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Biomedical subjects

J A Deatrick

Publications and source records attributed to J A Deatrick.

At least 19 recordsLinked to original sources
PubMed2002

Redefining treatment: how biological mothers manage their children's treatment for perinatally acquired HIV.

Current medical thinking supports early initiation of aggressive approaches to the management of perinatally acquired HIV infection. Biological mothers, however, may not endorse this way of managing their child's condition. For this study, grounded theory methods were used to conduct secondary analysis of eight semi-structured in-depth interviews with parents of children with perinatally acquired HIV. Biological mothers' perspectives on their children's treatment for perinatally acquired HIV infection, the strategies they used to manage their children's treatment and sociocultural influences on mothers' beliefs and actions are explored and described. Creation of a framework that may be useful for future research and recommendations for clinical practice are offered.

Adult↗
PubMed2000

Journey towards recovery following physical trauma.

Journey towards recovery following physical trauma Convalescence and recovery following illness are of central importance to nursing. These themes have been explored increasingly in the literature. The focus, however, has been primarily on the process of integrating chronic illness into one's life. Recovery from physical injury is rarely addressed. A body of work focusing on physical trauma demonstrates that recovery is often not complete after injuries that have not been viewed as disabling. To illuminate understanding of recovery following physical trauma, the purpose of our 1997 study was to describe more thoroughly the nature of recovery. A total of 63 adults, in a convenience sample, who survived serious physical trauma, were interviewed 2.5 years after injury using an open-ended semistructured interview guide. Three themes were identified: event, fallout, and moving-on. These themes provided the organizing structure for exploring the journey to recovery. This journey, as disclosed by the seriously injured, does not necessarily correspond with the views of most trauma clinicians. Traumatic events create a line of demarcation, separating lives into before and after. The event becomes the starting point of a journey to resume one's life. The event itself is more than the trauma; it is the perceptual and contextual experience that needs to be incorporated into a person's essence. Fallout from the injury is multifaceted and includes physical, psychological, social, and spiritual dimensions. Moving-on in this journey is nonlinear as survivors recognize their lives are forever different. The survivors' accounts suggest that nurses should carefully consider the question, 'What is successful recovery?'

Adaptation, Psychological↗
PubMed2000

Effects of home visits to vulnerable young families.

PURPOSE: Nurses' home visits to new parents have been replaced in many high-need communities by nonprofessional visits without clear evidence of effectiveness. Previous reviews of home visiting research have combined nurse and non-nurse interventions and have pooled studies from the US, where home visiting is mainly limited to low-income families, with those from nations where home visiting is a universal service. This integrative review was focused on nurse-delivered interventions in the US and Canada to identify the nursing-specific models with the greatest effect in this cultural context. Evaluation of support for social ecology theory was a secondary aim. DESIGN: The sample consisted of 20 experimental and quasi-experimental studies of home nursing interventions for families of newborn infants who were vulnerable because of poverty, social risks, or prematurity. METHODS: Each report was examined systematically using specific rules of inference and a scoring system for methodological quality. Intervention effects on five outcome domains were described. FINDINGS: Maternal outcomes, maternal-infant interaction, and parenting were more often influenced than was child development, except in preterm infants. Well-child health care did not improve. Effective programs generally began in pregnancy, included frequent visits for more than a year, had well-educated nurses, and were focused on building a trusting relationship and coaching maternal-infant interaction. Social ecology theory was partially supported. CONCLUSIONS: Future nurse home-visiting research should test a combination of these effective components. Nurses can use this information to seek funding of nurse-delivered interventions for vulnerable families.

Adult↗
PubMed2000

Discontinuing treatment in children with chronic, critical illnesses.

Decisions about optimal treatment for critically ill children are qualitatively different from those related to adults. Technological advances over the past several decades have resulted in myriad treatment options that leave many children chronically, critically ill. These children are often technology dependent. With new technologies and new patient populations comes the responsibility to understand how, when, and why these technologies are applied and when technology should not be used or should be withdrawn. Much has been written about ethical decision making in the care of chronically, critically ill adults and newborns. In this article, relevant factors about the care of children older than neonates are described: standards, decision makers, age of the child, and pain management. A case study is used as a mechanism to explore these issues. Dimensions of futility, discontinuing aggressive treatment, and a consideration of benefits and burdens are integrated throughout the discussion to inform nurse practitioner practice.

Child, Preschool↗
PubMed2000

Home care considerations for chronic and vulnerable populations.

Conducting a predischarge home assessment can provide important information to the hospital care team for discharge planning and postdischarge care. In addition, a predischarge home visit assists the family in preparing for the infant or child's care needs. This report describes an Environmental Assessment Guide initially developed and subsequently used in two nursing research studies. Anecdotal information from advanced practice nurse care records is provided to illustrate issues relating to predischarge assessment.

Child↗
PubMed1999

Clarifying the concept of normalization.

