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Biomedical subjects

Judith A Erlen

Publications and source records attributed to Judith A Erlen.

At least 19 recordsLinked to original sources
PubMed2006

Making sense of mild cognitive impairment: a qualitative exploration of the patient's experience.

PURPOSE: The proposed dementia precursor state of mild cognitive impairment is emerging as a primary target of aging research. Yet, little is known about the subjective experience of living with a diagnosis of mild cognitive impairment. This study examines, from the patient's perspective, the experience of living with and making sense of the diagnosis. DESIGN AND METHODS: We recruited 12 older adults with amnestic or nonamnestic mild cognitive impairment from a university-based memory disorders clinic. We conducted in-home, semistructured interviews in order to elicit rich descriptions of the personal experience of having mild cognitive impairment. We used the qualitative method of grounded theory to analyze narrative data. RESULTS: Understanding and coming to terms with the syndrome, or assigning meaning, constituted a fundamental aspect of living with a diagnosis of mild cognitive impairment. This process comprised interrelated emotional and cognitive dimensions. Participants employed a range of positive, neutral, and negative phrasing in order to depict their emotional reactions to receiving a diagnosis. Cognitive representations of mild cognitive impairment included both prognosis-focused and face-value appraisals. Expectations of normal aging, personal experience with dementia, and concurrent health problems were key contextual factors that provided the backdrop against which participants assigned meaning to a diagnosis of mild cognitive impairment. IMPLICATIONS: Clinicians who disclose diagnoses of mild cognitive impairment need to be mindful of the potential for varying interpretations of the information that is conveyed. Future research needs to include systematic, longitudinal investigations of illness representation and its impact on health behaviors among individuals with mild cognitive impairment.

Aged↗
PubMed2006

Nursing students' and faculty members' knowledge of, experience with, and attitudes toward complementary and alternative therapies.

This study was designed to describe and compare the knowledge, experience, and attitudes of nursing faculty and students (undergraduate and graduate) regarding complementary and alternative therapies (CAT). A cross-sectional survey (N = 153) of undergraduate (n = 41) and graduate (n = 57) students and faculty (n = 55) was conducted in one school of nursing. Most participants were White (87%) and female (78%). More than 70% of the students and faculty agreed that clinical care should integrate the use of CAT. More than 85% desired more education about CAT, especially in undergraduate nursing curricula. More than 65% agreed that the clinical nurse specialist or nurse practitioner role should include the use of CAT in their practice, and more than 50% agreed that they had some knowledge of CAT, but only approximately 30% had some experience with CAT. Faculty and students expressed positive attitudes toward integrating CAT into the undergraduate nursing curriculum and nursing practice. Faculty development and nursing research are needed to facilitate curriculum change and integrate CAT into nursing programs at all levels.

Adult↗
PubMed2005

Medication practice and feminist thought: a theoretical and ethical response to adherence in HIV/AIDS.

Accurate self-administration of antiretroviral medication therapy for HIV/AIDS is a significant clinical and ethical concern because of its implications for individual morbidity and mortality, the health of the public, and escalating healthcare costs. However, the traditional construction of patient medication adherence is oversimplified, myopic, and ethically problematic. Adherence relies on existing social power structures and western normative assumptions about the proper roles of patients and providers, and principally focuses on patient variables, obscuring the powerful socioeconomic and institutional influences on behaviour. Some professionals advocate for alternate approaches to adherence, but many of the available alternatives remain conceptually underdeveloped. Using HIV/AIDS as an exemplar, this paper presents medication practice as a theoretical reconstruction and explicates its conceptual and ethical evolution. We first propose that one of these alternatives, medication practice, broadens the understanding of individuals' medication-taking behaviour, speaks to the inherent power inequities in the patient-provider interaction, and addresses the ethical shortcomings in the traditional construal. We then integrate medication practice with feminist thought, further validating individuals' situated knowledge, choices, and multiple roles; more fully recognizing the individual as a multidiminsional, autonomous human being; and reducing notions of obedience and deference to authority. Blame is thus extricated from the healthcare relationship, reshaping the traditionally adversarial components of the interaction, and eliminating the view of adherence as a patient problem in need of patient-centred interventions.

