Publications

Abstract

Research findings have changed reproductive decisions for HIV-infected women in their childbearing years. A variety of studies in the United States place the risk of vertical transmission (from mother to fetus) at between thirteen and thirty percent. Recent results of the AIDS Clinical Trial Group (ACTG) 076 protocol have found that zidovudine (ZDV; AZT) had a significant inhibitory affect on HIV transmission from mother to fetus. The Centers for Disease Control and Prevention (CDC) recommends that all women, especially those who are pregnant, be given the opportunity to learn of their HIV infection status through voluntary HIV testing and counseling. This article briefly reviews these issues and other factors that HIV-infected women may consider when making reproductive decisions and HIV-related treatment choices once pregnancy is underway.

Abstract

This article examines issues of implementing nursing information computer systems in 17 hospitals in New Jersey and the initial effects of such systems as perceived by users. Unlike previous studies that examined the effects of one system in one hospital, this study examines the effects of several major systems in a variety of settings. Many of the hospitals experienced major delays or other problems with implementation; the hospitals in which timely implementation occurred were the ones that had purchased a commercially available stand-alone nursing system and did not try to develop interfaces or do extensive development. While these hospitals did meet with difficulties and needed some software customization, the problems were not so severe as to impede timely implementation. On the other hand, most of the hospitals that had major delays had planned more ambitious projects. These hospitals either required development work with vendors or were implementing a nursing information system while simultaneously putting in place a hospital system. Initial staff impressions of the effects of the system were positive; nursing department staffs reported that they liked the nursing systems. They said that documentation was better (more readable, complete, and timely) and they also believed that care was improved because the computer prompted nurses on what to look for and what to do. Support for these systems from hospital administration, outside of nursing, was cautious and based primarily on cost/benefit results.

Abstract

Facilitating family visits in critical care settings is a challenging nursing responsibility. Before family members are in a position to be supportive of patients, they must deal with stressful aspects of the ICU environment. A model of the stages in family visits derived from a clinical field study is described. This model provides a framework for assessment and intervention strategies to facilitate patient-family contact in critical care.

Abstract

This paper outlines strategies for all nurses to participate in nursing's research agenda, which aims to enhance the scientific basis of nursing practice. The emphasis here is on generating data for the outcomes movement as a tool for transforming the American health care delivery system.

Abstract

This article introduces and defines the concept of primary mental health care, a model for the delivery of community-based, comprehensive psychiatric-mental health nurs ing care. The primary mental health care model incorporates professional role re sponsibilities, role functions, and intervention activities for psychiatric-mental health nurses at the basic and advanced levels of practice. Use of this model will enable psychiatric nurses to articulate a nursing perspective about primary mental health care to colleagues, to policymakers, and to consumers. (J Am PSYCHIATR NURSES Assoc [1995]. 1, 154-163)

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

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.