Western Journal of Nursing Research

Long-term gastrostomy is a predictable intervention to ameliorate the effects offeeding and swallowing difficulties among children with severe spastic cerebral palsy. The evidence evaluating the efficacy and implications of the available gastrostomy devices in common use has focused primarily on the operative phase, ignoring the long-term effects that may be critical from a nurse's orfamily caregiver's point of view. In this study, the authors describe a sample of children with gastrostomy, comparing skin-level and tube devices on measures of nutritional outcome, complications, and caregiver satisfaction. In contrast to manufacturer's claims about the superiority of skin-level devices, the results presented here reveal few differences between the devices. The authors conclude, therefore, that device selection should be determined by individualized comprehensive assessment of the child andfamily circumstances.

This study conducted a psychometric evaluation of the construct validity of the Health Self-Determinism Index-Sexual (HSDI-S). The instrument was modified to measure motivation related to sexual health rather than motivation of general health in the Health Self-Determinism Index (HSDI). The HSDI-S was completed by 260 conveniently selected women (between the ages of 18 and 44) attending primary-care clinics in the southeastern United States. Confirmatory factor analysis using LISREL did not validate the four subscales of the original HSDI. Subsequent exploratory and confirmatory factor analysis isolated a single-factor model composed of eight items: four judgment items and four external/internal cues items. This finding is suggestive that changes in wording appear to have shifted the responses from motivation for sexual health to that of women's perception of their role in intimate relationships. The eight extrinsically worded items isolate a single-factor model of social and cultural influences of childbearing-age women's intimate relationships.

The nurse-family relationship in the intensive care unit (ICU) may replace the traditional nurse-patient relationship due to the patient's compromised state. As a result, the nurse-family relationship becomes extremely important. Nurses and families may develop a relationship in which they work together to benefit the patient, or an inadequate relationship may develop. In this study, strategies used by nurses andfamilies to either develop or inhibit the development of the nurse-family relationship were identified. Using unstructured interviews with ICU nurses and family members of ICU patients, categories of strategies were identified and behaviors described. Nurses and families perceived that they each displayed only positive behaviors yet identified inhibiting behaviors of the other Once the behaviors were shown to nurses as secondary informants, they were able to identify with theirnegative behaviors. An understanding of these strategies will help nurses to reevaluate theirpractice and enhance their understanding of the behaviors offamily members.

The concepts of hope, self-esteem, and social support have been identified as importantfactors in understanding a wide range of adolescent behaviors. The purpose of this exploratory study was to examine the relationship of perceived hopefulness, self-esteem, and social support with pregnancy status. Employing a cross-sectional design, a sample of pregnant (n = 58) and nonpregnant (n = 91) adolescents between the ages of 14 and 18 completed the Hopefulness Scale for Adolescents (HSA), the Rosenberg Self-Esteem Scale (RSES), and the Norbeck Social Support Questionnaire (NSSQ). Multiple regression analyses were used to assess the association of pregnancy status with hopefulness, self-esteem, and social support while controlling for age and socioeconomic status (SES). The effects of pregnancy status on each psychosocial variable were examined independently. Findings revealed pregnancy status was not associated with hopefulness, self-esteem, or perceived social support when age and SES were controlled.

Social and culturalfactors influence the experience offatherhood. This descriptivefocus-group study describes the lived experience of fatherhood from the perspectives of 5 unmarried, low-income, African American adolescent fathers in a Midwestern urban area. Naturalistic inquiry approach guidedthe study. Seven themes o(ffatherhood emerged: barriers tofatherhood, value offatherhood, introduction to.fatherhood, competencies offatherhood, role-set relationships, social norms of fatherhood, and father-child contact. This study suggests that nurses should support the involvement of adolescent fathers with their children. Future study may determine the influence of adult female family members on the decisions of adolescentfathers to remain involved with their children.

Nursing research programs are important innovationsfor health services organizations (HSOs). Evidence supports the positive impact that successful programs have on both clinical practice and patient outcomes. In the current era of scarce health care resources, decision makers must be able to accurately judge HSO readiness for nursing research programs to facilitate their success. Judging innovation readiness is an important and complex processfor decision makers. An Innovation Readiness Scale (IRS) was developed from research-based HSO contextual cues identified by nurse researchers as supportive of successful hospital-based nursing research programs. The IRS provides decision makers with a measure by which to judge HSO readiness for nursing research programs. Psychometric results are reported from a pilot and actual test of the IRS in two urban acute care settings involved in nursing research program innovation.