Publications

Abstract

• BACKGROUND: Although nurses are ideally situated to facilitate communication about prognosis and hospice referral among patients, patients' family members, and hospital staff, nurses do not always assume this task. • OBJECTIVE: To identify common obstacles to nurses' discussions of prognosis and referral to hospice care with terminally ill patients in the hospital setting. • METHODS: Data from a previous study were analyzed. In that study, a total of 174 experienced staff nurses working full-time in hospital practice areas where terminally ill patients routinely receive care at 6 randomly selected community hospitals in Connecticut participated. Each nurse completed a self-administered, cross-sectional survey. In this study, the open-ended responses of the nurses were examined by using content analysis and descriptive analysis. • RESULTS: The most common obstacles were unwillingness of a patient or the patient's family to accept the prognosis and/or hospice, sudden death or noncommunicative status of the patient, belief of physicians' hesitance, nurses' discomfort, and nurses' desire to maintain hope among patients and patients' families. • CONCLUSIONS: The reasons for noncommunication of prognosis and referral to hospice care by nurses are complex. Because limited discussion between clinicians and patients about prognosis and treatment options can reduce the likelihood of referral to hospice care, improved communication skills may result in more referrals and a smoother transition to hospice.

Abstract

Wound care, a form of palliative care, supports the health care needs of dying patients by focusing on alleviating symptoms. Although wound care can be both healing and palliative, it can impair the quality of the end of life for the dying if it is done without proper consideration of the patient's wishes and best interests. Wound care may be optional for dying patients. This article will discuss the ethical responsibilities and challenges of providing wound care for surgical wounds, pressure ulcers, and wounds associated with cancer as well as wound care in home health compared to end of life.

Abstract

Little is known about the contribution of advanced practice nurses (APNs) to the mental health care of older adults. This study describes mental health services to older adults by APNs compared with primary care physicians, psychiatrists, psychologists, and social workers. The study uses a retrospective, cross-sectional design with a 5% national sample of 1999 Medicare outpatient claims. Bivariate statistics and multinomial logit models were used to determine differences among these mental health providers. A small proportion of the nationally available providers (10.4%) submitted claims for mental health services rendered to older adults. APNs, psychiatrists, and primary care physicians care for a disproportionate number of rural and poor older adults with complex medical/psychiatric needs compared with psychiatrists, psychologists, and social workers. APNs seem to be an untapped resource for providing mental health services to older adults. Health policy reform is needed to remove barriers to meet mental health care needs.

Abstract

Some of the highest rates of curable sexually transmitted diseases in the USA are found among adolescents. Routine, comprehensive health care that includes a sexual history may contribute to alleviating this problem. We designed and ran a three-session small-group workshop for adolescents, using local community organizations as intervention sites, with peers (typically 2-3 years older) helping facilitate the interactive sessions. Outcomes are summarized elsewhere: in this paper, we present an examination of theoretically based psychological mediating factors that we sought to influence during the intervention, Adolescents' health care-seeking beliefs, general attitudes to seeking care, and intentions to do so all changed such that they held more positive beliefs, evaluated health care more favorably, and developed stronger intentions to seek care. Furthermore, relationships among these constructs were strengthened according to theoretical precepts. Adolescents' self-efficacy and their perceptions of social norms pertaining to health care-seeking, however, were unaffected by the intervention. We explored gender differences in mediating factors, finding no interaction, although females did score higher on post-intervention attitude and intention measures.

Abstract

In order to explore the relationship between use of club drugs (crystal methamphetamine, ecstasy, GHB, ketamine), and use of other drugs, survey data collected from 23,780 middle school students in New York City during 2002-2003 was examined. Results of HGLM analyses (a generalization of HLM to accomodate nonlinear outcomes), controlling for the effect of school, indicate that Black students are less likely than White students to use club drugs depending on the timeframe of use. The use of alcohol and/or marijuana predict club drug use regardless of the timeframe of use, and lifetime cigarette use predicts lifetime club drug use. Recommendations for future research and prevention efforts are discussed.

Abstract

Migrant populations have been found to be at risk of HIV/AIDS. The growth in immigrant and migrant Hispanic populations in the United States increases the need to enhance understanding of influences on their HIV-risk behaviors. Four challenges to conducting research among these populations were identified: (1) the need to use multilevel theoretical frameworks; (2) the need to differentiate between Hispanic subgroups; (3) challenges to recruitment and data collection; and (4) ethical issues. This article describes how two studies of Hispanic immigrants and migrants in the New York area addressed these challenges. One study focused on new immigrants from Mexico, the Dominican Republic, El Salvador, Honduras and Guatemala, and a second study focused on Puerto Rican drug users. Both studies incorporated qualitative and quantitative methods to study these hard-to-reach populations. Continued study of the sociocultural and contextual factors affecting HIV risk for mobile populations, and addressing the research challenges, is crucial to developing effective intervention programs.

