Publications

Abstract

Market transformations occurring within the health care industry require new patterns of organization and management to meet the increasing complexity of service delivery. A greater understanding of the innovation and entrepreneurial dynamic allows administrators, managers, and leaders to create a new vision of service delivery. Central management and leadership objectives include the development of service technologies that capitalize upon the inherent knowledge of workers to meet consumer needs. A strong sense of innovation and entrepreneurship leading to the introduction of new or improved nursing technologies is a primary component in the evolution of professional nursing practice for the 21st century.

Abstract

PURPOSE/OBJECTIVES: To develop a pamphlet for educating patients about patient-controlled analgesia (PCA). DATA SOURCES: Journal articles and pump manufacturers' materials. DATA SYNTHESIS: This pamphlet defines PCA and describes PCA pump operation, pain assessment, medication side effects, and safety considerations. A numerical pain-assessment tool also is included. CONCLUSIONS: This pamphlet has been helpful in assisting patients to use PCA pumps effectively. IMPLICATIONS FOR NURSING PRACTICE: Nurses can use this tool to educate patients requiring PCA therapy for pain management.

Abstract

The increased use of unlicensed assistive personnel (UAP) has raised the question: "What nursing research has been conducted to evaluate the effectiveness of the UAP in relation to patient outcomes?" To answer this question, the New York State Nurses Association Council on Nursing Research conducted a literature review on the issue of UAP. The specific purposes of this article are to: (a) present an overview of the health care climate and consumer and RN reaction in relation to the UAP movement, (b) summarize reported reviews of UAP research conducted between 1988 and 1994, (c) critique and synthesize the most recent UAP nursing research conducted between 1994 and 1997, and (d) make recommendations for education, practice, and research.

Abstract

With the changing perspectives of the HIV epidemic and the introduction of protease inhibitors to treat human immunodeficiency virus (HIV) disease, the issue of compliance has gained considerable interest among health care providers. The idea that clients with HIV disease should succumb to a patriarchal system of medical care has been challenged by AIDS activists since the beginning of the epidemic. The concept that there is only one explanation for "noncompliance" is outdated. The reasons for noncompliance are multifaceted in nature and include psychosocial factors, complex medication and treatment regimens, ethnocultural concerns, and in many instances substance use. Therefore, the notion that there is one intervention to resolve noncompliance is at best archaic. Interventions to enhance compliance include supervised therapy, improving the nurse-client relationship, and patient education, all of which should be combined with ethnocultural interventions. Plans to enhance compliance must incorporate person-specific variables and should be tailored to individualized needs.

Abstract

Sixty percent of patients with human immunodeficiency virus (HIV) in the United States and 90% throughout the world will have diarrhea at some point in their illness. This article provides an introductory exploration and discussion of Western and Eastern perspectives of chronic diarrhea in patients with HIV. Western etiologies and treatment approaches, as well as Eastern views from traditional Chinese medicine pathogenesis and treatment principles involving acupuncture and moxibustion are presented. Whereas their interpretations of the causes of diarrhea are different, both the East and West have something to offer patients with this distressing symptom. Further exploration and clinical research is needed in this area.

Abstract

Although Hispanics are overrepresented in AIDS cases in the United States, little information is available to help understand differences in drug and sex risk behaviors in Hispanic subgroups, needed to develop appropriate prevention programs. This study reports on HIV-related risk behaviors in three groups of Hispanic prostitutes recruited in the United States: Dominican (77), recruited in Washington Heights, NY; Mexican (151), recruited in El Paso, TX; and Puerto Rican (48), recruited in East Harlem, NY. Ethnographic interviews were conducted with a subsample of subjects to examine cultural meaning of risk behaviors; structured interviews were conducted with subjects to describe demographic characteristics and summarize levels of risk behaviors. Results indicated that the labels Hispanic and prostitute obfuscated important differences related to geographic and cultural factors. To be effective for diverse Hispanic groups, HIV prevention efforts and interventions must be based on knowledge of these differences.

Abstract

Recent availability of VL monitoring and multiple ARVT have ushered in a new era of medical management in patients (pts) with HIV. Studies in adults have demonstrated dramatic reductions in VL following the use of newer ARVT. We analyzed our first experiences in utilizing VL monitoring in a pediatric clinical setting, to examine the effect of changing ARVT on VL in children. VL was measured by the Roche-Amplicor PCR HIV Monitor Test. Of pts 1-13 yrs who had at least one VL between 7/96 - 12/96, 6 pts had a change in ARVT 4 weeks prior to the first VL (C), 23 pts had change 4-12 weeks prior to VL (B), and 35 had ARVT change >12 weeks prior to VL (A). Mean ± SD VL (copies/ml) and CD4 index (CD4 count/ 50% for age) were compared between these 3 groups. Viral Load CD4 Index p values (for VL) A 180,760±229,530 .42±37 A v B: <.07 B 61,573±68,893 .39±.36 B v C: <.05 C 7,322±7,643 .46±.35 A v C: <.07 Fifty pts had 76 follow up VLs during the same period. One drug change (n=5) produced a mean log fall of .84, 2 drugs (n=8) -1.27, and 3 drugs (n=3) change -1.77 log fall in VL. The change to AZT+3TC or DDI (n=3) resulted in 1.09 log drop, a change to 3TC+D4T -1.37 and 2 nucleoside analogs + 1 protease inhibitor -1.43 log fall. Significantly lower VL with no change in CD4 counts were measured in HIV infected children with a recent change in ARVT. Greater troughs in VL response were seen with combination therapy changes and with the use of newer ARV drugs. VL is a useful tool to assess ARVT response in children with HIV infection.