PubMed Health⌕ Search

Biomedical subjects

J A Erlen

Publications and source records attributed to J A Erlen.

At least 19 recordsLinked to original sources
PubMed2001

The use of life review to enhance quality of life of people living with AIDS: a feasibility study.

People living with AIDS (PLWA) are confronted with uncertainty and their own mortality at an earlier than expected age. Life review, an intervention that has the potential to increase life satisfaction in the elderly experiencing transition points in their lives, may have a similar effect when used with PLWA. Therefore, the purpose of this feasibility study was to explore the use of life review in a sample of 20 PLWA through a randomized controlled trial of its effectiveness in decreasing depressive symptoms and in increasing self esteem, quality of life, and purpose in life. Compared to the control group, the treatment group had an improved overall quality of life and self-esteem over 12 months, less depressive symptoms over 12 months, and a greater purpose in life at 3 months. The effects that were seen were mainly small to medium effects. The findings from this feasibility study suggest the potential value of life review to enhance quality of life, purpose in life, and self-esteem, and to decrease depressive symptoms in PLWA. Further research is needed with a larger sample and with other groups such as PLWA experiencing virologic failure.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Problem drinking and medication adherence among persons with HIV infection.

OBJECTIVE: To examine the relation between problem drinking and medication adherence among persons with HIV infection. DESIGN: Cross-sectional survey. SETTING/PARTICIPANTS: Two hundred twelve persons with HIV infection who visited 2 outpatient clinics between December 1997 and February 1998. MEASUREMENTS AND MAIN RESULTS: Nineteen percent of subjects reported problem drinking during the previous month, 14% missed at least 1 dose of medication within the previous 24 hours, and 30% did not take their medications as scheduled during the previous week. Problem drinkers were slightly more likely to report a missed dose (17% vs 12 %, P =.38) and significantly more likely to report taking medicines off schedule (45% vs 26%, P =.02). Among drinking subtypes, taking medications off schedule was significantly associated with both heavy drinking (high quantity/frequency) (adjusted odds ratio [OR], 4.70; 95% confidence interval [95% CI], 1.49 to 14.84; P <.05) and hazardous drinking (adjusted OR, 2.64; 95% CI, 1.07 to 6.53; P <.05). Problem drinkers were more likely to report missing medications because of forgetting (48% vs 35%, P =.10), running out of medications (15% vs 8%, P =.16), and consuming alcohol or drugs (26 % vs 3 %, P <.001). CONCLUSION: Problem drinking is associated with decreased medication adherence, particularly with taking medications off schedule during the previous week. Clinicians should assess for alcohol problems, link alcohol use severity to potential adherence problems, and monitor outcomes in both alcohol consumption and medication adherence.

Adult↗
PubMed2001

Transcending the suffering of AIDS.

The overall purpose of this qualitative study was to describe how patients with AIDS (PWAs) transcend the emotional and physical suffering of their illness. Content analysis of the interviews of 5 PWAs resulted in 3 main themes: creating a meaningful life pattern, connectedness, and self-care. The results of this study provide presumptive evidence that PWAs can transcend the suffering associated with a life-threatening illness and live meaningful and productive lives. Nurses who anticipate actual and potential growth in PWAs will be able to validate such experiences and feelings and encourage further development.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Adherence in chronic disease.

Nonadherence to treatment regimen is a prevalent problem of patients with chronic disorders. Approximately half of the patients with a chronic disease have problems following their prescribed regimen to the extent that they are unable to obtain optimum clinical benefit. This chapter reviews the state of knowledge regarding adherence to chronic disease regimens across the life span and demonstrates that the extent and nature of the adherence problems are similar across diseases, across regimens, and across age groups. Adherence to the commonly prescribed regimens is addressed, including pharmacological therapies, therapeutic diets, and therapeutic exercise. Randomized, controlled studies focusing on various educational, behavioral, cognitive, and affective interventions to improve adherence are included. Based on this review, further work is needed to better understand and improve adherence. New strategies for analysis and measurement will support these needed advances in the field of adherence.

Adolescent↗
PubMed1999

Psychometric properties of the Index of Homophobia Scale in registered nurses.

