Factors in the Perioperative Nurses' Work Environment That Predict Work Engagement

Perioperative nurse engagement and certification are associated with a culture of safety, which is crucial in perioperative environments. Therefore, examining relationships between engagement, the practice environment, and certification is warranted. The purposes of this study were to examine the relationships between the perioperative practice environment and reported nurse engagement, determine differences in engagement based on certification, and identify facilitators and barriers to attaining and sustaining certification. In this multiphase mixed-methods study, we used a convenience sample of perioperative nurses (N = 379) to examine relationships between engagement, the practice environment, and certification. Qualitative interviews were conducted (n = 15) to supplement the quantitative findings. Leadership support (β = 0.23, P = .001) and nursing foundations for quality care (β = 0.21, P = .01) were significant predictors of engagement. Certified nurses did not have significantly higher mean engagement scores when compared with noncertified peers. Qualitative interviews corroborated the findings.

The effect of a mindfulness-based intervention on stress overload, depression, and mindfulness among nurses: A randomized controlled trial

BACKGROUND

Nurses experience various health-related issues due to the nature of their work.

AIM

This study aimed to examine the effect of a mindfulness-based intervention on stress overload, depression and mindfulness among nurses. A secondary objective was to examine the role of the setting (i.e., in and out of the hospital as a natural setting) on mindfulness-based intervention effectiveness.

METHODS

A randomized controlled trial with three groups' pretest-posttest design was used in this study. A total of 195 nurses were recruited-65 intervention-inside hospital, 60 intervention-outside hospital, and 63 control. The mindfulness-based intervention was delivered by a certified mindfulness practitioner over 4 weeks in Jordan. Data were collected using a demographics questionnaire, the Stress Overload Scale Short, the Center for Epidemiologic Studies Depression Scale-Revised, and the Five Facet Mindfulness Questionnaire.

RESULTS

Multivariate analysis showed a statistically significant effect of the intervention on the linear combination of the dependent variables V = 0.44, F[6, 368] = 17.56, p < .001. Follow-up analyses showed that a mindfulness-based intervention significantly decreased stress overload, depression, and increased mindfulness levels among nurses in intervention groups compared with the control group. In addition, conducting a mindfulness-based intervention outside the hospital has a better effect on mindfulness levels than the inside hospital.

LINKING EVIDENCE TO ACTION

The effect of a mindfulness-based intervention on stress overload, depression, and mindfulness should be considered when planning for nurses' well-being and the quality of care provided. Nurse managers are encouraged to use the study's findings to promote nurses' well-being.

Predictors of cigarette smoking in pregnant women with substance use disorders

BACKGROUND

Cigarette smoking is common among pregnant women with substance use disorders (SUD) and may contribute to more adverse health consequences for the infant than alcohol and illicit drug use. However, most studies focused on stopping illicit drug use and paid little attention to cigarette smoking in pregnant women with SUD.

PURPOSE

To identify predictors of current smoking among pregnant women with SUD, given past-month psychological distress, alcohol use and illicit drug use, the receipt of past-year mental health and substance use treatment controlling for potential confounders.

METHODS

Secondary analysis of cross-sectional data from the National Survey on Drug Use and Health (NSDUH) 2015-2019 was conducted. The NSDUH included 3,540 pregnant women aged 18-44 years; among them were 195 lifetime smokers with SUD. Multiple logistic regression modeling was used to examine the probability of prenatal smoking.

RESULTS

Sixty-one percent of pregnant women with SUD reported current cigarette smoking. The likelihood of prenatal smoking increased with a higher level of past-month psychological distress (Adjusted Odds Ratio [AOR] 1.14; 95% Confidence Interval [CI]: 1.02-1.28), past-month illicit drug use (AOR: 5.68; 95% CI: 1.59-20.21), and past-year substance use treatment receipt (AOR: 5.73; 95% CI: 1.88-17.45).

CONCLUSION

The receipt of substance use treatment markedly increased the probability of smoking in pregnant women with SUD. Treatment and policy initiatives are required to address and integrate cigarette smoking within other substance use treatment modalities for pregnant women with SUD.

Telehealth Care for Perinatal Depression in Immigrant and Refugee Women: A Scoping Review

Immigrant and refugee women have higher rates of perinatal depression compared to native-born women. Innovative telehealth interventions provide opportunities for prevention and treatment of perinatal depression. However, little is known about telehealth for perinatal immigrant and refugee women with depression. The aims of this scoping review were to identify available literature addressing the use of telehealth care for perinatal depression in immigrant and refugee women, and to determine the content, mode of delivery, and outcomes of telehealth care when provided for this population. A systematic literature search from 2000 to July 2023 was conducted in six databases and grey literature. The initial search resulted in 988 articles which were screened for their titles and abstracts. Eighty-one full-text articles were reviewed, yielding five articles included in this review. One quantitative study (a feasibility descriptive study), three qualitative studies, and a commentary supported the user satisfaction and potential effectiveness of telehealth care, delivered via telephone and text messaging, in improving perinatal depression symptoms. This review revealed a dearth of data-based studies on the outcomes of telehealth care for perinatal depression among immigrant and refugee women. Collaboration among researchers, healthcare providers, and technology engineers is required to improve telehealth care for this population.

The Psychometric Properties of the World Health Organization Quality of Life-Bref Questionnaire in College Students

Background and purpose: Because there are conflicting perspectives on the factor structure of the World Health Organization Quality of Life-BREF (WHOQOL-BREF) Questionnaire among college students, we evaluated the psychometric properties of the instrument in a sample of US college students. Methods: We conducted secondary analysis of data collected from 1,138 undergraduate students from a large metropolitan university in the southeastern United States. Results: Confirmatory factor analysis did not support the original four-factor structure. Based on exploratory factor analysis, three factors were retained and rotated using Varimax rotation, which accounted for 96% of the item variance. Cronbach's alphas for the factors were: social/psychological health 0.84; physical health 0.81; and environment 0.77. Sexual minorities had significantly lower scores on all factors than those who identified as heterosexuals. Conclusions: In this sample of college students, the WHOQOL-BREF was three-dimensional, and a significant amount of the item variance was explained. Lower quality of life scores of nonWhites and sexual minority college students point to a critical need that should be addressed.