Abstract

Hepatitis C virus (HCV) infection is highly prevalent among drug users. While there are antiviral medications available to combat the virus, the medication regimen is quite arduous, presenting special issues for drug users. We examined the challenges and benefits of using residential substance user treatment programs as venues for clients to undergo HCV medication regimens. Analyses of qualitative data collected from clients and staff in 2003 at four residential substance user treatment programs in the U.S. indicate that challenges primarily include issues involving the medications' side effects, and both financial and communication concerns. Benefits especially involve clients' feelings that they are being proactive in addressing health issues in an environment that provides much-needed support. Findings illuminate the complex issues involved for both clients and the programs, and some steps that programs can take to better support HCV-infected clients regarding HCV medication concerns.

Abstract

Individual and maternal characteristics as potential risk factors for having severe mental retardation (SMR) occurring with and without cerebral palsy (CP), epilepsy, or a pervasive developmental disorder (PDD) were explored among a cohort of 119,404 children without Down syndrome born in the California Central Valley in 1992 and 1993. Unadjusted and adjusted relative risks (RRs) and their 95% confidence intervals (CIs) based on the Poisson distribution were used to estimate the risks associated with each individual and maternal factor studied for each SMR diagnostic category. The most notable increased risks for SMR occurring in isolation or with CP or epilepsy was for children born low-birth-weight or preterm who were at a substantially increased risk (RRs 2.6-9.9). In contrast, the risk of SMR occurring with a PDD was the greatest among males compared to females (RR = 3.4, 95% CI 1.5, 7.9), Blacks compared to Whites (RR = 5.1, 95% CI 1.7, 15.5), and Asians compared to Whites (RR = 3.9, 95% CI 1.3, 12.0). Etiologic heterogeneity when SMR occurs with a PDD was suggested.

Abstract

Homelessness has been associated with levels of stress beyond the normal strain of living in poverty. For mothers who are homeless, support from their social networks may provide a buffer from some of the stresses associated with being homeless. To better understand the relationship between social support and female-headed homeless families, an integrative review was conducted of 12 research articles that compare social support among low-income housed mothers and homeless mothers, using guidelines set forth by Ganong. The included studies revealed four significant attributes of social support among housed and homeless mothers: size of the social support network; composition of the social support network; contacts with members of the social support network; and perceived support from members of the social support network. Nurses who work with homeless families are in a position to help develop ways for these families to cultivate and maintain their social support networks while homeless. Nurses can be available to offer support, including the necessary mental health services or referrals.

Abstract

Medication administration is an essential component of quality child care, and nurses play a central role in assuring high-quality training of child care providers. Through key informant interviews and review of public documents, this case study explored the development of state statutes and regulations for medication administration training of child care providers in the state of Connecticut, nursing liability issues related to the definition of this activity, and the role of the Connecticut State Board of Examiners for Nursing. This article also examines the interpretation of the nursing role within this context as delegation versus professional activity and the impact of such designation on nursing practice, child care providers’ access to medication administration training by nurses, and children’s health status in child care settings. As a result of this case study, the Connecticut State Board of Examiners for Nursing revised its policies, demonstrating an exemplar linkage among research, practice, and policy.

Abstract

"Hustling" or sex work is a common means of surviving on the streets and paying for drugs among homeless youth. In this article, we formulate the concepts of "street capital" and "street competencies" to describe how 10 young men who have sex with men (YMSM) in New York City accumulated various knowledge and skills throughout their childhood and adolescence, and later entered into homelessness and the street economy as sex workers. While half of these young men described themselves as gay or bisexual, sexual identity was not a primary consideration amongst these youth. All were homeless and/or users of illegal drugs, and all survived through intimate involvement in the "street economy" - an informal system of exchange that circulates drugs, sex, and money across a range of settings and participants. Based upon an analysis of life history accounts gained through ethnographic interviews, we describe common pathways into the street economy with an emphasis on understanding how these 10 young men of diverse backgrounds became involved in homelessness, drugs, and sex work. In doing this, we document the differential sources of knowledge and particular childhood experiences that launched these youth into coherent street careers.

