Nursing research
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Statistical mediation is an important tool in behavioral health sciences, but it has been confined primarily to continuous variables. As prevention studies become increasingly common, more often the mediator or outcome is binary. Recent work by D. P. MacKinnon and J. H. Dwyer (1993) has explicated the steps necessary to estimate models for mediation when the mediator or the outcome is binary. ⋯ The SAS macros are available for download without charge from the second author's Web site. Instructions are provided in an included technical manual.
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Randomized Controlled Trial
A telephone-only motivational intervention to increase physical activity in rural adults: a randomized controlled trial.
Both urban and rural adults are likely to be inactive, but rural adults have less access to exercise classes or facilities to increase physical activity. ⋯ The intervention increased self-efficacy for exercise but did not increase physical activity, possibly due to seasonal effects, the control condition, or the length of the MI intervention. Even so, future studies are warranted because telephone-only MI has potential as a practical, relatively inexpensive method to provide health counseling to rural adults in a broad geographic area. This study produced an effect size on physical activity that will be useful to guide future studies.
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Balancing the development of cultures of safety with nursing workforce challenges is similar to navigating the perfect storm. The perfect storm is characterized as a tempest of extreme intensity that happens rarely, maybe once every 100 years, as a result of multiple factors that end in a situation worse than people have ever seen. Such a storm is currently evident when attempting to ensure patient safety while being confronted with a shortage of nurses and nursing faculty unlike any other shortage experienced in over a number of decades. ⋯ The perfect storm is created because of the existence of a steadily worsening shortage of nurses and nursing faculty. Multiple factors have converged to develop and sustain such a shortage. A blueprint for healthcare organizations is proposed, with examples of numerous innovative strategies that are being developed and studied for handling the major challenges posed by this perfect storm.
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Family caregiving researchers have explored the moderating or stress-buffering effects of variables such as coping and social support. However, the quality of the family caregiver-patient relationship and preparedness for caregiving have received little attention as potential moderators. ⋯ Analysis of three-way interactions provided new theoretical insights into the protective effects of mutuality and preparedness and demonstrated conditions under which caregivers are at increased risk for negative outcomes.
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Stress has been implicated as contributing to the initiation and exacerbation of bowel and discomfort symptoms in patients with irritable bowel syndrome (IBS). ⋯ Gastrointestinal symptom distress is associated with self-reported stress in women with IBS. Psychological distress moderates the effects of stress on GI symptoms. The IBS treatment protocols that incorporate strategies that decrease stress and psychological distress are likely to reduce GI symptoms.