The psychometric properties of the Index of Homophobia Scale (IHS; Bouton et al., 1987) were examined in a sample of registered nurses (n = 95). Scores on the IHS may range from 0 (no homophobia) to 28 (highly homophobic). This sample had relatively low total scores on the IHS (M = 7.99, SD = 5.41), indicating that subjects were predominantly not homophobic. Internal consistency as estimated by Cronbach's alpha was .88. The average item mean was 1.14 (SD = 0.29) ranging from .77 to 1.48. Corrected item-to-total scale correlations were satisfactory, ranging from .58 to .75. Inter-item correlations ranged from .35 to .67 indicating some redundancy in content sampling. The 7-item IHS indicates promise for future use with registered nurses, and perhaps also with other health care professionals in adequately and accurately measuring homophobia.

Adult↗
PubMed1998

Health-related quality of life in chronic disorders: a comparison across studies using the MOS SF-36.

The purpose of this report is to examine health-related quality of life (HRQoL) as measured by the Medical Outcomes Study Short Form-36, across patient populations with chronic disorders and to compare quality of life (QoL) in these subjects with normative data on healthy persons. Six studies, within the Center for Research in Chronic Disorders at the University of Pittsburgh School of Nursing, in patients with urinary incontinence, prostate cancer, chronic obstructive pulmonary disease (COPD), acquired immune deficiency syndrome (AIDS), fibromyalgia and hyperlipidaemia provided the data for analysis. The results demonstrated that not only did the prostate cancer and hyperlipidaemia patients have the highest QoL across the chronic disorders, but their QoL was comparable to normative data on healthy persons. Homebound, elderly, incontinent patients had the lowest QoL for physical functioning, whereas patients hospitalized with AIDS had the lowest QoL in general health and social functioning. Patients with COPD had the lowest QoL in role-physical, role-emotional and mental health. Patients with fibromyalgia had the lowest QoL in bodily pain and vitality. Compared to normative data, patients with urinary incontinence, COPD, AIDS and fibromyalgia generally had lower QoL. Prostate cancer and hyperlipidaemia patients had QoL comparable to normative data. Compared to normative data, patients with urinary incontinence, COPD, AIDS and fibromyalgia had more variability for role-emotional. AIDS patients had more variability on physical functioning, bodily pain and social functioning compared to the normative data. These data suggest that patients with various chronic disorders may have QoL that is lower in most domains compared to a healthy population. However, there may be differences in the domains affected as well as the extent of variation across specific chronic disorders.

Aged↗
PubMed1998

Do nurses avoid AIDS patients? Avoidance behaviours and the quality of care of hospitalized AIDS patients.

To examine whether AIDS patients are stigmatized by nurses providing their care a study was conducted with 100 matched AIDS and general medical (GM) patients in two university and two community hospitals. Quality of care and avoidance behaviours were measured by direct, systematic observation during a concurrent 12-hour period. Stigmatizing attitudes of nurses were measured using standardized instruments of homophobia, fear of AIDS and attitudes toward illicit drug use. Nurses made more eye contact and touched AIDS patients more frequently then GM patients, however these differences did not reach the level of statistical significance They spent significantly more time with AIDS patients (W = 3134.0, p = 0.012). Whether or not nurses were fearful of HIV infection, were homophobic or held negative feelings about drug use made no difference in the level of care provided to AIDS patients, but did for GM patients. However, avoidance behaviours were associated with lower quality of care across all patients regardless of diagnosis. Hierarchical regression models demonstrated that increased time spent with patients and higher percentage positive of verbal mannerisms were associated with an increase in the quality of patient care. Provision of physical care showed the least amount of variation between patients in general. It was concluded that nurses' attitudes had no impact on whether or not AIDS patients were shunned by nurses. The provision of psychosocial care showed the greatest variation and seemed more sensitive to individual nurses' attitudes. The quality of care received by the overwhelming majority of patients could only be termed adequate. Nurses exhibited the greatest caution when performing procedures with patients whose HIV status was unknown. The AIDS population studied were mostly well-educated, homosexual men. Whether these results would be replicated with a different population of patients is as yet unknown.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Multicultural issues and ethical concerns in the delivery of nursing care interventions.