Anti-HIV Agents↗
PubMed2004

Complementary and alternative therapies in nursing curricula: a new direction for nurse educators.

The scope of nursing practice is expanding to include the use of complementary and alternative therapies (CAT). This expansion is occurring because of changes in professional and societal attitudes toward the use of such therapies. In this article, we discuss the use of CAT and the development of medical and nursing educational programs related to these therapies in Eastern and Western societies. In addition, we identify future directions for incorporating content on such therapies into nursing education programs in the United States. We suggest that undergraduate nursing programs need to introduce the philosophy of Oriental medicine and content on some of the common therapies and that graduate nursing programs that include content on the use of CAT in nursing practice can possibly be developed.

Complementary Therapies↗
PubMed2004

HIV disease susceptibility in women and the barriers to adherence.

The late 1990s saw a decrease in the total number of new cases of HIV (human immunodeficiency virus) and AIDS (acquired immunodeficiency syndrome). However, data often do not reflect the increased incidence of HIV in women, particularly women from minority groups. The purposes of this clinical review are to address the disease susceptibility and disease manifestations of HIV in women, and to discuss selected barriers to adherence to antiretroviral medications such as stigma, social support, and depression.

Antiretroviral Therapy, Highly Active↗
PubMed2003

Effects of acupuncture therapy on insomnia.

BACKGROUND: Acupuncture therapy, commonly used in clinical practice in oriental cultures, has the potential to produce a positive effect with patients experiencing insomnia. AIM: The purposes of this systematic review were: (1) to assess the trends across intervention studies using acupuncture for insomnia from 1975 to 2002, (2) to examine dependent variables, and (3) to evaluate the effects of acupuncture therapy on insomnia in older people. METHOD: Data were collected from November 2001 to January 2003. A wide range of electronic databases was searched using the keywords 'insomnia', 'acupuncture' and 'experimental design'. Papers were included if they were published in the English language between 1975 and 2002 and described an experimental study using acupuncture therapy to treat insomnia. Eleven reports met these criteria. FINDINGS: Most of the studies had been conducted since 1990. The findings showed that the first author was usually a Chinese medical doctor (n = 9) employed in a traditional department of medicine. Most of the papers were published in two journals: International Journal of Clinical Acupuncture and Journal of Traditional Chinese Medicine. Data were limited because of the small number of studies available. Half the studies had small samples (50 subjects or fewer), which were composed mainly of older women who had a variable duration of insomnia from 3 days to 34 years. The main method used to assess outcomes was questionnaire. All the studies reported statistically significant positive results. CONCLUSION: The results of this review suggest that acupuncture may be an effective intervention for the relief of insomnia. Further research, using a randomized clinical trial design, are necessary to determine the effectiveness of acupuncture. More work is also needed to promote the long-term therapeutic effects of acupuncture and to compare it with other therapies for insomnia.

Acupuncture Therapy↗
PubMedDate not supplied

The utility of the Purpose-in-Life Test in persons with AIDS.

The purpose of this study was to describe the utility of the Purpose-in-Life Test among persons with AIDS using both Part A (quantitative) and Part B (qualitative). A cross-sectional descriptive design was used with a sample of 74 persons with AIDS from community settings. The Purpose-in-Life Test and a sociodemographic questionnaire were administered. Analytic methods included descriptive and inferential statistics and content analysis. Part A scores indicated that only one third of the participants reported a definite purpose in life; however, results from Part B demonstrated that the majority of participants viewed their life as meaningful and dynamic. Demographic characteristics such as race, income, and education were significantly related to purpose in life. Assessing purpose in life using both Part A and Part B of the Purpose-in-Life Test may assist nurses with a more in-depth understanding of purpose in life and assist persons with AIDS with identifying opportunities for personal growth.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Recruiting vulnerable populations for research: revisiting the ethical issues.

