Western Journal of Nursing Research

Sense of control in the context of an uncontrollable chronic illness is explored by analyzing the impact of the patient's perceived control over symptoms (PCS) and perceived control over disease progression (PCDP) on patient and caregiver outcomes. PCS was significantly associated with patient well-being, caregiver well-being, and less caregiver burden. No relationship was found between PCDP and patient well-being, caregiver well-being, or caregiver burden. Findings support the importance of symptom management, viewing the patient-caregiver dyad as a unit, and the needforfuture research on control and transition points in chronic illness.

Because lower bone-mineral density is one potential physiological consequence of eating disorders and chronic alcohol misuse, the risk for osteoporosis may be compounded in women who have both conditions. This study investigated the frequency of eating disorders in 25 women who misuse alcohol and compared bone-mineral density between those with and without multiple disordered eating behaviors. Disordered eating behaviors were assessed through the EAT-26 (Eating Attitudes Test) and a structured interview addressing binge eating, purging, and other weight-control behaviors. Bone-mineral density was measured using dual energy x-ray densitometry. Although only one woman met the DSM-III-R criteriafora current eatingdisorder, 12% had past histories suggestive of anorexia nervosa and 40% had multiple disordered eating behaviors with bulimic features. Bone-mineral density of the femoral neck was 9.3% greater in women with multiple disordered eating behaviors (p < .05).

As the epidemiologic picture of HIV changes to include increased numbers of women of childbearing age, particularly those of African American heritage and thosefrom rural southern cultures, those who provide services to these women need to understand the processes used by HIV-infected women to make reproductive decisions. Focus-group data with subsequent content analysis were used to discover themes surrounding pregnancy decisions among 22 women in two predominantly rural southeastern states. The results both validated and amplified previous findings and added new perspectives. The analyses revealed six overarching themes: spiritual and religious beliefs, knowledge and beliefs about HIV: previous experience with childbearing attitudes offamilies and sex partners, personal health, and intrapersonal motivation to have a baby.

This qualitative study examined experiences of adults requesting genetic-carrier testingforfour autosomal-recessive and X-linked-recessive disorders. The sample consisted of 34 adults with a positive family history or membership in an ethnic group at risk for the inherited disorder A semistructured interview guide was used to collect data during an interview I month after receipt of test results. Noncarriers experienced benefits of emotional relief andfreedom to move ahead with reproductive planning. Carriers experienced burdens of sadness and loss of reproductive expectations. Some subjects in both groups experienced difficulty disclosing results to selected family members and expressed concerns regarding disclosure of testing to insurance providers.

As nurses move from the hospital into the home setting, they are challenged to examine boundaries ofpractice andfamily-nurse relationships. This phenomenological study was undertaken to explore the experiences of nurses working with families of technology-dependent children in the home. The main theme emerging from the data was the nurse's presence as "a stranger in the family. " Additional themes focused on the nurse's advocacy for the child and family, boundary setting, collaboration, and occupational demands.

The aim of this study was to gain insight into nurses '(N = 8) experience of working in a neonatal intensive-care unit (NICU) that incorporated the developmental-care approach Although Als's model isfamily centered, the basic social process identified by nurses was putting the babyfirst. The process of putting the baby first was uncovered using grounded-theory methodology. The process included three phases: learning, reacting, and advocating/nonadvocating. In each of the phases, four main concepts-encountering, appraising, supporting, and gaining sensitivity-emergedfrom the data. Nurses appraised the advantages and disadvantages of this therapeutic approach not only to the infant but also to themselves.

Since Afghan refugees began coming to the United States in the early 1980s, the Afghan community of the San Francisco Bay Area has become the largest in the United States. This population copes with a number of stressors that negatively affect their health and psychological well-being. Based on an ethnographic study, we focus on the social context in which Afghan refugees find themselves, describing Afghans'perceptions of their interactions with mainstream American citizens and health and social service providers. The theme running through all such interactions is information-its scarcity, character, and cultural differences in type, purposes, and means of transmission. Quotes from interviews illustrate four types of problems: economic and occupational problems, health-care access, family and children's issues, and immigration issues/ethnic bias. Policy and program recommendations are applicable to other recent refugee populations that experience similar information problems with regard to the dominant society.