 2001, our nations' leaders, the press, and the general public have looked to the health sector for leadership in addressing acts of terrorism. It has become urgent for health agencies and related public services to collaborate and for all health professionals to become knowledgeable about disaster preparedness. This article describes collaboration between the public health department, local hospitals and the school of nursing in one community, Charlottesville, Virginia, to address disaster preparedness. In this story about our community's emergency preparedness, the focus is both on preparation and the hope we will never need to utilize this knowledge.

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Acute Care of the Elderly (ACE) units have been shown to improve outcomes for hospitalized elders. Because the literature offers little to describe the appropriate staffing of such units, we surveyed ACE units about their size, configuration, staffing, patient selection, training, and outcomes data. Although we had anticipated speaking with staff from 30 to 40 units, we were able to poll key personnel on only 18 ACE units. This article describes staffing and continuous quality improvement data for these sites.

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