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Biomedical subjects

V P Tilden

Publications and source records attributed to V P Tilden.

At least 19 recordsLinked to original sources
PubMed1995

Decisions about life-sustaining treatment. Impact of physicians' behaviors on the family.

BACKGROUND: Despite the growing availability of advance directives, most patients in the intensive care unit lack written directives, and, therefore, consultation with families about treatment decisions remains the rule. In the context of decision making about withdrawing life-sustaining treatments, we investigated which physician and nurse behaviors families find supportive and which behaviors increase the family's burden. METHODS: We conducted intensive 1- to 2-hour-long individual interviews using a semistructured interview protocol with 32 family members of patients without advance directives whose deaths followed a stay in the intensive care unit and withdrawal of treatment. We analyzed more than 700 pages of verbatim interview data using content analysis techniques and achieved more than 90% interrater agreement on data codes. RESULTS: Themes emerged as families identified selected physician and nursing behaviors as helpful: encouraging advanced planning, timely communication, clarification of families' roles, facilitating family consensus, and accommodating family's grief. Behaviors that made families feel excluded or increased their burden included postponing discussions about treatment withdrawal, delaying withdrawal once scheduled, placing the full burden of decision making on one person, withdrawing from the family, and defining death as a failure. CONCLUSIONS: Study findings provide an increased understanding of the unmet needs of families and serve to guide physicians and nurses in reducing actions that increase families' burdens as they participate in treatment withdrawal decisions.

Communication↗
PubMed1994

Addressing family violence among dental patients: assessment and intervention.

Health care professionals increasingly encounter family violence victims, but often do not recognize the signs of abuse. A mailed survey and personal interviews with dental health care workers reveal an uncertainty about intervening when abuse is suspected. The authors examine DHCWs exposure to family violence among their patients, educational history and thoughts about intervention.

Adult↗
PubMed1994

Factors that influence clinicians' assessment and management of family violence.

OBJECTIVES: High rates of family violence and low rates of detection, report, and therapeutic intervention by health professionals are well documented. This study was undertaken to determine what factors influence clinicians' decision making about identifying abuse and intervening with victims. METHODS: Survey data about clinicians' experiences with and attitudes toward family violence were gathered by mailed questionnaire from a random sample of practicing clinicians in six disciplines (n = 1521). RESULTS: Data showed similarities within and wide differences among three groups of subjects: dentists/dental hygienists, nurses/physicians, and psychologists/social workers. Overall, a third of subjects reported having received no educational content on child, spouse, or elder abuse in their professional training programs. Subjects with education on the topic more commonly suspected abuse in their patients than those without; among all subjects, spouse abuse was suspected more often than child abuse while elder abuse was suspected infrequently. Significant numbers of subjects did not view themselves as responsible for dealing with problems of family violence. Subjects indicated low confidence in and low compliance with mandatory reporting laws. CONCLUSIONS: There is a need for educators to expand curricula on family violence and for legislators to reexamine mandatory reporting laws.

Adolescent↗
PubMed1994

The Interpersonal Relationship Inventory: continued psychometric evaluation.

For norm-referenced measures to be useful in social-behavioral research, investigators who develop measures face several psychometric challenges, including: (a) adequate domain specification; (b) adequate initial evidence of reliability and validity; and (c) ongoing evidence of psychometric quality. The Interpersonal Relationship Inventory (IPRI) was developed in response to gaps in measurement of social relationships, and contributed scales for reciprocity and conflict to a measure of social support. For the IPRI, the first two points were addressed during the period of instrument development. The measure now has been in use for 4 years. This article reports evidence addressing the third challenge: ongoing evidence of psychometric quality. Findings from 19 studies using the IPRI provide compelling evidence for internal consistency reliability and construct validity of the scales.

Evaluation Studies as Topic↗
PubMed1993

Domestic violence: ethical issues in the health care system.

Domestic violence is a highly prevalent event in the United States. Health providers frequently treat abused patients; however, many do not routinely assess for family violence or suspect it when the injuries seem fairly obvious. Because abused women feel stigmatized by the violence, they are hesitant to volunteer the abuse. In 1990, the Joint Commission on the Accreditation of Healthcare Organizations added requirements for emergency and ambulatory care services to develop and use protocols for the identification of violence among patients. This article addresses the ethical and legal dilemmas facing nurses that influence their assessment and intervention in family violence.

Adult↗
PubMed1990

Social support: the experience of hospice family caregivers.