The successful recruitment of participants is essential to the research process. To increase the rate of subject participation, investigators have to rely on help from health care providers who often serve as gatekeepers to potential research study subjects. These well-meaning professionals may limit subject participation in a study involving vulnerable populations under the guise of protecting these individuals from harm. We describe some of the characteristics of vulnerable populations affecting their recruitment into research studies. We examine the ethical conflicts that occur when health care professionals control access to these subjects during recruitment for research studies. Finally, we discuss the implications for practice and research designed to protect the rights of vulnerable populations participating in research. We identify collaboration and dialogue between researchers, health care providers, and members of the potential subject populations as most important in recruiting sufficient numbers of subjects to ensure the scientific merit of the study.

Ethics, Research↗
PubMedDate not supplied

Effects of mutual dyad support on quality of life in women with breast cancer.

This study examined the effects of a mutual dyadic support intervention between survivors and women newly diagnosed with breast cancer on the quality of life and interpersonal relationships of the participants. This matched-pairs, baseline-postintervention study included 31 survivors and 31 newly diagnosed women with stage I or II breast cancer. The women met in mutually supportive, self-directed dyads at least twice a week for 8 weeks. Instruments included contact Logs and Meaningful Observations Journals. Content analysis of the Logs showed that most dyad interactions were by telephone. Most participant dyadic conversations focused on the health and functioning of newly diagnosed partners, with survivors providing informational and emotional support. Meaningful Observations Journal thematic analysis supported the social exchange theory to describe dyad partner relationships. Most dyadic relationships were supportive, some were reciprocal, and some experienced conflict. Themes varied little between groups and from baseline to postintervention. Themes across time were support of others, health, changing priorities, and faith. Further quantitative study is needed to examine the effects of a dyad support intervention on quality of life in more diverse populations of women with breast cancer. Nurses need to evaluate the existing social-network support systems of patients with breast cancer and consider the need for dyadic peer support.

Adult↗
PubMedDate not supplied

Fidelity to a 12-week structured medication adherence intervention in patients with HIV.

BACKGROUND: Researchers have been conducting efficacy and effectiveness studies on interventions that address medication-taking behavior in patients with HIV infection. However, they also must examine the fidelity to the research protocol for the delivery of the intervention. OBJECTIVES: The aims of this study were to determine the level of fidelity to each of the specified end points (number of intervention sessions, session duration, number of telephone calls per session, the length of time between sessions, sessions with multiple interventions, and attrition from the intervention protocol) in the delivery of the 12-week, nurse-delivered, structured telephone intervention designed to improve medication adherence and to determine the factors (race, gender, and socioeconomic status) related to participation in the intervention. METHODS: This descriptive correlational study was a substudy of a larger randomized clinical trial (N = 200) testing the effectiveness of a 12-week nurse-delivered intervention designed to improve medication adherence to antiretroviral medications in persons with HIV infection. The Intervention Tracking Form was used to collect data on all intervention delivery end points during the delivery of the structured intervention. A sociodemographic questionnaire was used to collect the sociodemographic characteristics of the sample. RESULTS: Two thirds of the sample (n = 66) were male, and slightly more than half were White. The average age was 39.68 (SD = 7.98) years. The average number of intervention sessions delivered was 8.1 (SD = 4.07). Participants were more likely to receive the first five intervention sessions (n = 77, 77.8%), and 21 (21.2%) dropped out of treatment before it was completed. Nearly one quarter (n = 24, 24.2%) of the sample had doubled-up interventions. Intervention sessions lasted, on average, 11.3 min. Typically, more than one telephone call was needed before the participant was reached (M = 2.2). The mean number of days between sessions was 11.5 days. Women were more likely to have doubled-up interventions (p = .036). There was a marginally significant difference (p = .075) in the number of sessions received between the Whites and non-Whites: Whites (M = 8.8, SD = 3.9) received slightly more sessions compared with non-Whites (M = 7.24, SD = 4.2). When examining the interaction effects between the demographic factors considered, a race-by-income effect was observed for the mean number of attempts to contact the participant (p = .044). DISCUSSION: These results demonstrate a lack of fidelity to the research intervention protocol. Factors beyond the researchers' control may have influenced fidelity to the intervention protocol.

Adult↗
PubMedDate not supplied

Adherence revisited: the patient's choice.

