Publications

Abstract

A view of physical restraint in older adults as ineffective, harmful, and assaultive to the dignity of the individual rather than routine and efficacious, created a paradigm shift among consumers and professionals. Studies exploring the response to restraint and interventions to help a restrained individual resolve the trauma, the assault on their personal integrity, and the loss of control, are needed. Recognition that physical restraint can be traumatic for individuals warrants an assessment of psychological responses of restrained older adults by health professionals and supports the goal of restraint reduction or elimination

Abstract

Objectives: To assess the effectiveness of an intervention for providing information and support to HIV-positive donors on changes in their sexual behavior, and to assess which donor characteristics are predictive of behavior change. Design: Subjects were randomly assigned to a structured intervention or community referral group. Follow-up assessments were conducted every 6 months. Setting: New York City, New York, USA. Participants: A cohort of 271 HIV-infected persons who donated blood to the New York Blood Center. intervention: Donors randomized to the structured intervention program met individually with a nurse for counseling and were offered a six-session support group. The program was designed to provide information, encourage safer sexual behavior and provide support. Main outcome measures: Sexual behavior, psychological distress and psychological help seeking, and immune function. Results: In both groups there was a large decrease over time in reports of unsafe sexual activity. However, more than 30% of participants in both groups reported unsafe sexual activity at the 1-year follow-up visit. Donors randomized to the structured intervention program did not report significantly more behavior change at the 1-year follow-up. Conclusions: Better programs to promote behavior change in seropositive individuals are needed.

Abstract

Risk factors for postcoital bleeding were examined in 475 women who were enrolled in a study of heterosexual transmission of human immunodeficiency virus (HIV). In bivariate analyses, history of sexually transmitted diseases (STDs; P =.03), HIV infection (P =.008), and dyspareunia or pain during intercourse (P =.0001) were significant risk factors. In multivariate analysis, the two latter factors remained significant (for HIV, odds ratio [OR] = 2.1, P =.02, 95% confidence interval [CI] = 1.1–4.0; for dyspareunia, OR = 3.5, P <.001, 95% CI = 1.8–6.6), as did the interaction term of STD history and heavy smoking (OR = 2.4, P =.02, 95% CI = 1.2–5.0). Pain during intercourse was the strongest predictor of postcoital bleeding but may be part of the same phenomenon. Similarly, because this study relied on cross-sectional data, the direction of the causal pathway linking HIV to postcoital bleeding cannot be established. However, these data suggest that smoking, a modifiable risk factor, may increase risk of postcoital bleeding and contribute to susceptibility for HIV and other STDs.

Abstract

Left ventricular (LV) function is an important predictor of morbidity and mortality after myocardial infarction (MI). Changes in LV function have been examined during the early and late phases after MI, but serial measurements of LV function during the subacute period have not been performed. To assess sequential changes in LV function during the subacute period after MI, we used quantitative two-dimensional echocardiography to examine 22 patients over a 1-year period. Twenty-one of the 22 patients had a Q-wave MI. Eleven had an anterior MI and 10 had an inferior MI; their peak creatine phosphokinase (CPK) was 1213 mlU/ml ± 14. Three weeks after acute MI, LV ejection fraction (LVEF) had increased from 45% to 52%. Seven of 19 patients showed an LVEF <43% at baseline. In five of these patients, LVEF improved, but in two patients, LVEF was still <43% in week 3. There was a significant enlargement of LV end-diastolic volume (LVEDV) (94 ml to 112 ml, p < 0.05) across the four observations but no change in LV end-systolic volume (LVESV; 54 ml to 56 ml, p = n.s.). When two groups (G1 [depressed], LVEF ≤43%; G2 [preserved], LVEF >43%) were compared, the group with depressed LVEF demonstrated a higher probability of improvement in LVEF (34% to 47%, p < 0.001) and stroke volume (38 ml to 65 ml, p < 0.01).

Abstract

Nurses recognize the increasing need to focus on primary and secondary prevention of cancer, yet the demands of current staffing prohibit many nurses from organizing and/or participating in cancer prevention and detection activities. This article describes an innovative program established at the Bronx Veterans Affairs Medical Center (VA). Funded by an American Cancer Society professional education grant, nurses at the Bronx VA formed the 'VANAC' Team (VA Nurses Against Cancer). The camaraderie of a team approach invited generalist nurses to become involved with the program. The formation and activities of the team are described. After an intensive orientation, nurses participated in a wide range of educational activities, including patient education, staff seminars, and community presentations. The logistics of arranging such a program are discussed and recommendations for future direction are offered. It is hoped that nurses in other institutions can adapt the VANAC approach to their individual settings, thereby increasing the number of nurses involved in cancer prevention.

Abstract

This study investigates the balance between the supply and demand for nurses and nurse assistive personnel in New York state. Data collected in 1992 and 1993 from three surveys of hospitals, nursing homes, and diagnostic and treatment facilities are combined, reported, and analyzed. Although there were regional differences, the mean non-New York City vacancy rate was 4% for registered nurses and 5% for licensed practical nurses. The 6-month mean turnover rate for registered nurses was 8%; however, licensed practical nurses, nurse technicians, and nurse attendants had mean turnover rates of 16% and over. Turnover rates were lowest in hospitals. Nurse anesthetists earned the highest salary, a mean of about $61,000 per year. Salaries for nurse anesthetists and other nurses varied substantially by region.

Abstract

Objective: To define the prevalence of cervical intraepithelial neoplasia (CIN), the validity of Papanicolaou tests, and the associations between CIN and risk factors for cervical disease in human immunodeficiency virus (HIV)-infected women. Methods: In this cross-sectional study, we enrolled 398 HIV-seropositive and 357 HIV-seronegative women from two HIV-AIDS clinics, two sexually transmitted disease clinics, a methadone clinic, and a clinic for participants in an HIV heterosexual transmission study. Each woman was interviewed and underwent a cytologic and colposcopic evaluation, and was tested for human papillomavirus (HPV) DNA. Results: Eighty (20%) of the 398 HIV-seropositive women compared to 15 (4%) of the 357 seronegative women had colposcopically confirmed CIN (odds ratio 5.7; P <.001). No invasive cancers were found. The sensitivity and specificity of Papanicolaou tests in seropositive women were 81 and 87%, respectively. By multiple logistic regression analysis using a model that included behavioral and biologic risk factors for CIN, CIN was independently associated with HPV infection (odds ratio 9.8), HIV infection (odds ratio 3.5), CD4+ T-lymphocyte count less than 200 cells/μL (odds ratio 2.7), and age greater than 34 years (odds ratio 2.0). Conclusions: Cervical intraepithelial neoplasia is a common finding in HIV-infected women. However, the results of this study suggest that Papanicolaou tests should be effective for detecting cervical disease in this population.

Abstract

Delirium or acute confusion increase the likelihood of physical restraint use and subsequent harmful physical and psychological effects. Assessment for delirium is presented as a conceptual framework to guide researchers, administrators, and clinicians in developing strategies to decrease the use of physical restraint and to support quality of life for hospitalized older adults.

Abstract

Attitudes about drug use, including nicotine and alcohol, shape the caregiving potential of the nurse/client relationship. Sometimes these attitudes enhance care provision; often the attitudes close doors to ways of working together. The author presents an overview of drug use, including healthcare providers' perspectives of the problem. Areas of positive interaction that can benefit patients and family are highlighted, and content essential to the client's overall wellbeing is presented for incorporation into nursing approaches.