Publications

Abstract

Four of the five John A. Hartford Foundation Centers of Geriatric Nursing Excellence (HCGNEs) have been involved in efforts designed to improve the quality of nursing care to older adults through evidence-based Best Practice Initiatives. This article describes the important role these initiatives play in building academic geriatric nursing capacity. Building on the work of other nurse researchers, these projects attend to organizational and individual aspects of change theory, the scientific basis for practice innovations, and the role of expert consultation to support change. Best practice examples from the HCGNE demonstrate how the science involved in translating research into gerontological nursing practice has evolved, creating important educational opportunities for nursing students at all levels. In order to build academic geriatric nursing capacity, it is essential that schools of nursing help undergraduate and advanced practice nursing students develop an appreciation for how research and education can improve the care of older adults.

Abstract

OBJECTIVES: To review the available scientific literature on cancer care in nursing homes and recommendations for clinical practice and further research are offered. DATA SOURCES: Research studies and review articles. CONCLUSION: Overlooked issues for older adults with cancer in nursing homes include screening, treatment, and symptom management. Cancer care and survivorship in nursing homes receives little direct attention. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses can improve cancer care and survivorship in nursing homes by considering nursing homes as a practice venue.

Abstract

CARE+ is a tablet PC-based computer counseling tool designed to support medication adherence and secondary HIV prevention for people living with HIV. Thirty HIV+ men and women participated in our user study to assess usability and attitudes towards CARE+. We observed them using CARE+ for the first time and conducted a semi-structured interview afterwards. Our findings suggest computer counseling may reduce social bias and encourage participants to answer questions honestly. Participants felt that discussing sensitive subjects with a computer instead of a person reduced feelings of embarrassment and being judged, and promoted privacy. Results also confirm that potential users think computers can provide helpful counseling, and that many also want human counseling interaction. Our study also revealed that tablet PC-based applications are usable by our population of mixed experience computer users. Computer counseling holds great potential for providing assessment and health promotion to individuals with chronic conditions such as HIV.

Abstract

Background: Stalking is a serious public health and societal concern affecting many college women. Purpose: The purpose of this study was to explore college women's experiences of stalking. The specific aims were to compare victims and nonvictims on physical and mental health indicators and to identify lifestyle changes made in response to being stalked. Methods: In this cross-sectional design, 601 women from two universities completed a stalking questionnaire, a mental health screening tool, and an injury checklist. Data analysis included frequencies, multivariate analysis of variance, analysis of variance, and χ2 analysis. Results: A quarter of the sample reported experiencing stalking, most often by an intimate or dating partner. Individuals who reported experiencing stalking reported significantly more mental health symptoms and lower perceived physical health status than individuals who did not. Victims reported changing routines, behaviors, and activities. Conclusions: Psychiatric nurses must be knowledgeable about stalking and its impact on health. Nurses can provide support, services, and community referrals.

Abstract

OBJECTIVE: To identify evidence on the role of assertiveness and teamwork and the application of aviation industry techniques to improve patient safety for inpatient obstetric care. DATA SOURCES: Studies limited to research with humans in English language retrieved from CINAHL, PubMed, Social Science Abstracts, and Social Sciences Citation Index, and references from reviewed articles. STUDY SELECTION: A total of 13 studies were reviewed, including 5 studies of teamwork, communication, and safety attitudes in aviation; 2 studies comparing these factors in aviation and health care; and 6 studies of assertive behavior and decision making by nurses. Studies lacking methodological rigor or focusing on medication errors and deviant behavior were excluded. DATA SYNTHESIS: Pilot attitudes regarding interpersonal interaction on the flight deck predicted effective performance and were amenable to behavior-based training to improve team performance. Nursing knowledge was inconsistently accessed in decision making. Findings regarding nurse assertiveness were mixed. CONCLUSIONS: Adaptation of training concepts and safety methods from other fields will have limited impact on perinatal safety without an examination of the contextual experiences of nurses and other health care providers in working to prevent patient harm.

Abstract

Purpose: To determine if selected client characteristics were factors influencing the provision of provider advice for diet, exercise, smoking cessation, alcohol cessation, eye and foot care, and influenza and pneumonia vaccine for those told by a provider that they had diabetes. Data sources: Data from the 2001 National Health Interview Survey were used in a secondary analysis to answer the research question. This study used a subsample who self-reported having provider-diagnosed diabetes; the subsample comprised 2287 unweighted subjects that, when weighted, represent 6.38% of the civilian noninstitutionalized individuals with diabetes in the United States. Conclusions: This study suggests that many patients are not receiving all the eight processes of care studied, particularly those with new onset diabetes, elders, black people, and Hispanics. Implications for practice: This study suggests that the present paradigm is not early prevention but treatment of established disease. Changes in entrenched thinking about clinical care need to be addressed. Patients with diabetes need to have an awareness that there is a standard of optimal care, and they should be encouraged to seek those who provide this care. Further, system changes may be required to address changes that are not easily made at the provider level.