Stressors and resilience are associated with well-being in young adult college students

Objective: The purposes were to describe stressors and resilience behaviors of college students and examine the relationships among stressors, resilience, and well-being. Hypothesis: Resilience will modify the relationship between stressors and well-being. Participants: The sample included 1,010 college students, ages 18-26, from an urban Midwestern university. Methods: A secondary analysis of cross-sectional data from an anonymous survey was conducted using multiple regression and simple slopes analysis. Results: Resilience did not modify the relationship between stressors and well-being. Stressors (β = -.44, p < .0001) and resilience (β = .33, p < .0001) accounted for 42% of the variance in well-being (adjusted R² = .42, F_2,999 = 365.98, p < .0001). The most frequently endorsed stressors were sleep problems, anxiety, and relationships. Conclusions: Stressors and resilience warrant special attention in the allocation of resources and development of programs to improve student well-being.

Cigarette Smoking Cessation Counselling in Pregnant Smokers with Mental Illness/Substance Use Disorders

Our objective was to determine if past-year mental illness and substance use disorders (SUD) among pregnant smokers predicted the probability of receipt of counselling for cigarette smoking cessation. A secondary analysis of data from the National Survey on Drug Use and Health 2016-2019 was conducted. We found that approximately 83% of pregnant smokers (N = 373) received screening for cigarette smoking, and 65% received cessation counselling. Having mental illness predicted the probability of receipt of counselling for smoking cessation in pregnant smokers (adjusted odds ratio [AOR]: 3.75; 95% confidence interval [CI]: 1.25-11.27). However, having SUD (alcohol [AOR: 2.30; 95%CI: 0.57-9.26] or illicit drug use [AOR: 1.32; 95%CI: 0.26-6.82]) or comorbid mental illness and SUD (AOR: 0.23; 95%CI: 0.03-2.03) was not associated with receipt of counselling for smoking cessation. Practice guidelines and policy initiatives are needed to reduce cigarette use and its related adverse health outcomes in pregnant smokers with SUD.

Psychometric Evaluation of Three Translated Measures of Functional Health Literacy among Jordanians

Assessment of functional health literacy (FHL) is not integrated into clinical settings in Jordan possibly because relevant psychometric studies are lacking. The aim of this secondary analysis of data on family caregivers (N = 115) was to evaluate the internal consistency reliability and construct validity of three measures of FHL among Jordanians: the Short Test of Functional Health Literacy in Adults (S-TOFHLA), the Rapid Estimate of Adult Literacy in Medicine-Revised (REALM-R), and the Single Item Literacy Screener (SILS). Cronbach's alpha was excellent for the S-TOFHLA (.92), but suboptimal for the REALM-R (.67). In bivariate analysis, FHL measured by the S-TOFHLA and the REALM-R, but not the SILS, was positively associated with educational attainment (p < .05) and negatively related to self-reported anxiety (p < .05). Among Jordanians, psychometric rigor was fully demonstrated for the S-TOFHLA and partially for the REALM-R, but not for the SILS.

The prevalence of nurse burnout and its association with telomere length pre and during the COVID-19 pandemic

Background

Burnout is a work-related stress syndrome characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment. Nurse burnout is related to nurses’ deteriorating mental health and poorer patient care quality and thus, is a significant concern in healthcare. The Coronavirus Disease 2019 (COVID-19) pandemic has swept the world and distressed the healthcare systems. Because of the body’s stress mechanism, it is vital to examine the current prevalence of nurse burnout and understand it at a biological level, using an epigenetic biomarker, telomere length.

Purpose

To determine the prevalence of burnout among nurses in the Peri-Operative and Labor & Delivery settings pre and during the COVID-19 pandemic and to examine the effects of burnout on absolute telomere length.

Methods

This is a cross-sectional study assessing the prevalence of nurses’ burnout and the relationships between nurses’ burnout and telomere length. Due to the COVID-19 pandemic, we had to stop the study during the mid of data collection. Even though the study was not designed to capture changes before and during the pandemic, we analyzed two groups’ data before and during the pandemic. The study took place in a US hospital. Nurses in the hospital’s Operating Room, Post-Anesthesia Care Unit, and Labor & Delivery Unit participated in the study. Maslach Burnout Inventory survey and nurses’ demographics were administered online. Telomere length was measured via finger-prick blood.

Results

146 nurses participated in the study, with 120 participants’ blood samples collected. The high-level burnout rate was 70.5%. Correlation analysis did not reveal a direct correlation between nurse burnout and telomere length. However, in a multiple regression analysis, the final model contained the burnout subscale of emotional exhaustion, years as an RN, and work unit’s nursing care quality. There was a low degree of departure from normality of the mean absolute telomere length in the pre-pandemic group and a substantial degree of departure in the during-pandemic group.

Conclusions

Nurse burnout is a prevalent phenomenon in healthcare, and this study indicates that nurses currently experience high levels of burnout. Nurses’ cellular biomarker, telomere length, is shorter in the group of nurses during the COVID-19 pandemic than before. Appropriate measures should be implemented to decrease nurses’ burnout symptoms and improve nurses’ psychological and physical health. Nurses, especially those younger than 60, report higher burnout symptoms, particularly emotional exhaustion. This study indicates the need for intervention to promote nurses’ health during the pandemic and beyond. If not appropriately managed, nurse burnout may continue to be a significant issue facing the healthcare system.

Cigarette smoking cessation and mental health treatment receipt in a U.S national sample of pregnant women with mental illness

OBJECTIVES

To (1) compare the probability of cigarette smoking cessation for pregnant women with and without past-year mental illness by the trimester of pregnancy; and (2) examine the association between the receipt of past-year mental health treatment and prenatal cigarette smoking cessation among pregnant lifetime-smokers with mental illness.

METHODS

We conducted secondary analysis of data from the National Survey on Drug Use and Health (NSDUH) 2008-2014. The NSDUH included 2019 pregnant lifetime smokers aged 18-44 years, 528 of whom had a mental illness. We used multiple logistic regression to model the probability of prenatal cigarette smoking cessation.

