Publications

Abstract

Knowledge of health policy is an increasingly important aspect of nursing practice and education, especially as nurses strive to improve the rapidly changing health care delivery system. At the same time, many educators, researchers, foundations, and government officials are touting the benefits of service learning. In particular, service learning offers ways to enhance partnerships between academia and community agencies and to extend learning beyond the traditional classroom. We present a model for educating nurses as advanced practice nurses in health policy that links service learning with a framework for the political development of nurses. Under the rubric of service learning, the curriculum is based on the overlap among health policy, the role of the nurse as consultant, and community-based care. After discussing the importance of health policy for graduate nursing education and reviewing the essentials of service learning, we describe a three-semester graduate sequence in health policy service learning. The focus is on the clinical and classroom components of both individual and group practica and their relationship to stages of nursing's political development. The article concludes with evaluation considerations and the implications of our work for nursing theory, research, practice, and education.

Abstract

The feasibility of a randomized clinical trial to implement and compare the effectiveness of three components of an intervention for women with breast cancer and their partners was tested. The intervention components, standardized education by videotape (SE), telephone counseling (TC), and education with telephone counseling (SE+TC), were designed with a complementary approach to disease management of breast cancer at each of four phases of the breast cancer experience: diagnostic, postsurgery, adjuvant therapy, and ongoing recovery. A standardized Telephone Counseling Training Manual was developed. A nonprobability sample of 12 patient-partner pairs was accrued. Four pairs were randomly assigned to each of the three intervention components. A set of questionnaires was completed by each patient and partner at baseline and following each intervention for assessment of emotional, physical, and social adjustment, and perceived support. Attrition was minimal and return rate for the completed questionnaires at all five data-collection points was high. Validation of the SE and the TC, one of the objectives, was by data from the preliminary descriptive study (Hoskins, 1990-1994), pretests and posttests for standardized education, audiotapes for each phase-specific telephone counseling session, and evaluation forms for each intervention session. The positive findings included significant changes from pre-to postmeasurement in patients' and partners' scores for the standardized education in each of the four phases. Even with the limited statistical power, the effects were marked, lending support for a full-scale randomized clinical trial, to understand better the relative treatment efficacy and differential benefit of one or some interventions over others.

Abstract

Insulin-induced hypoglycemia occurs commonly in intensively treated patients with type 1 diabetes, but the cardiovascular consequences of hypoglycemia in these patients are not known. We studied left ventricular systolic [left ventricular ejection fraction (LVEF)] and diastolic [peak filling rate (PFR)] function by equilibrium radionuclide angiography during insulin infusion (12 pmol·kg-1·min-1) under either hypoglycemic (∼2.8 mmol/l) or euglycemic (∼5 mmol/l) conditions in intensively treated patients with type 1 diabetes and healthy nondiabetic subjects (n = 9 for each). During hypoglycemic hyperinsulinemia, there were significant increases in LVEF (ΔLVEF = 11 ± 2%) and PFR [ΔPFR = 0.88 ± 0.18 end diastolic volume (EDV)/s] in diabetic subjects as well as in the nondiabetic group (ΔLVEF = 13 ± 2%; ΔPFR = 0.79 ± 0.17 EDV/s). The increases in LVEF and PFR were comparable overall but occurred earlier in the nondiabetic group. A blunted increase in plasma catecholamine, cortisol, and glucagon concentrations occurred in response to hypoglycemia in the diabetic subjects. During euglycemic hyperinsulinemia, LVEF also increased in both the diabetic (ΔLVEF = 7 ± 1%) and nondiabetic (ΔLVEF = 4 ± 2%) groups, but PFR increased only in the diabetic group. In the comparison of the responses to hypoglycemic and euglycemic hyperinsulinemia, only the nondiabetic group had greater augmentation of LVEF, PFR, and cardiac output in the hypoglycemic study (P < 0.05 for each). Thus intensively treated type 1 diabetic patients demonstrate delayed augmentation of ventricular function during moderate insulin-induced hypoglycemia. Although diabetic subjects have a more pronounced cardiac response to hyperinsulinemia per se than nondiabetic subjects, their response to hypoglycemia is blunted.