The concepts of social support, reciprocity, cost, and conflict were examined through a methodological study that assessed the reliability and validity of Tilden's (1986) Cost and Reciprocity Index (CRI). The CRI was modified for the face-to-face interviews with 70 family members who were caring for a terminally ill relative enrolled in a hospice program. Item analyses was undertaken with the four subscales because of qualitative comments, a desire to streamline administration of the measure and an overall drop in the alpha coefficients compared with those previously reported. Based on this work 25 items were retained in the four subscales, 13 were eliminated. Cronbach's alpha coefficients and the average inter-item correlation for the revised subscales are reported. Correlation analysis of the revised subscales was also undertaken in order to explore the relationship among the subscales and with time since the care receiver's diagnosis.

Adult↗
PubMed1989

Response of the health care delivery system to battered women.

In this article I describe and analyze the response of the health care delivery system to battered women. Conceptual frameworks that explain the perpetration of battering and the obstacles to its identification by health professionals are examined. Clinical protocols aimed at changing staff's response to battered women are described. Recommendations are made for systems-level changes that are needed to alter the response of the health care delivery system to battered women.

Attitude of Health Personnel↗
PubMed1988

International nursing research in social support: theoretical and methodological issues.

Social support has been widely studied within cultures as a variable that is protective of health and mental health, either directly or as a buffer against life stress. When research is conducted across cultures, several conceptual and methodological issues emerge. The purpose of this paper is to discuss the conceptual basis for assuming that social support is a universal phenomenon, to suggest areas in which manifestations of social support may be culture-specific, and to present methodological issues that need to be addressed in conducting valid international research on social support.

Cross-Cultural Comparison↗
PubMed1987

Increasing the rate of identification of battered women in an emergency department: use of a nursing protocol.

In recognition of the increasing problem of family violence, the authors developed and tested an interview protocol focused on female victims of family violence. The purpose of the protocol was to increase nurses' identification of battered women receiving care in the emergency department. Using a time-series design, data were collected from patient records during four months prior to introduction of the protocol. These data were compared to comparable post-protocol data. There was a significant increase in nursing staff identification of female domestic violence victims following introduction of the protocol.

Clinical Protocols↗
PubMed1987

Social support and the chronically ill individual.

Nurses caring for the chronically ill need to be alert for the problems of social isolation and social impairment. Families often respond initially to serious illness by becoming over-protective and fostering dependence and a sense of impaired competence in the ill person. As the illness continues, families often experience exhaustion because of the demands of new roles, depleted finances, and other aspects of a changed lifestyle. Feelings of anger, guilt, and helplessness occur in the network, often leading to withdrawal of support--especially as the ill person's ability to reciprocate support is impaired. Nursing interventions in situations of social isolation focus on reducing isolation by promoting social interaction as appropriate, and by directly or indirectly mobilizing or expanding the social network. The problem of impaired social interaction may occur secondary to the personality changes that often accompany chronic illnesses, or as a function of the chronic illness or disability itself, as in the case of mental illnesses. Social impairment is an appropriate nursing diagnosis in abusive families. Nursing interventions range from educational programs for social skill development to reduction of the amount of contact within the network to involvement of protective and psychotherapy services. Chronic illness has profound effects on social support and the social network of both the ill person and his or her family. As both long-term illnesses and family involvement in care giving increase, nursing care in situations of chronic illness must include attention to issues of social support. Nursing diagnosis provides a framework for nurses to include social support in their care of the chronically ill patient. Social isolation and social impairment can be reduced by nursing interventions.

Chronic Disease↗
PubMed1986

New perspectives on social support.

Many health sciences, including nursing, have contributed to research and theory development in the area of social support. Because of this, social support is shared knowledge rather than borrowed knowledge. This article reviews the evidence that social support is a major determinant of health and illness. It is likely that, in the future, nurse practitioners will increase their use of social support theory in planning patient care.

Health↗
PubMed1985

Issues of conceptualization and measurement of social support in the construction of nursing theory.

Social support has emerged in the last decade as a significant health behavior and, therefore, a promising focus of theory development in nursing. Nursing's concern with health, environment, and person provides an ideal perspective from which to take the lead in research, instrument development, and theory construction in social support. The focus of this article is the present development of the construct to assist nurse scholars toward an adequate conception of social support. Theoretical frameworks underlying definitions are examined, and issues of measurement and clinical assessment are discussed.

Humans↗