RESULTS

Pregnant lifetime-smokers with mental illness had a lower rate of cigarette smoking cessation than women without mental illness (47.9% vs. 61.7%, p = 0.001). Compared to pregnant women without mental illness, pregnant women with mental illness had a significantly lower odds of smoking cessation in the first trimester (Adjusted Odds Ratio [AOR]: 0.34, 95% Confidence Interval [CI]: 0.18-0.66), but not in the second (AOR: 0.87, 95% CI: 0.46-1.63) and third trimesters (AOR: 0.94, 95% CI: 0.51-1.72). The likelihood of quitting smoking did not differ significantly for pregnant lifetime-smokers with mental illness who received and did not receive mental health treatment (AOR: 1.69, 95% CI: 0.87-3.28).

CONCLUSION

Pregnant lifetime-smokers with mental illness are less likely to quit smoking than those without mental illness; overall, pregnant women tended to quit smoking as they progressed in their pregnancy. The receipt of mental health treatment was not associated with quitting smoking. Mental health care providers need to screen for cigarette use among pregnant women and strengthen smoking cessation efforts.

CLINICAL RELEVANCE

Pregnancy presents a unique opportunity for mental health care providers to screen for cigarette use in women with mental illness and support their smoking cessation efforts.

Trends in mental health and substance use disorders and treatment receipt among pregnant and nonpregnant women in the United States, 2008-2014

PURPOSE

To compare trends in mental health and substance use disorders and treatment receipt of pregnant and nonpregnant women from 2008 to 2014.

METHODS

Using data from the 2008-2014 National Survey on Drug Use and Health, logistic regression was used to compare trends in mental health and substance use disorders and treatment receipt for mental health and substance use disorders among propensity score-matched groups of pregnant (n = 5520) and nonpregnant women (n = 11,040). Among women in the matched sample who met criteria for at least one mental illness, trends in mental health treatment receipt of pregnant (n = 1003) and nonpregnant women (n = 2634) were compared.

RESULTS

There were no differences in the trends by pregnancy status from 2008 to 2014. Past-year anxiety disorder, past-month psychological distress and illicit drug use disorder increased in the total sample from 2008 to 2014, yet trends in mental health treatment and unmet need for substance use treatment did not change over time. Pregnant women had lower odds of mental illness, but those who had mental illness were less likely to receive mental health treatment than their nonpregnant counterparts.

CONCLUSIONS

There is a need for preventive strategies addressing anxiety disorder, psychological distress and illicit drug use among women of childbearing age as well as initiatives to increase access to mental health treatment among pregnant women.

Self-care behavior: a new insight of the role of impulsivity into decision making process in persons with heart failure

Background

Self-care behavior has been reported to be below optimum in persons with heart failure, while the underlying decision making is not well understood. The Hot/Cool System model is a psychological model that may have potential applications in decision making process in persons with heart failure. The aim of this study was to examine the decision making process in self-care behavior in persons with heart failure in the light of the Hot/Cool System model.

Methods

We used the Hoot/Cool System Model to guide this study. Participants with heart failure from in-patients setting (N = 107) were recruited. Data were collected using self-report questionnaires. Moderated mediation analysis was used to study complex relationships among study variables.

Results

The current study showed that impulsivity and perceived stress were negatively associated with self-care behavior. The results also showed that self-care confidence and impulsivity significantly predict self-care maintenance. The moderated mediation analysis revealed that self-care confidence mediated the relationship between impulsivity and self-care maintenance at lower levels of perceived stress, but not at higher levels of perceived stress.

Conclusion

Our findings revealed that persons with heart failure tend to make impulsive choices that may negatively affect disease progression under higher levels of perceived stress. This study provides foundational knowledge regarding the decision making process in persons with heart failure.

Depression, Anxiety, and Substance Use Disorders and Treatment Receipt Among Pregnant Women in the United States: A Systematic Review of Trend and Population-Based Studies

The objective of this systematic review was to synthesize findings of trend and population-based studies on depression, anxiety, and substance use disorders and treatment receipt among pregnant women in the United States. Twenty-eight articles (nine trend studies and 19 population-based studies) were included for review. Two trend studies showed that illicit drug use disorder increased in pregnant women over the past decade, particularly opioid and marijuana use disorders. Three studies reported an increase in treatment admissions for these disorders from 1992 to 2012; however, the overall treatment admission rate for pregnant women remained relatively stable at 4%. Three studies identified an increase in antidepressant use from 1995 to 2010 in pregnant women. Nine of 19 population-based studies revealed that White ethnicity, older reproductive age, college education, and health insurance coverage were associated with mental health and substance use treatment receipt among pregnant women. Further studies are warranted among a nationally representative sample of pregnant women.

Self-Management as a Mediator of the Relationship between Social Support Dimensions and Health Outcomes of African American Adults with Type 2 Diabetes

Social support promotes behavior change and self-management that leads to improved health outcomes. The purpose of this study was to evaluate the role of self-management in mediating the relationship between social support dimensions and health outcomes of African Americans with type 2 diabetes (T2D). Cross-sectional data were collected from 102 African Americans with T2D at an outpatient clinic. The majority of the participants were female, single, unemployed, and having low income. Functional support, the quality of the primary intimate relationship, and the number of support persons were negatively correlated with depression. Functional support and satisfaction with support explained a significant small amount of the variance in self-management. However, self-management did not mediate the relationships between social support dimensions and the health outcomes. The results of this study shed the light on the unique relationships of social support dimensions with health outcomes of African Americans with T2D.

Evaluation of an interprofessional education program for advanced practice nursing and dental students: The oral-systemic health connection

BACKGROUND

In response to the growing body of evidence supporting the need for expanded interprofessional education among health professions, an interprofessional education program, based on the Interprofessional Education Collaborative Core Competencies, was piloted with nurse practitioner and dental students.

OBJECTIVES

The purpose of this pilot study was to evaluate a technology enhanced interprofessional education program focused on the oral-systemic health connection for nurse practitioner and dental students.

DESIGN

A two-group comparative study using cross-sectional data and a quasi-experimental one-group pre-test/post-test design were used to evaluate students' knowledge of IPE core competencies, attitudes toward interprofessional education and interdisciplinary teamwork, and self-efficacy in functioning as a member of an interdisciplinary team.