Abstract

According to most experts, the U.S. faces a growing shortage of registered nurses, threatening the quality of care hospitals can provide. In the setting of nurse shortages and simultaneous concern about patient safety, nurses' job satisfaction and their assessment of quality of care become critical. This Issue Brief highlights a cross-national survey that describes nurses' perceptions of their hospital work environment, and identifies core problems in work design and workforce management in five countries.

Abstract

This study examines the concurrence of drug users' self-reports of current HIV status with serotest results. The analyses are based on data obtained from face-to-face interviews with 7,256 out-of-treatment injection drug and/or crack users in 10 sites that participated in the Cooperative Agreement for AIDS Community-Based Outreach/Intervention Research Program (funded by the U.S. National Institute on Drug Abuse). Although the degree of concurrence between HIV-negative individuals' self-reports of their current HIV status and their serotest results was high (specificity, 99%), this was not the situation for individuals who tested positive for HIV (sensitivity, 44%).

Abstract

Hospitals of all sizes should provide an orientation for their newly hired critical care nurses-but when the hospital is a rural community facility, resources for such programs may be in especially short supply. In this article, we describe how our hospital overcame staffing and funding shortages to create a successful, collaborative orientation program for its critical care nurses.

Abstract

With the advancement of the therapeutic management of the human immunodeficiency virus (HIV), changes in the manifestation and clinical presentation of the disease are also evident. Clinicians and patients are continually challenged by these changes because frequently they are the first individuals to encounter them. Thus, clinical questions raised by clinicians/practitioners can often guide the endeavor of researchers. In this summation, the authors, a research scientist and clinician, highlight the main themes of the current state of the science of diarrhea and wasting presented at the 12th Annual Association for Nurses in AIDS Care conference. The experiences of both authors will hopefully provide greater insight into the current state of diarrhea and wasting in HIV.

Abstract

A new initiative may have implications for American nursing.

Abstract

This research was designed to explore factors that affect the choice of long-term care modalities in the older population and to discuss the appropriate target population of home health care services within the entire long-term care system. The study subjects' activities of daily living limitations, cognitive status, and sociodemograhic data at the time of admission were obtained from retrospective chart reviews. The sample included 134 older subjects who were receiving long-term care from a Long-Term Home Health Care Program or a nursing home in New York City. The results indicated that Long-Term Home Health Care Program use by older persons was characterized by a higher rate of being admitted from private homes, less cognitive impairments, less limitations in activities of daily living, and younger age than older patients who were nursing home residents. Consequently, in the choice of different care modalities, health-related factors of the older population were found to be more important predictors than sociodemographic characteristics or support system. The implication to both nurses and researchers is the development of eligibility criteria that captures the unique characteristics of disabled older persons in each of the different long-term care programs to serve them better in a cost-effective manner.

Abstract

American College of Nurse-Midwives (ACNM) membership data collected from 1995-1999 offer a description of the evolution of the profession of midwifery, as shown in the characteristics of certified nurse-midwives and certified midwives, including basic demographics, practice characteristics, and employment components. During the period studied, slight increases were noted in age, number of years in practice, salary, and education level. Although the overall proportion of midwives of color did not change appreciably during the 5-year period, the absolute numbers of culturally diverse midwives increased. Student midwives were found to be younger and more culturally diverse than they were in the early 1990s. Data about midwifery practice provide valuable information to health care managers, educators, policy makers, legislators, and professional organizations, which may guide allocation of resources and reflect how members of the professions can influence access to health care for women and their families.

