Publications

Abstract

Effective HIV intervention, and its evaluation, requires close collaboration between community members and researchers. This article explores our experience as white, middle-class researchers in poor, inner city, multicultural neighborhoods. Research role demands put us at an automatic distance from our respondents, clients, and community membersources of valuable information for design and evaluation of interventions. Distance is further compounded by differences in culture, mutual stereotypes, and the history of the research enterprise in these and similar communities. Strategies for reducing distance include methods for undoing stereotypes, emphasizing research as a joint enterprise, stressing fairness, learning about the contexts within which the community functions, and assessing and addressing immediate community needs. The authors provide examples from their own experiences creating and maintaining collaborative HIV interventions and their evaluation. A discussion is included of the ways in which the researchers have been educated by the community to correct misperceptions and false expectations of what HIV work in the community would entail. The article concludes with a discussion of effective HIV prevention messages and their delivery.

Abstract

BACKGROUND: Despite the fact that the effectiveness of thrombolytic therapy for acute myocardial infarction is inversely related to the time between the onset of signs and symptoms and definitive therapy, long delays in seeking treatment have been reported consistently. A variety of reasons for the delays have been suggested. Because such delays are associated with longer hospital stays and higher mortality and morbidity, interventions that reduce delays are especially important. PURPOSE: To examine research on patients with myocardial infarction who delay seeking professional treatment and the factors related to the delay, and to review studies indicating that black patients have premonitory clinical signs and symptoms of myocardial infarction and changes in the structure and function of the cardiovascular system that are different from those in whites. METHODS: Studies were reviewed by using MEDLINE and by doing a manual search of relevant research journals in cardiovascular, nursing, and behavioral medicine published since 1970. Data published by the United States Department of Health and Human Services and the Agency for Health Care Policy and Research were also reviewed. RESULTS: Although the lengths of the delays have varied considerably, blacks have generally experienced longer delays than whites between acute onset of signs and symptoms of myocardial infarction and arrival at the emergency department. Studies show that black patients have a lower incidence of classic chest pain or discomfort but an increased incidence of dyspnea, whereas white patients are much more likely to complain of chest pain. CONCLUSION: Culturally sensitive public education about typical and atypical premonitory clinical signs and symptoms of myocardial infarction and the significance of early treatment of myocardial infarction in blacks is needed.

Abstract

The most common types of psychiatric diagnoses linked with substance abuse or dependence in women are defined and discussed. A framework is described to facilitate the nurse provider's understanding of the various relationships psychiatric symptoms can have to substance-using patterns. Guidelines are provided to assist the nurse in identifying problems of dual diagnoses and providing care to women with dual diagnoses in general care settings.

Abstract

Intraparenchymal injections of the neurotoxin 6-hydroxydopamine (6-OHDA) into the medial forebrain bundle in rats destroys the dopaminergic neurons in the pars compacta of the substantia nigra. In other transmitter systems it has been found that axotomy or neurotoxin exposure produces an initial loss of neurotransmitter phenotype, with cell death occurring over a much slower time course. To determine whether this also occurs in dopamine neurons after 6-OHDA, two approaches were utilized. First, the effect of injections of 6-OHDA into the medial forebrain bundle on nigral dopaminergic neurons was studied using combined fluorogold and immunocytochemical labeling. Four weeks after the 6-OHDA injection, there was an 85% reduction in the number of tyrosine hydroxylase (TH)-immunoreactive cells on the lesioned side. In contrast, there was only a 50% reduction in the number of fluorogold-labeled cells on the lesioned side. Second, the time course of the rescue of dopaminergic neurons after 6-OHDA by glial cell line-derived neurotrophic factor (GDNF) was determined using TH immunocytochemistry. Greater numbers of dopamine neurons were rescued 9 weeks after GDNF compared with counts made 5 weeks after GDNF. Taken together, these results suggest loss of dopaminergic phenotype is greater than cell loss following 6-OHDA injections, and that GDNF restores the phenotype of affected cells.

Abstract

Advanced practice nurses have contributed significantly to the nation's healthcare for decades by providing primary care and specialty services. Despite financial and regulatory barriers, opportunities for advanced practice nurses continue to flourish, due, in part, to the unique contributions that these nurses can make in the areas of healthcare access, quality, and cost-effectiveness. This article analyzes the role and scope of advanced practice nurses in relation to organized delivery systems. The success of these systems depends on health-needs assessment and capitated-based risk for defined populations, as well as on the development of innovative governance and health delivery models. Advanced practice nurses can contribute to each of these success factors by providing access to primary care services and specialized care to high-risk populations. To achieve success, organized delivery systems must include advanced practice nurses as providers and partners in governance structures.

Abstract

The purpose of this article is to advance the debate about whether the NP or the CNS alone should be the predominant advanced practice role in psychiatric-mental health nursing, or whether a blended advanced practice role is more appropriate for meeting the needs of services in the 21st century. We argue that a blended role is most appropriate in moving the psychiatric-mental health nursing specialty forward. The blended advanced practice role retains the excellence of our psychosocial tradition and incorporates the biological perspective of the future.

Abstract

Chronic diarrhea, common in people with HIV infection, can be both debilitating and demoralizing. But with a diet-based management strategy, you can help your patient keep it in check.

Abstract

The chief nurse officer brings the value-adding contribution of client partner to the executive management team. The nurse executive contributes professional nursing's client-centered, health-enabling approach to care delivery to assist organizations in developing new client and community services. The single most important leadership-challenge presented to nurse administrators, leaders, and managers is the ability to articulate a vision of client-centered care, demonstrate the costs and benefits of service innovations, and effectively shape organizational cultures to achieve innovations in service delivery.

Abstract

Latina women are overrepresented among AIDS cases in the United States. To assist in developing appropriate prevention and intervention programs, information regarding HIV risk behaviors is needed on the many diverse Latina subgroups. This study examined sociodemographic characteristics and HIV risk behaviors of Dominican female prostitutes, comparing those who worked primarily in brothels with those who were street workers. A total of 77 Dominican prostitutes (54 brothel; 23 street) were recruited in New York City to participate in a structured interview and were offered HIV testing. Ethnographic interviews were conducted with a subscale. Results indicated that there were many significant differences in demographics and risk behaviors between the two groups, and those working in brothels engaged in lower levels of risk behaviors. In addition, those working in brothels had closer ties to the Dominican and Spanish cultures. Implications for AIDS prevention efforts are discussed.

Abstract

Hispanic women whose sexual partners have other sexual partners may be at risk for HIV. A structured interview was administered to 106 Dominican and Puerto Rican women who reported that they knew or suspected that their partner had other partners. A subsample participated in qualitative interviews. The study assessed concern about HIV and predictors of condom use. The majority of women reported that they worried about getting HIV and almost half had been HIV-tested. Most of the women discussed HIV/AIDS concerns with their partners, and one-third reported some condom use. Predictors of condom use were: born in the Dominican Republic/Puerto Rico, having talked with their partner about being tested, and belief that he used condoms with others. Although the women were concerned about HIV, condom use was infrequent. Results suggested methods to address this discrepancy: introducing condoms early in the relationship, developing women-controlled methods, and directly influencing men's behavior.

Abstract

This paper describes policy formation and its relationship to nursing research, examining ways in which nursing's disciplinary research can have greater influence on American health care policy. The American Nurses Association's Social Policy Statement (1995) is discussed in its role as a guide for nursing research efforts in a health care reform environment where favorable patient outcomes are key.