Adherence to treatment is an age-old issue in the health care provider-patient relationship. Although findings show that adherence has the potential to increase the efficacy of a treatment, is that the only consideration when examining the ethical questions surrounding adherence? What if the competent adult patient chooses not to adhere? The purpose of this paper is to examine the patient's choice to not adhere to a prescribed therapy. The author uses a hypothetical case as a way to identify and to challenge the assumptions underlying traditional adherence models.

Adult↗
PubMedDate not supplied

When there are limits on health care resources.

Controlling health care costs has been a goal within the health care system for nearly 40 years. Yet, what is occurring is that health care costs are actually increasing, and the quality of care is decreasing. Patients and health professionals are complaining that accessibility to services is limited. There are inadequate numbers of nursing staff to care for patients who are both sicker and have shorter lengths of stay. Patients are bewildered by a system that they find to be extremely impersonal and difficult to navigate. This article uses a hypothetical case to identify and examine some of the ethical issues related to access to health care within a managed care system. Recommendations for nurses are presented to help them meet the challenges of limited health care resources.

Cost Control↗
PubMedDate not supplied

When all do not have the same. Health disparities.

Eradicating health disparities and increasing health-related quality of life are the overall goals of Healthy People 2010. To achieve these goals requires that healthcare providers have an understanding of respect for individuals, trust, and implications of distributing resources equitably within society. The purposes of this article are to discuss health disparities and to briefly describe how ethics helps healthcare providers address health disparities. In addition, strategies that professional nurses can incorporate into their clinical practice in order to reduce health disparities are presented.

Ethics, Nursing↗
PubMedDate not supplied

Technology. Possibilities and pitfalls.

An amazing growing area in healthcare is the increase in the development of technology that is designed to augment human functioning and decrease an individual's dependence on others to provide personal care. Yet, what does it mean to extend a person's life through technology? Within the context of a hypothetical case, this article considers ethical questions raised by new and futuristic technologies designed to augment human functioning. These ethical issues are grounded within the context of the possibilities and the pitfalls of technology. When providing care to patients and families, nurses must recognize and understand the significant ways in which quality of life, personhood, accessibility, and cost may be challenged by the promises of new technologies.

Adult↗
PubMedDate not supplied

Caring doesn't end.

Despite the advances in healthcare technology and the new treatment regimens, all patients are not eligible for these treatments. Although some providers might indicate that there is nothing more that they can do, other healthcare providers do not give up on their patients and families. They continue to provide care, regardless of whether treatment options have been exhausted, and help these patients to have a "good death." The purpose of this article is to use two case examples to show how caring does not end but is rather transformed when intensive treatment ends. There is a discussion of the development of the hospice movement, upholding dignity and respect, and continuing to care. Recommendations for action that inform nursing practice are identified.

Aged↗
PubMedDate not supplied

Functional health illiteracy. Ethical concerns.

Functional health illiteracy is a silent disability demanding the attention of healthcare professionals because it affects millions of people in the United States. Patients are reluctant to disclose this problem because they fear discrimination and stigmatization. Inadequate health literacy raises ethical questions because it is a barrier to healthcare and results in poor health outcomes. The purposes of this article are to provide an overview of functional health illiteracy, identify related ethical concerns, and discuss selected, relevant nursing implications. Nurses are in a unique position to serve as advocates, mediators, and translators for their patients who are functionally health illiterate.

Adult↗
PubMedDate not supplied

Wanted-nurses. Ethical issues and the nursing shortage.

The persistent nursing shortage is challenging the values and beliefs of the nursing profession and causing nurses to ask how they can fulfill their ethical responsibilities to patients when there are an insufficient number and a maldistribution of nurses. Nurses are expressing job dissatisfaction, experiencing moral distress, and wondering about their inability to provide quality patient care. In this article, the author addresses the commitment to care for patients and the ethical dilemma with which nurses are grappling: caring for self versus caring for others. Recommendations for possible action include reenvisioning the profession of nursing, empowering nurses, providing support, and restructuring the work environment. Taken together, these actions have the potential to reduce the moral distress that nurses are experiencing and to enable them to honor their commitment to patient care.

Ethics, Nursing↗