Publications

Abstract

Nurse staffing has received a great deal of attention recently as hospitals have restructured care delivery and modified staffing mix and as nurses have expressed quality-of-care concerns. Using data from the American Hospital Association Annual Hospital Survey, a des- cription of the number of nurses working in hospitals between 1990 and 1996 is presented. Overall hospital staffing and registered nurse staffing increased between 1990 and 1996, whereas licensed practical nurse staffing declined by approximately 14% during the period. The authors identify the need for (a) detailed nurse staffing data across all levels of hospital nursing personnel to facilitate nurse staffing analyses, and (b) more reliable and valid measures of patient acuity to determine nurse staffing in relation to current patient needs. Given the current emphasis on evidence-based practice, a strong foundation is needed for decision making related to the allocation and deployment of nursing staff.

Abstract

Nurses can identify alcohol related problems in early stages of development as well as the existing problems with alcohol use through secondary prevention efforts, using observation of patient, taking history and using the screening instruments such as the CAGE, T-ACE or AUDIT. They can also counsel patients about the effects of alcohol use and about the required behavioral changes. Nurses should provide help in detecting, treating and counselling the patients in the acute phases of alcoholism, as well as during the withdrawal period and throughout some specialized healthcare procedures for alcoholics, such as Disulfiram therapy. Help can be provided by themselves, or the patients can be referred to other healthcare providers (physicians, agencies). By combining knowledge about the nature of addiction and the basic nursing knowledge, nurses can maximize the benefit of teaching, counselling and nursing care opportunities.

Abstract

This study examined prehospital delays and clinical symptoms of myocardial infarction (MI) in blacks and whites and the relationship between longer delays and types of clinical symptoms. The convenience sample included 128 patients, admitted consecutively, with acute MI. Data on types of clinical symptoms of MI and treatment-seeking behavior were collected on day 2 or 3 after admission, using face-to-face semistructured interviews. The total mean delay time differed significantly between blacks and whites (16 hours vs. 8.8 hours, p < .05). Although the frequency of chest pain was similar in both blacks and whites (78% vs. 77%), more than twice as many blacks as whites presented with symptoms of dyspnea (56% vs. 24%, p < .01) and fatigue (32% vs. 17%, p < .05). There was an interactive effect of race-ethnicity and types of symptoms on delay (p < .05) was present. Delay times for whites with chest pain were shorter than for whites without chest pain. Delay times for blacks with dyspnea were significantly shorter than for blacks without dyspnea, although delay times did not differ between whites with and without dyspnea.

Abstract

Current evidence supports the concept that oral administration of probiotic lactobacilli may be therapeutic in preventing antibiotic-associated diarrhea in children and in reestablishing normal flora in the gastrointestinal tract. Children with human immunodeficiency virus (HIV) infections may have episodes of diarrhea and frequently experience malabsorption associated with possible bacterial overgrowth; together these may interact to produce the growth abnormalities characteristic of this group. The overall objective of this investigation has been to determine whether oral administration of the probiotic Lactobacillus plantarum 299v could improve nutrient status and promote growth in children congenitally exposed to HIV. In addition, the possible beneficial effect of Lactobacillus plantarum 299v in modulating immune response was evaluated. In preliminary results described here, we report on the ability of Lactobacillus plantarum 299v to colonize children with HIV and to elicit specific systemic immune response after oral supplementation.

Abstract

Chronic heart failure patients often experience significant functional impairments. A better understanding of the biopsychosocial correlates of functional status may lead to interventions that improve quality of life in this population. Social isolation, mood disturbance, low socioeconomic status, and non-White ethnicity were evaluated as possible correlates of impaired functional status in 2,992 U.S. patients with left ventricular ejection fractions (LVEFs) ≤ 35%. Even after controlling for age and clinical characteristics, all of the psychosocial variables examined were significant predictors of risk for experiencing severe limitations in intermediate and social activities of daily living at 1 year, with adjusted odds ratios in the 1.5-2.0 range. The ability of psychosocial characteristics to predict future functional status was also independent of baseline functional status, comorbid medical conditions, and deterioration in heart failure signs and symptoms over the intervening year. These results suggest that psychosocial factors influence patient functional status even in the later phases of cardiac disease.

