Publications

Abstract

The effects of information systems on nursing resource use are reviewed. The information systems in place in various hospitals differ in major ways; some have an impact on nursing resource use while others do not. Evidence is strong and consistent that computer systems that manage flow of information between nursing units and ancillary departments save time for nurses. The reported findings may even understate the case because workload may have increased during the period of the studies. There is also strong, but unreplicated, evidence that a work plan or electronic Kardex for each patient saves time at report. If nurses are paid for overtime, these savings can translate into cost savings for hospitals. On the other hand, systems that emphasize on-line charting and not communications do not save time. Bedside terminals are too new to have been subjected to careful research by independent investigators, but early reports, which primarily come from vendors, indicate that bedside terminals may further save time and reduce errors. More systematic research into effects of various components is needed to fully document the effect of computers on nurses' time.

Abstract

The dissolution of a marriage through divorce represents a major loss in the lives of all family members. Losses can include those of a physical, social, and emotional nature. The self as it was defined within the marital context and the loss of that self as a result of divorce is a significant source of potential dysfunction in adult family members during and after the divorce. From a family systems' perspective, the lower the level of differentiation of self in family members, the greater is the likelihood that the self was defined in a fusional way during the marriage. As such, when the fused common self is lost through divorce, one or both spouses is likely to experience a significant sense of loss as well as potential dysfunction. The purpose of this article is to propose a model that helps divorced people deal with the loss of self and assists them to define a more differentiated sense of self.

Abstract

The development of a structured psychoeducational support group model for blood donors who tested positive for human immunodeficiency virus Type I antibody is described. Salient group therapy techniques and educational content are discussed, issues of group structure are identified, and the need for support of clinicians is highlighted. 1990 American Orthopsychiatric Association

Abstract

The abortion policies in legal and social context of the United State, Canada, Great Britain and Italy are compared and contrasted. U.S. abortion policy is unique in being promulgated by the courts, rather than the legislature. The 1973 Roe v. Wade decision made the U.S. one of the 1st Western countries to liberalize abortion. U.S. law seems to be interested is protecting the life of the fetus, in contrast to other Western nations whose policies further the life of the child and support mothers and families. The U.S. has a relatively low rate of contraceptive use, because contraceptive services are not free to all in need, and furthermore are provided by medical specialists who bill at market rates. The Canadian federal abortion law of 1967 was reversed by the supreme court in 1988, leaving abortion policy up to each province. Where abortion is paid for by state funds, doctors usually add on a fee. In contrast to the U.S., contraception is subsidized and readily available. In Great Britain, the Abortion Act of 1967 permits abortion in hospitals after the woman receives permission of 2 doctors. Since 1976 it has been permitted in private clinics, but most women wait the average 3 weeks and go for the 2-day hospital stay under the National Health Service. Abortion rates are less than half those in the U.S., while contraceptive use is more than double. In Italy abortion is available through the National Health Service in 1st trimester for medical, psychological and social reasons. Most clients are married mothers aged 25-34, reflecting the lower contraceptive use rate there.

Abstract

Nurses spend an average of only 31% of their time with patients. The authors determined how nurses spend their time and suggest three ways to reduce time spent on non-essential nursing functions: delegation of some tasks to support personnel, greater use of pharmacy personnel in a decentralized setting, and greater use of computers. Together these changes may both decrease demand for nurses' time and enable professional nurses to focus their energy on tasks that require professional expertise.

Abstract

Forty-two obese subjects with non-insulin-dependent diabetes mellitus had their plasma insulin, C peptide, and glucose levels measured after an overnight fast and in response to a 75-g oral glucose loading. Subjects were then prospectively followed up with dietary treatment, and the same measurements were repeated at 1 year. Although insulin values tended to be lower with greater fasting hyperglycemia at baseline, no correlation was observed among three parameters. However, near-normalization of glycemia (measured as the level of hemoglobin A1) was associated with significantly higher fasting and stimulated plasma insulin concentrations. Sixteen subjects were matched to each other for equivalent baseline hyperglycemia (by glycosylated hemoglobin) and divided into group 1 (normalization of the hemoglobin A1 value to 7.0% ± 0.3% [mean ± SE]) and group 2 (persistent hyperglycemia) (hemoglobin A1 value, 10.7% ± 0.7% [mean ± SE]). Before dietary therapy, the plasma insulin concentrations were twofold to threefold higher in group 1, and despite similar degrees of weight loss, group 2 failed to demonstrate improved glycemia. We concluded that the outcome of diet therapy for non-insulin-dependent diabetes mellitus is dependent on the duration of diabetes and endogenous insulin secretory reserve. There is a subgroup of patients with non-insulin-dependent diabetes mellitus in whom delayed dietary intervention may have a beneficial effect.

Abstract

Studies of delirium in general medical populations have used criteria for delirium different from current DSM-III or DSM-IIIR criteria of the American Psychiatric Association, or have used DSM-III or DSM-IIIR criteria without operationalizing the components of these criteria. Therefore this prospective study was conducted to establish an approach to operationalizing DSM-III criteria and to determine the incidence and prevalence of delirium. Two hundred thirty-five consecutive subjects age 70 and over admitted to general medicine underwent daily standardized screening. Patients with low scores on screening tests or clinical evidence suggestive of any psychiatric disorder and controls were seen by a psychiatrist, who determined whether delirium was present by applying explicit operational definitions to each component of the DSM-III criteria for delirium. We conclude that the syndrome of delirium as defined by the American Psychiatric Association is prevalent on admission among elderly on general medical services, but the number of cases developing in the hospital is much less than often stated in the literature.

Abstract

A comparative anthropometric assessment involving 2175 measurements of 1533 children under the age of 5 was carried out in Malawi, both before and after the harvest seasons (February and May, 1985). Subjects were randomly drawn from socioeconomically similar rural environments within and outside a large-scale agricultural development project. Chronic malnutrition (height for age less than 90 per cent of the median) was found to be 36 per cent in February and 41 per cent in May. The prevalence of acute malnutrition (weight for height less than 80 per cent of the median) was 4 per cent and 5 per cent, respectively. Tests of significance found no statistical difference between the project and non-project children for a variety of nutritional status indices. It is postulated that such factors as increased female access to extension services and male access to nutrition education may have greater impact on morbidity than income increases alone, and should be part of agricultural development planning.

Abstract

The use of the human immunodeficiency virus (HIV) antibody test for women of childbearing age is discussed. Serological tests used to determine HIV status are reviewed. Practitioners should be aware of the legal and ethical issues involved in testing. Psychological responses to knowledge of test results are considered. The goal of the counseling session is to provide sufficient information for the woman to make an informed decision about reproductive choices. The format and content of pre- and post-test sessions are outlined, and checklists that may assist the practitioner in post-test counseling appear in the Appendixes.