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Biomedical subjects

B Riegel

Publications and source records attributed to B Riegel.

67 records · Page 4Linked to original sources
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The relationship of education to critical thinking ability and values among nurses: socialization into professional nursing.

Exposure to faculty is assumed to positively influence critical thinking ability and professional values; therefore, faculty must be assumed to be superior in these characteristics. As a first step toward testing these assumptions, this study used a cross-sectional survey technique to compare critical thinking ability and values in ADN-prepared (n = 32) and BSN-prepared (n = 32) registered nurses, nursing faculty (n = 32), and sophomore college students (n = 32) beginning a baccalaureate degree program in nursing. The critical thinking ability of faculty was not significantly higher than that of sophomore nursing students when the influence of age was controlled statistically. The values of all three groups of nurses were strikingly similar, although faculty valued achievement most highly (P = .0001), while sophomore students valued goal orientation most highly (P = .001). All subjects valued support highly, but only sophomore students valued benevolence highly.

Adolescent↗
PubMedDate not supplied

Development and testing of a clinical tool measuring self-management of heart failure.

BACKGROUND: Self-management is a primary goal of treatment for heart failure. Yet no measure of self-management in this patient group currently exists. OBJECTIVES: To develop a clinically useful measure of the abilities of patients with heart failure to manage their disease. Self-management in this context was defined as a cognitive decision-making process undertaken in response to signs and symptoms of heart failure. A panel of experts agreed that the process involved 4 distinct stages: recognizing a change, evaluating the change, implementing a treatment strategy, and evaluating the treatment. The tool was developed to reflect this process. METHODS: Face validity of the process model was assessed in a sample of 25 patients with heart failure and used to develop a 65-item tool with 6 subscales. The subscales measure the 4 stages as well as the patients' ease in evaluating the signs and symptoms and their self-efficacy. The tool was pilot tested with 2 samples of patients with heart failure (N = 17; N = 129). Psychometrics of the final tool were then tested in a sample of 127 patients with heart failure. RESULTS: Face and content validity of the tool were demonstrated adequately through this study. Internal consistency scores of the 6 subscales of the Self-Management of Heart Failure instrument ranged from 0.79 (ease of evaluating treatment) to 0.92 (evaluating the change). Reliability could not be calculated for 1 subscale (evaluating the treatment) because of missing data that resulted from patients skipping sections because they had not experienced a symptom. CONCLUSION: Clinicians interested in evaluating the self-management abilities of their patients with heart failure are encouraged to use this tool and to contribute to additional testing.

Aged↗
PubMedDate not supplied

Gender differences in adjustment to acute myocardial infarction.

OBJECTIVE: To compare psychosocial adjustment, functional class, and return to work in a matched sample of women and men experiencing a first acute myocardial infarction (AMI). DESIGN: Longitudinal survey. SETTING: Subjects were identified from six hospitals in the Southern California area. Data were collected in the home setting 1 and 4 months after hospital discharge. SUBJECTS: Data on 32 women experiencing a first AMI were matched on neuroticism and cardiac dysfunction with 32 men from the same sample. MEASURES: The following instruments were administered 1 and 4 months after hospital discharge: Self-Perception Inventory (self-esteem); Profile of Mood States (emotional distress); General Health Perceptions Questionnaire (health perceptions); Interpersonal Dependency Inventory (dependency); and the UCLA Social Support Inventory (social support). The Eysenck Personality Inventory (neuroticism) was administered at 1 month. Cardiac dysfunction was measured with data available from the hospital record. Functional class was measured at 1 month with the Specific Activity Scale. Self-report of demographics and return to work were obtained 1 and 4 months, respectively. RESULTS: Women experienced improved perceptions of current health whereas their ratings of prior health decreased. Overall emotional distress, anxiety, and depression decreased significantly over time in women. Women reported wanting, receiving, and giving more support than men did at 1 month and receiving and giving more support than men did at 4 months, although stress in support relationships rose over time. In men anxiety, depression, and health concern all decreased significantly over time whereas their ratings of prior health rose. The match between social support wanted and received decreased over time in males as did their satisfaction with the support received. Men reported a higher functional class than women at 1 month, but return to work at 4 months did not differ. CONCLUSIONS: Both women and men experienced improved psychologic adjustment within 4 months after AMI, although the specific areas of improvement differed. Return to work was comparable in spite of differences in functional class. The women appeared to activate their social support system more effectively than the men after AMI. Further research is needed to determine whether differences in social support contribute to adjustment that is better than what normative data predict for women.

Adaptation, Psychological↗
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Development of an instrument to measure cardiac illness dependency.

OBJECTIVE: Dependency is frequently mentioned in the literature as a response of patients with cardiac disease. The purpose of this study was to develop and test a measure of dependency occurring in response to a cardiac illness. Illness dependency is defined as the need for emotional protection and social support after a significant change in health. DESIGN: Instrument development study. SAMPLE: Convenience sample of 311 patients with cardiac disease. RESULTS: The final version of the instrument has 25 items, each of which is measured on a 5-point Likert-type scale. Content validity was demonstrated using a panel of experts. Internal consistency of the total scale was 0.90; subscale alpha coefficients ranged from 0.64 to 0.81. Exploratory factor analysis supported a four factor solution: Attention, Reassurance, Concern, and Assistance, which accounted for 57.4% of the variance in scores. Discriminant validity was demonstrated by a low correlation with neuroticism. Social desirability of responses was minimal. CONCLUSION: Internal consistency reliability, content validity, and discriminant validity of the Illness Dependency Scale have initial support. This instrument is ready for use in research in which the investigator wishes to measure dependency associated with cardiac illness.