SETTING AND PARTICIPANTS

This program was implemented with master of science in nursing students pursuing a primary care nurse practitioner (NP) degree and dental students at a large urban academic health sciences center. Cohort 1 (N = 75) consisted of NP (n = 34) and dental students (n = 41) at the end of their degree program who participated in a one-time survey. Cohort 2 (N = 116) was comprised of second-year NP students (n = 22) and first-year dental students (n = 94) who participated in the IPE program.

METHODS

Students participated in a multi-faceted educational program consisting of technology- enhanced delivery as well as interactive exercises in the joint health assessment course. Data were collected prior to the initiation and at the conclusion of the program.

RESULTS

Nurse practitioner and dental students who participated in the program had better self-efficacy in functioning as a member of an interdisciplinary team than graduating students who did not participate. Students from both nursing and dentistry who participated in the program had significantly improved self-efficacy in functioning in interprofessional teams from pre- to post-test.

CONCLUSION

An interprofessional education program can be a valuable addition to the health professions curriculum of nurse practitioner and dental students. Care must be taken to address logistical issues when working with students in different academic programs.

Psychometric Properties of the Ambulatory Surgery Index of Nausea, Vomiting, and Retching

BACKGROUND AND PURPOSE

At least one-third of ambulatory surgery patients will experience nausea or vomiting during the recovery period. The purpose of this study was to examine the psychometric properties of the Ambulatory Surgery Index of Nausea, Vomiting, and Retching (AS-INVR).

METHODS

Secondary analysis of longitudinal data from a study of 203 adult ambulatory surgery patients was conducted.

RESULTS

Based on the results of factor analysis, the retching item was eliminated and the 6-item, 2-dimensional AS-INV was formed. Cronbach's alphas for the AS-INV ranged from .83 to .87 across the 5 days postsurgery. Higher AS-INV scores were associated with self-reported presence of nausea and lower quality of life.

CONCLUSIONS

The shortened AS-INV provides a reliable and valid measure of the amount and distress because of nausea and vomiting in adult patients after ambulatory surgery and should be considered for use in future studies.

Predicting grief intensity after recent perinatal loss

OBJECTIVE

The Perinatal Grief Intensity Scale (PGIS) was developed for clinical use to identify and predict intense grief and need for follow-up after perinatal loss. This study evaluates the validity of the PGIS via its ability to predict future intense grief based on a PGIS score obtained early after a loss.

METHODS

A prospective observational study was conducted with 103 international, English-speaking women recruited at hospital discharge or via the internet who experienced a miscarriage, stillbirth, or neonatal death within the previous 8weeks. Survey data were collected at baseline using the PGIS and the Perinatal Grief Scale (PGS). Follow-up data on the PGS were obtained 3months later. Data analysis included descriptive statistics, Cronbach's alpha, receiver operating characteristic curve analysis, and confirmatory factor analysis.

RESULTS

Cronbach's alphas were ≥0.70 for both instruments. PGIS factor analysis yielded three factors as predicted, explaining 57.7% of the variance. The optimal cutoff identified for the PGIS was 3.535. No difference was found when the ability of the PGIS to identify intense grief was compared to the PGS (p=0.754). The PGIS was not inferior to the PGS (AUC=0.78, 95% CI 0.68-0.88, p<0.001) in predicting intense grief at the follow-up. A PGIS score≥3.53 at baseline was associated with increased grief intensity at Time 2 (PGS: OR=1.97, 95% CI 1.59-2.34, p<0.001).

CONCLUSIONS

The PGIS is comparable to the PGS, has a lower response burden, and can reliably and validly predict women who may experience future intense grief associated with perinatal loss.

Facilitating Self-Transcendence: An Intervention to Enhance Well-Being in Late Life

This randomized controlled pilot study evaluated the effects of the Psychoeducational Approach to Transcendence and Health (PATH) Program, an 8-week intervention hypothesized to increase self-transcendence and improve well-being in community-dwelling women aged 60 years and older ( N = 20). The PATH combined mindfulness exercises, group processes, creative activities, and at-home practice using community engaged research methods. Findings provided some support for the effectiveness of PATH. Although there was no significant Group × Time interaction, self-transcendence, psychological well-being, and life satisfaction differed significantly pre- and postintervention in the wait-listed control group, which received a revised version of the program. Further study is needed with a larger sample to determine the effectiveness of PATH. Potentially, PATH may be a convenient and affordable activity to support personal development and improve well-being among older adults at senior centers, retirement communities, nursing homes, church groups, and other places where older adults gather.

Psychometric Properties of the Patient Health Questionnaire-9 in Patients With Heart Failure and Gastrointestinal Symptoms

BACKGROUND AND PURPOSE

Patients who have coexisting medical conditions tend to be more depressed. The purpose of this study was to examine the reliability, validity, and dimensionality of the Patient Health Questionnaire-9 (PHQ-9) in patients with heart failure and gastrointestinal (GI) symptoms.

METHODS

The cross-sectional data for this secondary analysis were collected in four studies. Cronbach's alpha was used to examine reliability. Concurrent validity with the Beck Depression Inventory-II (BDI-II) was examined.

RESULTS

Cronbach's alpha for the PHQ-9 was .87. Concurrent validity with BDI-II was excellent (r = .78, p < .01).

CONCLUSIONS

The evidence from this study supports the reliability and validity of the PHQ-9 as a measure of depression in patients with heart failure and GI symptoms.

Postdischarge nausea and vomiting: management strategies and outcomes over 7 days

PURPOSE

The purpose of this study is to determine patient management strategies and outcomes for self-care of postdischarge nausea and vomiting (PDNV).

DESIGN

Prospective, comparative, descriptive, and longitudinal study.

METHODS

The sample consisted of 248 patients aged 18 years or older undergoing a procedure requiring general anesthesia. Patients recorded incidence and severity of nausea and vomiting, the impact of symptoms, and actions taken to alleviate symptoms for 7 days postdischarge.