PURPOSE: To refine and develop the concept of normalization. While firsthand accounts, clinical observation, and numerous studies suggest that parents of children with chronic conditions often strive to lead a normal family life, the distinguishing characteristics of normalization need to be understood before evaluating the feasibility and consequences. Conceptualizing these efforts as normalization, researchers have identified cognitive and behavioral strategies used by parents to normalize family life. SOURCES: A total of 33 articles representing 14 studies were selected through computer-assisted searches of the topic from 1966-1997, hand searches of nursing journals from 1970-1997, and analysis of reference lists. Key words in the searches included: adaptation, psychological; chronic disease; disabled persons; family; child; adolescence; parent-child relations; models, psychological; and nursing theory. Articles (N = 19) that applied and expanded the concept comprised the sample used in the analysis. A normalization construct was used. METHODS: Attributes for normalization were inductively derived based on the most recent methods for refining and developing concepts, with special attention to how family and illness affect manifestations of normalization. FINDINGS: The attributes identified in 1986 remained relevant, but required revision and expansion to reflect a contemporary understanding of normalization. Unique manifestations of normalization were identified within certain illness and family contexts. CONCLUSIONS: Knowledge synthesized from previous studies can enhance how normalization is used in future qualitative and quantitative research and in theory development. Findings indicate the need for researchers to build on the current state of knowledge and continue to further develop the concept. Understanding the findings can also sensitize clinicians to the complex process of normalizing when a child has a chronic condition.

Adaptation, Psychological↗
PubMed1999

Conceptual and pragmatic considerations in conducting a secondary analysis. An example from research of families.

In this article, the authors discuss conceptual and pragmatic considerations for conducting research of families using large secondary data sets. Conceptual considerations include establishing consistency among the theory, variables, and available data, and determining reliability and validity of the data in the context of the theory. Pragmatic considerations include the use of resources such as management of the data among several authors, criteria and methods for selection of a subsample, and, recoding of the data to examine dyadic difference scores. The Family Special Interest Group of the Eastern Nursing Research Society initiated this research as part of a project to analyze families using large national data sets. The purpose of the secondary analysis was to identify family beliefs about healt-promoting behaviors. Combining parent and teen data to create relational level data resulted in new information that had not been identified in the original survey.

Data Interpretation, Statistical↗
PubMed1999

Parent-teen worry about the teen contracting AIDS.

A secondary data analysis of the National Commission on Children: 1990 Survey of Parents and Children was conducted with a subsample of 457 parent-teen pairs who responded to the "worry about AIDS" question. The teen's worry about contracting AIDS was associated with race, parent's education, the amount of discipline from the parent for engaging in sex, the teen's desire to talk to the parent about the problem of sex, the teen's rating of the neighborhood as a safe place to grow up, whether the parent listened to the teen's telephone interview, and the parent's response to whether his or her teen had a history of sexually transmitted disease. Of the parent-teen pairs in the subsample, 46% (N = 210) agreed in their responses about worry. Agreement was more frequent among the parent-teen pairs when compared to randomly constructed surrogate pairs. Dyadic analysis supported a family system view of perceived susceptibility.

Acquired Immunodeficiency Syndrome↗
PubMed1995

The determinants of successful self-catheterization programs in children with myelomeningoceles.

Myelomeningocele is a birth defect that results in lifelong consequences for the child and family. One of the abnormalities that results from the defect is a neurogenic bladder. Most children with myelomeningoceles will require a clean intermittent catheterization (CIC) program for continence. Yet, many children do not have success with these programs. The purpose of this report is to identify in the literature components of a successful self-catheterization program. The importance of proper urinary management in children with myelomeningoceles will be discussed. Physiological, developmental, and motivational qualities that are present in successful self-catheterization programs will be identified. The importance of knowing when the child is ready to learn, how to know when the child is ready to learn, and different styles of teaching self-catheterization will be discussed. Finally, nursing implications for children on CIC programs will be described.

Adolescent↗
PubMed1994

The experience of high-risk pregnancy.

OBJECTIVE: To describe the experience of high-risk pregnancy from the perspectives of mothers and fathers. DESIGN: A naturalistic inquiry using selected grounded-theory techniques. SETTING: Interviews occurred within the hospital. PARTICIPANTS: A sample of 21 parents who experienced high-risk pregnancy and the birth of a preterm infant. MAIN OUTCOME MEASURES: Responses and management of responses to high-risk pregnancy. RESULTS: Emotional responses to high-risk pregnancy were (a)vulnerability--the realization that pregnancy outcome was at risk, (b)heightened anxiety--the transition from normal activities to bed rest and hospitalization, and (c)inevitability--the imminent premature delivery of an infant with a guarded prognosis. CONCLUSIONS: These findings have relevance for perinatal nurses. Nurses who have knowledge of the emotional responses parents experience during high-risk pregnancy can provide supportive care to these individuals.

Adult↗
PubMed1994

Enhancing specialist preparation for the next century.