Aged↗
PubMedDate not supplied

Predictors of self-care in persons with heart failure.

OBJECTIVE: The objective of this study was to test a model of individual patient characteristics, covering symptom severity, comorbidity, social support, education, age, socioeconomic status, and gender, derived from Connelly's Model of Self-Care in Chronic Illness as predictors of self-care in heart failure. DESIGN: This was a nonexperimental correlational study. SETTING: The study took place in 6 hospitals in southern California. PATIENTS: The study included 209 patients diagnosed with heart failure by their physicians. The typical study participant was age 73 years, Class III, married, grade-school educated, and earning an income of less than $20,000 per year. The genders were almost equally represented. OUTCOME MEASURE: Self-care was measured by the Evaluating the Change subscale of the Self-Management of Heart Failure Instrument. RESULTS: The model of 7 variables, analyzed by using multiple regression analysis, explained 10.3% of the variance in self-care. Only 2 of the variables were significant predictors of self-care: education (P =.009) and symptom severity (P =.046); 89.7% of the variance remained unexplained. CONCLUSIONS: Persons with higher education and those who are symptomatic may be more likely to engage in self-care than those who are poorly educated or asymptomatic. Further research is needed to confirm these Results and identify other predictors of self-care.

Adult↗
PubMedDate not supplied

Self-care abilities of patients with heart failure.

BACKGROUND: Self-care is difficult for patients with heart failure (HF) because early symptoms are subtle and the treatment regimen is complex. The primary purpose of this study was to describe HF self-care abilities and the difficulties that patients have in achieving success in self-care. A secondary purpose was to compare self-care abilities in patients experienced with HF with those patients who are newly diagnosed. METHODS: Descriptive, cross-sectional, comparative surveys were conducted to assess demographic and clinical factors that may interfere with self-care and lifestyle changes made to accommodate the diagnosis of HF. Symptoms the patients had and self-care responses to those symptoms were assessed by using the Self-Management of Heart Failure questionnaire. RESULTS: The 139 patients were primarily elderly, male, retired, unmarried, and earning less than $20,000 annually. Hearing and eyesight were impaired and most patients were functionally compromised. Most of the group had multiple HF symptoms during the past year, yet their knowledge of the importance of signs and symptoms was poor and many misperceptions were evident. Recognition of changes in signs and symptoms was difficult for most patients, but easier for those more experienced with HF. Experienced patients were more likely to use appropriate self-care remedies than newly diagnosed patients. Few patients were comfortable evaluating the effectiveness of their self-care actions and most had low self-confidence in their ability to perform self-care. CONCLUSIONS: With the low level of self-care ability and the number of difficulties these patients face, it is not surprising that rehospitalization rates remain high. Specific recommendations for the teaching and delivery of care are provided.

Age Distribution↗
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Patient teaching to promote behavioral change.

Nurses are taught that patient teaching is an essential component of their professional role. This article describes the research on which effective patient teaching should be based.

Behavior Therapy↗
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Implementation of a multidisciplinary disease management program for heart failure patients.

Institutions across the country are considering the feasibility of a disease management program for heart failure (HF) patients. Published reports suggest that such programs can save money and improve outcomes. However, the design of a disease management program can be challenging. This paper describes the structure and function of a successful disease management program for heart failure patients. The program is supported by a multidisciplinary team of nurses, pharmacists, dietitians, social workers, and physicians who approach the problem from a self care perspective. Program components include standardized educational materials, reinforcement of educational contacts, monthly support groups, and a quarterly newsletter. Existing staff built the program with few additional resources and staff. The program, which costs only approximately $330/patient for a 6 month intervention, has decreased hospital readmissions (29%) and days in the hospital (43%) significantly. (c)1999 by CHF, Inc.

Journal Article↗
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Psychogenic cough treated with biofeedback and psychotherapy. A review and case report.

Psychogenic cough is a barking or honking cough, which is persistent and disruptive to normal activity. The cough may be a debilitating condition that interferes with work and social relationships. Although the frequency of this condition is low, it is not rare. The majority of cases reported involve pediatric or adolescent patients. Surprisingly, there are scant data describing this condition in the adult population and no reports of biofeedback being used to treat this syndrome. We present a case report of an adult patient with psychogenic cough and review the available pediatric and adult literature. A 41-yr-old obese female presented with a complex 7-yr history of intractable, nonproductive, chronic cough. She had been avoiding social activities because of embarrassment by her repeated episodes of coughing. Extensive diagnostic work-up failed to find an organic etiology. Numerous medical and surgical treatments had failed. The patient was treated with a combination of biofeedback-assisted relaxation training, psychotherapy, and physical therapy. Review of the literature revealed only one report on adults, in which three of four patients were successfully treated with a combination of speech therapy, relaxation techniques, breathing exercises, and psychotherapy. Our success suggests a possible future use of this treatment protocol for cases of psychogenic cough.

Adult↗
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Visitation: policy versus practice.

Few topics have generated as much controversy as visitation policies in critical care units. This national survey of nurses caring for acute myocardial infarction patients reveals that the number of nurses working in units with an open visiting policy has increased substantially. Open-ended responses reveal the complex judgement that goes into nurses' decisions about whether or not to allow visitors. This article offers managers, educators, advanced practice nurses, and bedside clinicians insight into the factors that nurses consider when making these decisions.

Attitude of Health Personnel↗