FINDINGS

The prevalence of PDNV was 56.9%. The methods used to relieve symptoms included antiemetic use by a minority and nonpharmacologic techniques of self-management by some. The effect of nausea on QOL, patient functioning, and patient satisfaction was significantly worse for those who experienced postdischarge nausea on all days.

CONCLUSION

Patients with PDNV use minor self-care strategies to manage symptoms. The presence of PDNV affects overall quality of life, patient functioning, and patient satisfaction.

The Peer and Family Smoking Index: A Valid Measure of Secondhand Smoke Exposure in Adolescents

PURPOSE

Nearly half of all adolescents in the United States are exposed to secondhand smoke (SHS) daily, primarily at home, resulting in respiratory infections, asthma exacerbations, and reduced lung function. A concise self-report measure is needed to identity adolescents exposed to SHS. The purpose of this study was to test whether nonsmoking adolescents who reported exposure to peer and/or family smoking on the Peer and Family Smoking Index had higher salivary cotinine levels than those reporting no exposure to either peer or family smoking.

METHODS

A convenience sample of 135 English-speaking adolescents ages 15-18 years was recruited from two high schools. Those who reported use of nicotine replacement therapy, cigarette smoking (past 30 days), smokeless tobacco use (past 30 days), or who self-reported pregnancy were excluded. Salivary cotinine and self-report data from the Peer and Family Smoking Index were collected after obtaining parental consent and assent from the adolescent.

RESULTS

Mean salivary cotinine levels differed by exposure group (none, family, peer, or family and peer), F (3, 130) = 5.44, p = .001. The post hoc analysis identified a significantly higher mean cotinine level among those exposed to SHS from both family and peers than among those with no exposure (p = .001).

CONCLUSIONS

Known groups validity of the index was supported. Adolescents who reported family smoking or a combination of family and peer smoking had significantly higher salivary cotinine levels than unexposed adolescents. The Peer and Family Smoking Index is a concise and valid self-report measure for SHS exposure in adolescents.

Nicotine Dependence Measures for Perinatal Women

This integrative review provides an overview of nicotine dependence measures used with perinatal women and an evaluation of their psychometric properties. Fifty-five articles that met inclusion and exclusion criteria were identified from five different databases. Most of the studies used the Fagerström Test for Nicotine Dependence (FTND). Other approaches included diagnostic tests, the Wisconsin Inventory of Smoking Dependence Motives (WISDM), the Tobacco Dependence Screener, and single-item measures. This review indicated that the FTND may not be the best option for measuring nicotine dependence in this population. The WISDM is a newer instrument that has excellent psychometric properties and captures nonnicotinic dimensions of nicotine dependence relevant to women. Future research is needed to assess its reliability in the perinatal population. Other recommendations from this review include the use of biomarker validation, thorough psychometric reporting on nicotine dependence instruments, and the use of multiple instruments to maximize comparability between nicotine dependence instruments.

A Pilot Test of the Everyday Stressors Index-Spanish Version in a Sample of Hispanic Women Attending Prenatal Care

BACKGROUND AND PURPOSE

Prenatal and postpartum psychosocial stress are associated with adverse pregnancy outcomes. Hispanic women experience higher levels of stress during pregnancy. This pilot study assessed the psychometric characteristics of the Everyday Stressors Index-Spanish (ESI-S) version.

METHODS

Secondary analysis in a convenience sample, n = 51 women.

RESULTS

The ESI-S showed adequate internal consistency (Cronbach's alpha = .86). Two factors accounted for 40% of the item variance. The greatest sources of stress were "having too many responsibilities" and "not enough money for basics". Higher levels of stressors were associated with older age, living without a partner, and working part or full time. The ESI-S was positively correlated with measures of perinatal depression.

CONCLUSIONS

Findings support the reliability and validity of the newly translated ESI-S.

Psychometric Properties of the Brief Symptom Inventory Hostility Subscale in Patients With Heart Failure

Background and Purpose: Patients with heart failure (HF) often have increased hostility. The Brief Symptom Inventory (BSI) Hostility subscale has not been evaluated in this population. The purpose of this study was to explore dimensionality, internal consistency, and construct validity of BSI Hostility subscale in HF. Method: Measures examined were BSI Hostility, Depression, and Anxiety subscales; Patient Health Questionnaire-9 (PHQ-9); and Multidimensional Scale of Perceived Social Support (MSPSS). Cronbach's alpha, exploratory factor analysis, and correlational analysis were used. Results: Cronbach's alpha for the BSI Hostility subscale was .77. Hostility was positively associated with the PHQ-9, BSI Depression, and Anxiety subscales and negatively related to the MSPSS. Discussion: The BSI Hostility subscale provides a reliable and valid measure of hostility in patients with HF.

Assessing the Psychoeducational Approach to Transcendence and Health Program: An Intervention to Foster Self-Transcendence and Well-Being in Community-Dwelling Older Adults

The late-life developmental process of self-transcendence shapes elders' perspectives on self, others, the nature of this world, and of a dimension beyond the here and now. This qualitative pilot study evaluated the Psychoeducational Approach to Transcendence and Health (PATH) Program, a psychoeducational intervention to promote self-transcendence and well-being in community-dwelling women at a senior center. The intervention involved eight weekly group sessions using group processes, mindfulness practices, creative experiences, and independent at-home practice. The findings supported the underlying theory-based structure and content of the intervention and indicated the intervention may empower elders to attend to self-care, develop acceptance, and learn new skills associated with health and well-being, thus merits further study. Based on insights gained from facilitators' and participants' experiences and perceptions, the intervention will be revised and strengthened.

Predictors of well-being among college students

OBJECTIVES

Identification of health-related risk behaviors associated with well-being in college students is essential to guide the development of health promotion strategies for this population. The purposes were to evaluate well-being among undergraduate students and to identify health-related risk behaviors that predict well-being in this population.

METHODS

A cross-sectional Web-based survey of undergraduate students was conducted at a metropolitan university in the Southeast United States. A total of 568 students responded (response rate 14.2%). Data were collected on health-related risk behaviors using the National College Health Assessment II.

RESULTS

Controlling demographic characteristics, the best predictive model included physical activity, current tobacco user, depression, ever received mental health services, and sleep quality, which was the strongest predictor (β = .45, p < .001). This model explained 35% of the variance in well-being.