While the curricula of clinical nurse specialist (CNS) programs have proved to be successful in meeting past and current health care needs of specialty populations, the needs of children requiring care by the CNS have changed greatly over the past few years. Because of advanced technology, more children are surviving, although they may have serious physical, developmental, and psychosocial disabilities. At the same time, the educational, health, and social services for these children have become harder to access. A conceptual model, Family-Focused Pediatric Transitional Care (FFPTC), was used to interpret a survey of graduates of a pediatric clinical specialist program and their employers. Recommendations regarding possible changes in pediatric clinical nurse specialist curricula are offered to guide future educational agendas. Advanced skills in clinical decision making and coordinating care across the continuum from the hospital to the community and to the home have become essential role competencies for the clinical nurse specialist.

Clinical Competence↗
PubMed1994

The atypical becomes typical: the work of oncology nurses.

PURPOSE: To describe a typical day for nurses who work with patients with cancer. DESIGN: Multi-institutional, descriptive, qualitative. SETTING: Six sites in different regions of the United States; rural and urban cancer and noncancer centers. SAMPLE: 38 oncology nurses (mean age = 35 years; average time in nursing = 10 years; and in oncology = 7 years; 47% bachelor of science in nursing, 29% diploma, 13% associate degree in nursing, and 11% master's prepared. METHODS: Phenomenological; content analysis of interviews. FINDINGS: There is no typical day for oncology nurses. As such, the atypical becomes typical. This dialectic influenced how the nurses organized and managed their work. Management became a paradox or a juggling act--an attempt to control the uncontrollable, to manage the unmanageable. Time was a central metaphor used in the descriptions. The amount of time available influenced nurses' abilities to perform a certain quality and quantity of work. Demands on time, whether legitimate or illegitimate, were the context for the day-to-day work. IMPLICATIONS FOR NURSING PRACTICE: It is necessary to recognize the value that nurses continually place on participation in patients' daily care, the unpredictability inherent in cancer and patient care, and the organizational routines that nurses use to accomplish their work.

Adult↗
PubMed1994

Rewards and difficulties of oncology nursing.

PURPOSE: To describe oncology nurses' perceptions of the rewards and difficulties of their work. DESIGN: Multi-institutional, descriptive, qualitative. SETTING: Six sites in different regions of the United States; rural and urban cancer and noncancer centers. SAMPLE: 38 oncology nurses (mean age = 35 years; average time in nursing = 10 years and in oncology = 7 years; 47% bachelor's degree in nursing, 29% diploma, 13% associate degree in nursing, and 11% master's prepared). METHODS: Phenomenological; content analysis of interviews. FINDINGS: Nurses described sources and origins of both job stress and satisfaction. The three most important sources of rewards were patients, co-workers, and new skills. These sources of rewards also were described as sources of difficulties. Additional sources of difficulties include lack of competent administrators, lack of time, and life stresses. IMPLICATIONS FOR NURSING PRACTICE: Nurses' experiences with work are shaped by both common and very individual and personal realities. Aspects that are rewarding also are difficult, and individual experiences and perceptions change the meaning of work and the needs that nurses have. Considering the findings in the context of nurses' lives may yield more fruitful approaches to providing support and resources that nurses need to be able to provide effective care for patients and their families.

Adaptation, Psychological↗
PubMed1992

Children's participation in research: their right to consent.

This article discusses the ethical and legal considerations related to the inclusion of children in the research process. Specific attention is paid to situations in which customary guidelines are inappropriate. In addition, the results of a survey to determine the manner in which Institutional Review Boards are addressing these issues is presented with suggestions to assist nurse researchers in acquiring review board approvals.

Child↗
PubMed1990

Children should be seen and heard. Chronically ill children should have a voice in treatment decisions.

Traditionally, sick children have obeyed orders--the doctor's orders, their parents' orders. Father (mother, doctor, nurse) knows best. But indications are that in the future, chronically ill children will have some say in their own treatment decisions. And although few healthcare facilities today have any policies in place to ensure such participation, they may face increasing pressure to implement such policies. Both the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research and the American Academy of Pediatrics recommend that children actively participate in the consent-assent-dissent process for healthcare decisions. Children's participation need not be total or complete; it may involve only selected aspects. Participation will (1) increase their ownership of the decision and encourage them to obtain the necessary follow-up care, (2) increase their ability to make such decisions in the future, and (3) perhaps make healthcare less threatening and more attractive to them as future healthcare consumers. Providers could encourage a cautious, gradual increase in participation by chronically ill children and adolescents. It should start by involving them in concrete tasks (like setting dates and times) and lead to active negotiation with parents and healthcare workers regarding treatment.

Adolescent↗
PubMed1990

Management behaviors: day-to-day adjustments to childhood chronic conditions.

To understand how families who have children with chronic conditions make daily adjustments to accommodate the children's special needs, the concept of management behaviors is explored. On a theoretical level, the adjustments are linked to an emerging conceptual model, family management style (FMS). As such, the management behaviors component of the FMS model is highlighted and developed to guide further clinical exploration and research.

Adaptation, Psychological↗