Abstract

In the absence of surrogate markers, the evaluation of suspected nonalcoholic fatty liver disease (NAFLD) is highly dependent on histological examination. The extent of sampling variability affecting the reliability of a single liver biopsy in patients with suspected NAFLD is poorly characterized. This prospective study aimed to correlate precise histological findings in paired biopsies - right and left lobe - in the diagnosis of NAFLD in morbidly obese subjects undergoing bariatric surgery employing both Brunt and Matteoni classifications and the NAFLD Activity Score (NAS). We also aimed to determine whether the composite histopathological findings of the two biopsies would improve diagnostic accuracy. Consecutive subjects had an intraoperative biopsy from both right and left lobes, evaluated and scored in a blinded manner. Intraobserver agreement was also assessed. Kappa coefficients of agreement were calculated. Forty-one subjects had acceptable biopsies. Agreement for steatosis was excellent and moderate for fibrosis. Concordance was only fair for most features of necroinflammation. Intraobserver agreement was only moderate for lobular inflammation. Excellent agreement was seen for the diagnosis of NASH using Brunt criteria and good agreement when using Matteoni and NAS scoring systems. Composite biopsy data particularly improved identification of hepatocyte ballooning. The diagnostic accuracy also improved substantially when composite features were compared with single-sided biopsy features, especially for the Matteoni and NAS scoring systems. In conclusion, significant sampling variability occurs in NAFLD, particularly for features of necroinflammation. This should be factored into the design of clinical trials and studies of the natural history of the disease.

Abstract

This article describes the use of nursing art to solve problems related to the management of pain in cognitively impaired persons who live in nursing homes. The result of naturalistic inquiry, the Model of Sequential Trials arose from a qualitative study of the beliefs, experiences, and behaviors of nurses managing pain in this context. The model illustrates a strategic process of evaluation, trials, reevaluation, and repeated trials that demonstrates the rationale and process underlying nursing management of pain. Future research is needed to evaluate the model's usefulness in other practice settings and in teaching clinical decision making.

Abstract

Although short- and long-term outcomes in individuals with DM following ACS, PCI, and CABG have improved over the past decade, CVD continues to be an important cause of morbidity and mortality in this population. Nursing has a critical role in the prevention of CVD, and in the early detection of symptomatic and asymptomatic CHD. Following ACS, PCI, or CABG, ongoing assessment for new ischemia, HF, or renal insufficiency, and specific complications of ACS or revascularization is crucial. Long-term prevention of recurrent ischemia, ACS, HF, and death necessitates multifactorial CHD risk factor reduction, along with aggressive glucose control, in all individuals with DM.

Abstract

Nurses and health care increasingly are embracing and guided by achievements and challenges of evidence-based practice and reflective practice. Nursing science advances have positioned nurses to move forward in the development of science. New directions for nursing knowledge need to emerge in several ways including the development of interdisciplinary knowledge, emphasis on the nursing care process, creation of new workforce patterns, and development of economic theories of nursing practice.

Abstract

Purpose: To discuss the pathophysiology and the current treatment approaches for the dysregulation of glucose metabolism in the context of human immunodeficiency virus (HIV) infection. Data sources: Selected research, clinical studies, clinical guidelines, and review articles. Conclusions: In HIV infection, multiple factors are associated with the pathogenesis of glucose dysregulation. Studies suggest that protease inhibitors, a class of antiretroviral agent, as well as viral factors, lipodystrophy, hepatitis C infection, injection drug use, and second-generation antipsychotics have been implicated in the development of glucose disorders and diabetes. Current treatment recommendations are based on extrapolated data from non-HIV diabetic patients. More research is needed to establish the most appropriate management for the disorders of glucose metabolism in the context of HIV infection. Implications for practice: If left untreated, patients are at increased risk for cardiovascular disease and complications associated with untreated diabetes.