CONCLUSIONS

Interventions that promote sleep quality among college students may be most beneficial in improving well-being.

Promoting self-transcendence and well-being in community-dwelling older adults: A pilot study of a psychoeducational intervention

Self-transcendence changes how older adults perceive themselves, their relationships with others, the material world, and the metaphysical or spiritual dimension. It is associated with multiple indicators of well-being. The purpose of this pilot study (N = 20) was to examine the feasibility and effectiveness of a psychoeducational intervention to increase self-transcendence and well-being in older adults. Data were analyzed using generalized estimating equations. All variables trended in the directions hypothesized. Self-transcendence increased in the intervention group and decreased in the control group but not significantly. The group × time interaction for life satisfaction was significant (z = 2.89, p = .004). This feasibility study supports further investigation to assess the effectiveness of the intervention in a larger sample.

Development of a short version of the Cataldo Lung Cancer Stigma Scale

Lung cancer stigma is an important phenomenon experienced by many lung cancer patients that can be a barrier to medical help-seeking behavior. The purpose of this study was to shorten the Cataldo Lung Cancer Stigma Scale (CLCSS). The original 31-item scale had excellent internal consistency reliability but item redundancy. The majority of lung cancer patients are diagnosed at an advanced stage, and patient burden with survey completion may be higher in this population. To reduce patient burden with participation in lung cancer stigma-related research, a psychometrically sound short measure of lung cancer stigma is valuable. Factor analysis was used to evaluate the dimensionality of the CLCSS. Results were used to shorten the measure to 21 items. The shortened scale showed strong evidence of internal consistency reliability (Cronbach's alpha =.93). Results also indicate the scale is three dimensional with reliable subscales: stigma and blame, social isolation, and discrimination.

Development of a quality of patient-health care provider communication scale from the perspective of patients with rheumatoid arthritis

OBJECTIVES

To devise a patient-perspective driven measure of the quality of patient-health care provider communication and to evaluate the psychometric properties of this scale in a sample of 150 patients with rheumatoid arthritis.

METHODS

Items were developed from interviews with 15 patients with rheumatoid arthritis. Two rheumatologists, a behavioral scientist, and a nurse researcher provided item feedback. Exploratory factor analysis with Oblimin rotation was used to examine the dimensionality of the newly developed Patient-Health Care Provider Communication Scale (PHCPCS). Cronbach's alpha was computed to assess internal consistency. Test-retest reliability was determined using the intraclass correlation coefficient. Construct validity was tested by comparing the PHCPCS with the Perceived Involvement in Care Scale (PICS) using correlation analysis.

RESULTS

The PHCPCS measured two dimensions of the quality of patient-health care provider communication [Quality Communication (α = 0.94) and Negative Patient-Health Care Provider Communication (α = 0.73)]. The total PHCPCS score and its Quality Communication Subscale were positively correlated with the total score on the PICS and with the doctor facilitation subscale of the PICS.

DISCUSSION

This new measure of the quality of patient-health care provider communication has the potential for use in clinical practice, provider education, and further studies to improve health care to patients with rheumatoid arthritis.

Anxiolytic medication use is not associated with anxiety level and does not reduce complications after acute myocardial infarction

AIMS AND OBJECTIVES

To examine the association of anxiety level and anxiolytic medication use with in-hospital complications in patients following acute myocardial infarction (AMI).

BACKGROUND

There are conflicting data about the protective effect of anxiolytic medication used in patients after acute myocardial infarction. Examination of the interaction of anxiolytic medication and anxiety level may explain these disparate results.

DESIGN

This was a secondary analysis of existing data from a multisite, prospective study of the impact of anxiety on in-hospital complications in patients with AMI.

METHODS

Patients were primarily men, Caucasians, with Killip class 1 or 2, from the USA and Australia (n = 156). Anxiety level in the emergency department and intensive care unit and in-hospital complications were collected using self-report measures and medical record review. Logistic regression analyses examined whether the use of anxiolytic medication influenced the relationship between anxiety and in-hospital complications after controlling for demographic and clinical covariates.

RESULTS

In the ED, 31% of participants were very or extremely anxious; anxiolytic medication was given to only 5%. In the intensive care unit, nearly half of participants received anxiolytic medication. There was no association between anxiety level and use of anxiolytic medication. Anxiety was an independent predictor of the probability of in-hospital complications. The administration of anxiolytic medication did not alter the relationship between anxiety and in-hospital complications.

CONCLUSION

Use of anxiolytics in patients with AMI was not associated with anxiety level and did not reduce the probability of in-hospital complications.

RELEVANCE TO CLINICAL PRACTICE

Clinicians need to regularly assess anxiety and treat it appropriately. Regular anxiety assessment may promote appropriate use of anxiolytic medication. Clinical guidelines for the management of patients with an AMI should address anxiety assessment and appropriate use of anxiolytic medication to improve patients' outcomes.

Psychometrics of the PHQ-9 as a measure of depressive symptoms in patients with heart failure

BACKGROUND

Depression in patients with heart failure commonly goes undiagnosed and untreated. The Patient Health Questionnaire-9 (PHQ-9) is a simple, valid measure of depressive symptoms that may facilitate clinical assessment. It has not been validated in patients with heart failure.

AIMS

To test the reliability, and concurrent and construct validity of the PHQ-9 in patients with heart failure.

METHODS

A total of 322 heart failure patients (32% female, 61 ± 12 years, 56% New York Heart Association class III/IV) completed the PHQ-9, the Beck Depression Inventory-II (BDI-II), and the Control Attitudes Scale (CAS).

RESULTS

Cronbach's alpha of .83 supported the internal consistency reliability of the PHQ-9 in this sample. Inter-item correlations (range .22-.66) and item-total correlation (except item 9) supported homogeneity of the PHQ-9. Spearman's rho of .80, (p < .001) between the PHQ-9 and the BDI-II supported the concurrent validity as did the agreement between the PHQ-9 and the BDI-II (Kappa = 0.64, p < .001). At cut-off score of 10, the PHQ-9 was 70% sensitive and 92% specific in identifying depressive symptoms, using the BDI-II scores as the criterion for comparison. Differences in PHQ-9 scores by level of perceived control measured by CAS (t(318) = -5.05, p < .001) supported construct validity.