Abstract

Background. "Telephone tag" for questions about postoperative symptoms and other concerns often engenders dissatisfaction. E-mail use may improve communication between patients and clinicians. This study aimed to describe surgeons' and nurses' use of E-mail with patients and their caregivers after head and neck cancer surgery. Methods. We conducted a cross-sectional national survey of head and neck nurses and surgeons. Results. Ninety-six percent of surgeon and 87% of nurse respondents used E-mail, but only 40% and 25%, respectively, used it with patients. More than 50% of both clinician groups that used E-mail with patients have done so for 2 to 5 years and began this practice at the request of patients. Surgeons not using E-mail with patients were twice as likely as nurses to cite privacy and liability issues, as well as time management and miscommunication concerns. Conclusions. Some clinicians use E-mail with patients, most often by patient request. Medicolegal and clinical ramifications require further study.

Abstract

Academic exchanges between the U.S. and other countries around the world are increasing and teaching students abroad is part of this trend. China is in its initial stage of developing gerontology education and is in great need of new concepts and ideas for dealing with its rapidly aging population. This paper discusses the challenges and rewards of teaching gerontology to health care professionals in China. To achieve the desired learning outcomes in another country requires culturally appropriate course materials and teaching methods; drawing on students' knowledge and expertise by using an interactive format and gaining students' respect.

Abstract

Ketones may bypass the defect in complex I activity implicated in Parkinson disease (PD). Five of seven volunteers with PD were able to prepare a "hyperketogenic" diet at home and adhere to it for 28 days. Substituting unsaturated for saturated fats appeared to prevent cholesterol increases in four volunteers. Unified Parkinson's Disease Rating Scale scores improved in all five during hyperketonemia, but a placebo effect was not ruled out.

Abstract

Although unlicensed staff have routine contact with patients in pain, little research relates to their role with these patients. The purpose of this study was to describe the experiences of unlicensed inpatient hospital staff caring for cancer patients in pain. We sought to understand pain identification and communication practices, describe common practice situations, and identify training needs. We conducted 4 focus groups with unit secretaries, nurses' aides, and housekeepers (N = 24) on 2 inpatient oncology units at an urban, northeastern teaching hospital. Group processes were tape-recorded, transcribed, and analyzed using Atlas/ti software and content analysis. Analysis generated 5 issues related to pain in the daily practice of unlicensed staff: perceived function with pain, building relationships with patients, interpreting patients' pain, system issues, and job challenges and coping strategies. Unlicensed staff reported performing important functions related to pain, including alerting nursing staff to patients' pain, and providing psychosocial support. Participants shared difficulties of working with patients in pain and expressed interest in education on pain identification and course of illness. Findings provide insight into the role of unlicensed staff, and have implications for the educational preparation of this group as well as the nature of their participation in the care delivery system.

Abstract

HM74 (GPR109B) and the highly homologous gene, HM74A (GPR109A) code for Gi-G protein-coupled orphan receptors that recently have been discovered to be involved in the metabolic effects of niacin. The B vitamin niacin is an important agent used in the treatment of dyslipidemias, but its use is limited by side effects. The novel role of the adjacent HM74 and HM74A genes in the metabolism of niacin may provide new targets for drug development. Human genetic variations in HM74 and HM74A have been reported but have not been studied in detail. These variations may play a role in the response to agents targeting receptors coded by these genes. Here we show that many of the nonsynonymous SNPs listed in public databases for HM74 and HM74A are artifacts resulting from extensive homology between these two genes. This may be representative of a neglected phenomenon in reporting sequences of highly homologous genes. We provide primer sequences that permit selective amplification of the complete coding regions of HM74 and HM74A. Using these primers, we show that subsequent sequencing of HM74 and HM74A reveals a novel and unique variation in the HM74A gene. Haplotype analysis suggests four SNPs can define the five major haplotypes that lie within a single haplotype block encompassing these two genes.

Abstract

OBJECTIVE: To examine experiences of older persons and their clinicians with shared decision making (SDM) and their willingness to use an SDM instrument. DESIGN: Qualitative focus group study. PARTICIPANTS: Four focus groups of 41 older persons and 2 focus groups of 11 clinicians, purposively sampled to encompass a range of sociodemographic and clinical characteristics. APPROACH AND MAIN RESULTS: Audiotaped responses were transcribed, coded independently, and analyzed by 3 reviewers using the constant comparative method. Patient participants described using informal facilitators of shared decision making and supported use of an SDM instrument to keep "the doctor and patient on the same page." They envisioned the instrument as "part of the medical record" that could be "referenced at home." Clinician participants described the instrument as a "motivational and educational tool" that could "customize care for individual patients." Some clinician and patient participants expressed reluctance given time constraints and unfamiliarity with the process of setting participatory clinical goals. CONCLUSIONS: Participants indicated that they would use a shared decision-making instrument in their clinical encounters and attributed multiple functions to the instrument, especially as a tool to facilitate agreement with treatment goals and plans.