Abstract

Over the last decade, there has been a dramatic rise in the number of women arrested for drug offenses, and many have serious drug abuse problems. Increasingly, these women have been mandated to drug treatment, often in community-based settings. This article examines the impact of the treatment programs on the short-term posttreatment drug use of women offenders (N = 165) leaving two community-based treatment programs in Portland, Oregon. Our analyses indicate that women who abstained from drug use during the first week after treatment were more likely than those who used drugs during this time to have remained in treatment longer, received a plan to make a successful transition out of treatment, avoided associations with other drug users after leaving treatment, and obtained encouragement from individuals and groups in support of abstinence.

Abstract

Genes contributing to common forms of hypertension are largely unknown. A number of studies in humans and in animal models have revealed associations between insulin resistance, dyslipidemia, and elevated hypertension. To identify genes contributing to blood pressure (BP) variation associated with insulin-resistant dyslipidemia, we conducted a genome-wide scan for BP in a set of 18 Dutch families exhibiting the common lipid disorder familial combined hyperlipidemia. Our results reveal a locus on chromosome 4 that exhibits a significant lod score of 3.9 with systolic BP. In addition, this locus also appears to influence plasma free fatty acid levels (lod=2.4). After adjustment for age and gender, the lod score for systolic BP increased to 4.6, whereas the lod score for free fatty acid levels did not change. The chromosome 4 locus contains an attractive candidate gene, α-adducin, which has been associated with altered BP in animal studies and in some human populations. However, we found no evidence for an association between 2 intragenic α-adducin polymorphisms and systolic BP in this sample. We also observed suggestive evidence for linkage (lod=1.8) of diastolic BP to the lipoprotein lipase gene locus on chromosome 8p, supporting a finding previously observed in a separate insulin-resistant population. In addition, we also obtained suggestive evidence for linkage of systolic BP (lod=2.4) and plasma apolipoprotein B levels (lod=2.0) to a locus on proximal chromosome 19p. In conclusion, our genome scan results support the existence of multiple genetic factors that can influence both BP and plasma lipid parameters.

Abstract

This article identifies factors that differentiate HIV-negative, drug-involved women in New York City (N = 104) who communicate their HIV status to their intimate partners from those who do not. Findings indicate that HIV-negative women are more likely to reveal their status to their intimate partners if they (a) were tested more often for HIV, (b) talked with supporters about various HIV/AIDS-related issues besides their HIV status, (c) had a larger number of other supporters (in addition to intimate partners), (d) also communicated their HIV status to a larger percent of their other supporters, and (e) felt very sure they could ask their partner(s) about their partners' other sex partners. Drug treatment programs may be able to help HIV-negative women avoid contracting the virus by encouraging them to communicate with their supporters, especially their intimate partners, about their HIV status as well as HIV risk reduction practices.

Abstract

This article highlights the primary causes of HIV-related diarrhea. This article also reviews and evaluates available stool outcome measures frequently used in gastrointestinal studies examining fecal outcomes. Discussion focuses on instruments, scales, and other quantitative measures to assess stool outcomes. A discussion of the advantages and limitations of each instrument is included.

Abstract

This article describes posthospitalization visits by 83 nursing students to 57 older patients and their caregivers discharged from two large academic medical centers and one community hospital. Patient and caregiver interviews in the home focused on the areas of geriatric assessments of cognitive and functional status, patient and caregiver satisfaction with recent hospitalization, ongoing health management, patient teaching, and discharge planning.

Abstract

The past decade has witnessed pronounced changes in the organization of U.S. hospitals, many the direct result of restructuring and reengineering initiative intended to decrease costs and increase productivity. Little is known about how these initiatives have affected clinical care and patient outcomes. Using data from a variety of sources, the authors describe initiatives that hospitals undertook over this period, indicate how staffing changed relative to the case-mix of patients receiving care, and examine changes in nursing practice environments over the period from 1996 to 1998. The authors found that apparent increases in nurse-to-patient ratios may be deceiving and that increases in patient acuity and nurses' responsibilities may have increased the workload of nurses in hospitals in ways, when coupled with a deteriorating practice environment, may adversely affect patient outcomes.