CONCLUSION

The PHQ-9 is a reliable, valid measure of depressive symptoms in patients with heart failure.

The relationship among young adult college students' depression, anxiety, stress, demographics, life satisfaction, and coping styles

Recent research indicates that young adult college students experience increased levels of depression, anxiety, and stress. It is less clear what strategies college health care providers might use to assist students in decreasing these mental health concerns. In this paper, we examine the relative importance of coping style, life satisfaction, and selected demographics in predicting undergraduates' depression, anxiety, and stress. A total of 508 full-time undergraduate students aged 18-24 years completed the study measures and a short demographics information questionnaire. Coping strategies and life satisfaction were assessed using the Brief COPE Inventory and an adapted version of the Brief Students' Multidimensional Life Satisfaction Scale. Depression, anxiety, and stress were measured using the Depression Anxiety and Stress Scale-21 (DASS-21). Multiple regression analyses were used to examine the relative influence of each of the independent variables on depression, anxiety, and stress. Maladaptive coping was the main predictor of depression, anxiety, and stress. Adaptive coping was not a significant predictor of any of the three outcome variables. Reducing maladaptive coping behaviors may have the most positive impact on reducing depression, anxiety, and stress in this population.

The psychometric properties of the Brief Symptom Inventory depression and anxiety subscales in patients with heart failure and with or without renal dysfunction

More than 5 million Americans have heart failure (HF); approximately one third have concomitant renal dysfunction. Anxiety and depressive symptoms are the most common psychological responses of these individuals and may influences outcomes; thus a reliable valid instrument to measure these is needed. This article reports a psychometric evaluation of the Brief Symptom Inventory (BSI) depression and anxiety subscales in patients with HF and with or without renal dysfunction, as these scales are commonly used in this population for research studies. This rigorous psychometric analysis used existing data from 590 patients with HF with an average ejection fraction of 35% ± 15% and average age of 63 ± 13 years. Patients were categorized as normal renal function (n = 495) or renal dysfunction (n = 95), and groups were compared and analyzed separately. Cronbach's alpha for the BSI subscales was .82 for those with normal renal function and .88 for those with renal dysfunction. Factor analysis determined that the subscales evaluated one dimension, psychological distress, in both groups. Construct validity was examined using hypothesis testing, and construct validity was supported in patients with HF and with normal renal function by significant associations of the BSI subscales with another measure of depression and a measure of perceived control. Construct validity in patients with HF and renal dysfunction was not strongly supported. Only the BSI depression subscale predicted poorer outcomes in patients with HF and with normal renal function; neither subscale was associated with event-free survival at 12 months in those with renal dysfunction. The BSI anxiety and depression subscales provide reliable and valid data in patients HF and normal renal function. Although reliability is excellent, construct validity was weak in those patients with HF and with concomitant renal dysfunction, which may reduce the validity of those data.

Developing a shortened measure of negative thinking for use in patients with heart failure

OBJECTIVE

Negative thinking is a target for treatment of depressive symptoms in patients with heart failure (HF). A brief instrument is needed to measure negative thinking in these patients. The study objective was to shorten the Crandell Cognitions Inventory (CCI) for use in patients with HF.

METHODS

Baseline data from outpatients with HF (N = 179, 30% were female, age 60 ± 13 years) were used to evaluate psychometrics of the CCI. Internal consistency reliability was measured with Cronbach's alpha construct validity with hypothesis testing. Principal components analysis was used in shortening. A separate sample of hospitalized patients with HF (N = 77, 49% were female, age 66 ± 11 years) was used to validate the shortened CCI (CCI-SF).

RESULTS

The CCI showed evidence of reliability and validity, but there was item redundancy in outpatients with HF. The 12-item CCI-SF showed good evidence of reliability and validity in inpatients with HF.

CONCLUSION

The results support the reliability and validity of the CCI-SF to measure negative thinking in hospitalized patients with HF.

Spielberger's state anxiety inventory: development of a shortened version for critically ill patients

The length of Spielberger's State Anxiety Inventory (SAI) makes its use difficult for critically ill populations. To shorten it, exploratory factor analysis was used with data from 530 acute myocardial infarction patients. The resulting 6-item shortened version demonstrated good internal reliability consistency with a Cronbach's alpha of .84. Construct validity of the shortened version was supported by strong correlations with the original SAI and the Brief Symptom Inventory (BSI), another measure of state anxiety, and through support of known hypotheses. This study offered a short version of the SAI with excellent psychometric properties that can be used in critically ill patients.

A psychometric analysis of the functional social support questionnaire in low-income pregnant women

The purpose of this study was to examine the psychometric properties of the Functional Social Support Questionnaire (FSSQ) in pregnant women. A secondary analysis of data from 186 low-income pregnant women in their third trimester was conducted to assess the internal consistency reliability, dimensionality, and concurrent validity of the FSSQ. Cronbach's alpha was .83. Factor analysis supported the unidimensionality of the FSSQ. Correlations with the Interpersonal Support Evaluation List (ISEL) and the Center for Epidemiologic Studies-Depression Scale (CES-D) supported concurrent and construct validity. This secondary analysis provided evidence of the psychometric soundness of the FSSQ in this sample.

Psychometric properties of the Rosenberg self-esteem scale in African American single mothers

The Rosenberg Self-Esteem (RSE) Scale is a commonly used measure of global self-esteem, an important element of mental health. The purpose of this cross sectional secondary analysis was to examine the psychometric properties of the scale in a sample of 98 African American single mothers. The RSE Scale showed adequate internal consistency with an alpha coefficient of .83. Two factors that accounted for a total of 54.7% of the variance were extracted. Self-esteem showed a strong negative relationship with both depressive symptoms and negative thinking. This study provides support for the internal consistency of the RSE Scale and partial support for its construct validity in this population. The RSE appears to represent a bidimensional construct of self-esteem for African American women, with the cultural influences of racial esteem and the rejection of negative stereotypes forming a separate and distinct aspect of this concept. The RSE Scale should be used and interpreted with caution in this population given these findings.