Abstract

Until the passage of the Balanced Budget Act of 1997, acute care nurse practitioners could not be directly reimbursed for inpatient services provided to Medicare patients. With the enactment of this legislation, acute care nurse practitioners may now be directly compensated for care provided. The historical and contextual issues that surround reimbursement for nursing and advanced practice nursing services are reviewed to serve as a foundation for understanding the current Medicare reimbursement regulations. The implications of the Balanced Budget Act of 1997 for acute care nurse practitioners and their professional colleagues are critically examined. The language of the Balanced Budget Act of 1997 and the subsequent rules and regulations issued by the Health Care Financing Administration are reviewed with specific focus on implications for acute care nurse practitioners. The opportunities for reimbursement for services provided by acute care nurse practitioners are more extensive than ever before. Acute care nurse practitioners and their physician colleagues will be wise to become fully conversant with the changes in Medicare reimbursement regulations.

Abstract

Introduction: The purpose of this research was to examine infant birth weights and high school completion rates for two cohorts of adolescent mothers attending an urban school-based program, the Polly T. McCabe Center. Results: The uncidence of low birth weight infants born to students was 4% in study I and 13.6% in study II. High school continuation/completion rates for study I were 79% at 3 years after leaving the program and 80% for study II at 1 year after leaving the program. Discussion: The young mothers and infants appear to have benefitted from the McCabe Center's intervention. Findings of the study suggest that continued implementation of supportive school-based programs similar to the McCabe Center may help prevent lower birth weight infants born to adolescent mothers and may help decrease the high school drop-out rate among this population.

Abstract

Secondary analysis, which involves the use of existing data sets to answer new research questions, is an increasingly popular methodological choice among researchers who wish to investigate particular research questions but lack the resources to undertake primary data collections. Much time loss and considerable frustration may result, however, if researchers begin secondary analyses without an awareness of the distinctive methodological and practical challenges involved. This article highlights difficulties that may arise when researchers use data from previous clinical research projects, including theoretical issues and problems involving sampling, measurement, and external and ecological validity. It also offers practical suggestions for undertaking a secondary analysis and criteria for evaluating secondary analyses.

Abstract

For patients on telemetry monitoring, knowledge is power--and comfort. This article describes how two nurses developed informational materials to help busy nurses give patients the information they need to set their minds at rest about telemetry.

Abstract

To determine why some women offenders complete prison-based drug user treatment and others leave early, clients' (N = 101) perceptions of various aspects of the quality of the treatment experience were compared. Analyses of both quantitative and qualitative data indicate that clients who completed the program had a more favorable perception of staff and felt empowered by the experience in treatment. Most of the clients who left early did so because of conflicts or disagreements with the program's rules. We discuss how a supportive approach to personal development may enhance client perceptions of program quality and increase retention rates.

Abstract

Familial combined hyperlipidemia (FCHL) is a common familial lipid disorder characterized by a variable pattern of elevated levels of plasma cholesterol and/or triglycerides. It is present in 10%-20% of patients with premature coronary heart disease. The genetic etiology of the disease, including the number of genes involved and the magnitude of their effects, is unknown. Using a subset of 35 Dutch families ascertained for FCHL, we screened the genome, with a panel of 399 genetic markers, for chromosomal regions linked to genes contributing to FCHL. The results were analyzed by use of parametric-linkage methods in a two-stage study design. Four loci, on chromosomes 2p, 11p, 16q, and 19q, exhibited suggestive evidence for linkage with FCHL (LOD scores of 1.3-2.6). Markers within each of these regions were then examined in the original sample and in additional Dutch families with FCHL. The locus on chromosome 2 failed to show evidence for linkage, and the loci on chromosome 16q and 19q yielded only equivocal or suggestive evidence for linkage. However, one locus, near marker D11S1324 on the short arm of human chromosome 11, continued to show evidence for linkage with FCHL, in the second stage of this design. This region does not contain any strong candidate genes. These results provide evidence for a candidate chromosomal region for FCHL and support the concept that FCHL is complex and heterogeneous.