Nurses are beginning to recognize the importance of understanding the values, beliefs, and health practices of different cultures in order to provide care that is appropriate and culturally relevant to diverse patient populations. Individuals from other cultures may have different languages and customs. These cultural factors are important to the nurse's understanding of the specifics of health care practice. Culture and ethnicity may influence one's physical development and exposure to health compromising environments and conditions. This article uses a case study to describe a process that health care providers can use when faced with ethical dilemmas that arise when caring for patients from different cultures. Nursing strategies to promote culturally sensitive care are discussed, and include cultural assessment, heightening sensitivity to ethical issues in cultural diversity, and the role of continuing education in providing culturally competent care.

Cultural Diversity↗
PubMed1997

Critical care nurses, ethical decision-making and stress.

Considerable attention has focused on describing ethical issues that critical care nurses face in their practice: however, less attention has been directed at describing the process of ethical decision-making. Systematic research linking aspects of ethical-decision making and stress is lacking. This cross-sectional study examines the relationship between selected aspects of ethical decision-making, stress and selected nurse characteristics. Sixty-one critical care nurses completed the Nurse's Ethical Decision Making--ICU Questionnaire and the Health Professions Stress Inventory. Findings revealed that nurses who selected the patient advocacy model had significantly higher nurse autonomy scores, that perceived anxiety had a negative association with nurse autonomy, and that workplace restrictions and stress were related.

Adult↗
PubMed1994

Health care professionals' characterizations of the system of care for long-term ventilator-dependent patients: a preliminary study.

The purpose of this study was to characterize, from multiple professional perspectives, current management approaches and systems of care for long-term ventilator-dependent patients. This study was preliminary in nature and served to generate questions to be explored with subsequent research. A focus group methodology was used. Three focus sessions were held, with participants representing nursing, social services, and respiratory therapy. Field notes were recorded by two independent observers. The primary themes arising from the narrative data were: (i) caregiver impact, (ii) system barriers to appropriate care, (iii) communication difficulties among professionals and between patients and professionals, (iv) ethical concerns, and (v) patient characteristics that influence medical management and patient outcomes. Implications include the need for systematic research regarding caregiver impact, ethical practice of health care professionals, and the epidemiology of ventilator dependency, as well as evaluative studies of different system approaches to caring for these patients.

Attitude of Health Personnel↗
PubMed1994

Ethical dilemmas in the high-risk nursery: wilderness experiences.

Ethical dilemmas in the high-risk nursery are similar to wilderness experiences. Reinforcers of these experiences for nurses include a lack of knowledge of ethics, communication failures, and the immediacy of the situation. Recommendations are presented to enable nurses to address these ethical dilemmas and to become more actively involved in the decision-making process.

Communication↗
PubMed1991

Ethical principles contained in currently professed medical oaths.

This study analyzed the pledges received from all U.S. medical schools accredited in 1989 by the Liaison Committee on Medical Education of both the Association of American Medical Colleges and the American Medical Association to determine what pledges were affirmed and what ethical principles they contained. The Oath of Hippocrates was the most frequently affirmed pledge (the wording of which was used by 60 schools). Few oaths clearly demonstrated respect for patients' autonomy. The principle of veracity was not evident in any oath. However, nonmaleficence, beneficence, and justice were evident in half of the pledges, and confidentiality was included in three-fourths of them. The authors conclude that the medical oaths failed to address the changing doctor-patient relationship emerging in the 1990s, whereas they continued to affirm traditional principles of nonmaleficence and beneficence.

Beneficence↗
PubMed1991

Stigma, AIDS and quality of nursing care: state of the science.

Reports of fear and psychological distress on the part of nurses when caring for AIDS patients have drawn attention to the real possibility that care for this very sick group of patients may be less than adequate. This paper reviews what is currently known about the attitudes of nurses and the care provided to HIV-infected individuals. The authors reveal the paucity of empirical data concerning quality of care and how the concept of stigma might serve to aid our understanding. The need for more research documenting the quality of care provided to HIV-infected patients is discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Evolving issues in surrogate motherhood.

Surrogate mothering is an arrangement whereby a woman who gives birth to an infant intends--through a contractual agreement--to give that baby to another couple. The recent Baby M case in the United States has raised numerous legal concerns causing many legislative bodies to consider possible statutes to regulate or prohibit surrogacy. The competing interests among and between the individuals involved in this relationship (i.e., the surrogate mother, the couple, the baby, and society) suggest various ethical issues related to benefits, risks, and autonomy. Legal and ethical concerns surrounding the technologically possible procedure of surrogate motherhood are discussed.

Adoption↗