Testing the psychometric properties of the Medication Adherence Scale in patients with heart failure

OBJECTIVE

Many factors may contribute to medication nonadherence in heart failure (HF), but no standard measure exists to evaluate factors associated with nonadherence. To fill this gap, we developed the Medication Adherence Scale (MAS) and tested its reliability and validity in patients with HF.

METHOD

Questionnaire data were collected from 100 patients with HF at baseline using the MAS, and objective adherence data were collected for 3 consecutive months using the Medication Event Monitoring System.

RESULTS

Principal component analysis yielded three factors that explained 63% of the variance in medication adherence: knowledge, attitudes, and barriers to medication adherence. Cronbach's alphas for these subscales ranged from .75 to .94, which supported their internal consistency. The Spearman rho correlation coefficients between the Medication Event Monitoring System and Knowledge, Attitudes, and Barriers scores were .25 to .31 (P < .05), demonstrating support for construct validity.

CONCLUSION

These results support the reliability and validity of the MAS as a measure of knowledge, attitudes, and barriers of medication adherence.

Measuring tobacco smoke exposure among smoking and nonsmoking bar and restaurant workers

PURPOSE

This study assesses the validity of hair nicotine as a biomarker for secondhand smoke (SHS) exposure. Although most biomarkers of tobacco-smoke exposure have a relatively short half-life, hair nicotine can measure several months of cumulative SHS exposure.

DESIGN

A cross-sectional study of hospitality-industry workers.

METHOD

Hair samples were obtained from 207 bar and restaurant workers and analyzed by the reversed-phase high-performance liquid chromatography with electrochemical detection (HPLC-ECD) method. Self-reported tobacco use and sources of SHS exposure were assessed.

FINDINGS

Higher hair-nicotine levels were associated with more cigarettes smoked per day among smokers and a greater number of SHS-exposure sources among nonsmokers. Number of SHS exposure sources, gender, number of cigarettes smoked per day, and type of establishment predicted hair-nicotine levels.

DISCUSSION

Hair nicotine is a valid measure of SHS exposure. It may be used as an alternative biomarker to measure longer term SHS exposure.

Testing an intervention to reduce negative thinking, depressive symptoms, and chronic stressors in low-income single mothers

PURPOSE

To test the effectiveness of a cognitive-behavioral group intervention in reducing depressive symptoms, negative thinking, and chronic stressors in low-income, single mothers at risk for depression.

DESIGN AND METHODS

A randomized, controlled prevention trial was conducted with 136 low-income, single mothers with children between the ages of 2 and 6 years. Each participant was screened before enrollment and was determined to be at risk for depression. Participants were randomly assigned to either the control or experimental group. The experimental group was invited to participate in a 4- to 6-week cognitive-behavioral group intervention. Data on depressive symptoms, negative thinking, and chronic stressors were collected via self-report questionnaires from control and experimental groups at baseline, 1 month, and 6 months after the intervention to assess the effects of the intervention.

FINDINGS

Compared with those in the control group, women who received the intervention had a greater decrease in depressive symptoms, negative thinking, and chronic stressors; these beneficial effects were maintained over a 6-month period.

CONCLUSIONS

The findings indicate the effectiveness of this cognitive-behavioral group intervention and show the beneficial effects of reducing negative thinking via the use of affirmations and thought-stopping techniques.

Testing a published model of health-related quality of life in heart failure

BACKGROUND

Health-related quality of life (HRQOL) in patients with heart failure is compromised and associated with increased mortality and rehospitalization. Inadequate conceptualization of variables related to HRQOL has hampered clinicians' efforts to enhance HRQOL. The purpose of this study was to test the Wilson and Cleary model (WCM) of HRQOL in patients with heart failure.

METHODS AND RESULTS

Data from 293 patients with heart failure were analyzed to determine the best multivariate HRQOL model given variables derived from WCM. HRQOL was measured using the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Health perception, symptom status, and age predicted the total MLHFQ (P < .0001) and the emotional scale (P < .0001), and health perception, symptom status, New York Heart Association predicted the physical scale (P < .0001). Health perception was a mediator of the effect of symptom status on HRQOL. Functional status was not a mediator of the effect of symptom status on health perception.

CONCLUSION

The most influential variables associated with HRQOL were the subjective variables: health perception and symptom status. Objective variables proposed by WCM to drive the model were not significant predictors. Mediator effects hypothesized in the WCM were not fully demonstrated in this sample. Thus modification of the WCM is warranted.

Testing the psychometric properties of the Minnesota Living with Heart Failure questionnaire

BACKGROUND

Health-related quality of life (HRQOL) is an important outcome in patients with heart failure. One of the most commonly used instruments to measure HRQOL in this population is the Minnesota Living With Heart Failure Questionnaire (LHFQ). Although the psychometric properties of the LHFQ have been tested, the results do not definitively support the psychometric soundness of the instrument.

OBJECTIVE

To examine the psychometric properties of the LHFQ.

METHOD

Data from 638 patients with heart failure were used to assess the reliability, homogeneity, representativeness, discriminative ability, and construct validity of the LHFQ before and after deletion of 5 items that showed lack of representativeness and contributed to inadequate factor structure.

RESULTS

Cronbach's alphas for the LHFQ Total and subscales were greater than .80. Interitem correlation coefficients in 17 of the 21 items, item-total correlation coefficients in 20 items, and discriminative ability in all items were acceptable. The total and both subscales of the LHFQ differentiated New York Heart Association functional groups. The Physical subscale was moderately related to the physical measures (the Specific Activity Scale and symptom status), whereas the emotional subscale was weakly related to the measures. The results of item p level testing and factor analysis demonstrated that 7 items were consistently problematic and 5 items were recommended to be deleted. The results of the reliability, homogeneity, and construct validity after deletion of these items demonstrated that the psychometric properties of the LHFQ were improved as a result.

DISCUSSION

The initial results provided additional support for the reliability and substantial evidence for the validity of the LHFQ. However, the results of item and factor analyses did not fully support the psychometric soundness of several items. The psychometric properties of the LHFQ after deleting these items were improved. These results could provide researchers and clinicians a more useful measure of HRQOL.