Abstract

Hepatitis C virus (HCV) infection is the most common blood-borne infectious disease among drug users in the US. Drug treatment programs are ideally situated to assist their clients to obtain HCV medical and support services. Using data collected from 233 drug free and methadone maintenance treatment programs (MMTPs) throughout the US, this article examines the range of HCV services that treatment programs provide to their HCV positive clients. Findings indicate that MMTPs offer more comprehensive HCV services to more of their HCV positive clients than drug free programs, although drug free programs provide more individualized services. While 84% of the programs provided some HCV services, there are still serious gaps in the provision of these services (e.g., dealing with medical providers to obtain HCV medication and facilitating access to liver transplant lists). Drug treatment programs need increased funding and staff training to be able to provide comprehensive HCV services to their HCV positive clients.

Abstract

Objective: Associations between magnitude and timing of maternal pregnancy blood lead (Pb) levels (BLLs), birth weight, and total days of gestation were examined, as well as associations with related clinical diagnoses of low birth weight (LBW), preterm, and small-for-gestational-age (SGA) birth. Study Design: Among a sample of 262 mother-infant pairs studied retrospectively, one-way analysis of variance and regression statistics were used to measure the relationship between level of maternal pregnancy BLLs and birth outcomes while controlling for key maternal and newborn factors. Results: Women with maximum pregnancy BLLs (max-PBLLs) ≥10 μ/dl tended to give birth earlier and their babies were at substantially increased risk for preterm and SGA birth. By holding other explanatory factors constant, each unit increase in max-PBLL above 10≥ μ/dl was found to be associated with a decrease of -0.3 in total days of gestation. Compared to women with lower levels, women with max-PBLLs 10≥ μ/dl were at a threefold increased risk for preterm birth (adjusted OR = 3.2, 95% CI 1.2-7.4) and more than a fourfold increased risk for having an SGA infant (adjusted OR = 4.2, 1.3-13.9). Second trimester maximum BLLs 10≥ μ/dl were associated with a steep decrease in total days of gestation (a decrease of -1.0 days per each unit increase above 10≥ μ/dl). Conclusions: These data provide evidence of the adverse effects of maternal pregnancy BLLs, particularly when levels are 10≥ μ/dl. Prenatal Pb exposure at these levels was associated with significant decreases in total days of gestation and an increased risk of preterm and SGA birth.

Abstract

Objective: To evaluate the effects of protease inhibitors (PIs) as antiretroviral therapy in comparison with other antiretroviral (non-PI) medications on glucose tolerance, lipid metabolism, and body fat distribution in human immunodeficiency virus (HIV)-infected young patients. Methods: We conducted a cross-sectional clinical study in an outpatient HIV clinic. The study population consisted of 21 patients (15 female and 6 male) who had had at least 6 months of antiretroviral treatment. The mean age of the patients was 11.9 years (range, 6 to 16.5). Results: Fifteen patients treated with PIs and 6 patients treated with non-PIs were enrolled in the study. We found no significant differences in the lipid panel and insulin resistance, as determined by using the Quantitative Insulin Sensitivity Check Index formula, in the PI group in comparison with the non-PI group. Lipodystrophy was observed in 47% (7 of 15) of the PI group and 33% (2 of 6) of the non-PI group (P = 0.66). In the presence of lipodystrophy, serum triglyceride levels were higher in the PI group than in the non-PI group (P = 0.046). No such difference was found between the treatment groups when no lipodystrophy was present. There was no significant difference in insulin resistance between the treatment groups in the presence or absence of lipodystrophy. Conclusion: Our study found the presence of lipodystrophy in HIV-infected young patients regardless of whether they were taking PIs or not. In the patients who had lipodystrophy, those treated with PIs had higher serum triglyceride levels than those not treated with PIs.

Abstract

Even children who appear healthy can have dangerous levels of environmental toxins in their bodies. The health effects of environmental toxins, especially neurological effects, are particularly damaging to children. Environmental toxins have several similarities among them as most are neurotoxins and cannot be destroyed. Chemicals such as arsenic, PCBs, lead, and mercury will remain part of our environment for years to come. Pediatric nurse practitioners must become knowledgeable about environmental toxins and inform their families of ways to prevent exposures. Much of the information regarding environmental toxins is available via the World Wide Web. However, many Web sites for information regarding environmental toxins and other pediatric environmental health issues may not contain accurate information. Nurse practitioners should make themselves aware of Web sites for environmental toxins that contain accurate information that may be suggested to patients and their families. The Web sites for the EPA (www.epa.gov), the ATSDR (www.atsdr.cdc.gov), and the CDC (www.cdc.gov) contain accurate and current information regarding environmental toxins. These Web sites also link readers to other Web sites with reliable, valid information on environmental toxins.