This review provides the reader with the up-to-date evidence-based basis for prescribing exercise as medicine in the treatment of 26 different diseases: psychiatric diseases (depression, anxiety, stress, schizophrenia); neurological diseases (dementia, Parkinson's disease, multiple sclerosis); metabolic diseases (obesity, hyperlipidemia, metabolic syndrome, polycystic ovarian syndrome, type 2 diabetes, type 1 diabetes); cardiovascular diseases (hypertension, coronary heart disease, heart failure, cerebral apoplexy, and claudication intermittent); pulmonary diseases (chronic obstructive pulmonary disease, asthma, cystic fibrosis); musculo-skeletal disorders (osteoarthritis, osteoporosis, back pain, rheumatoid arthritis); and cancer. The effect of exercise therapy on disease pathogenesis and symptoms are given and the possible mechanisms of action are discussed. We have interpreted the scientific literature and for each disease, we provide the reader with our best advice regarding the optimal type and dose for prescription of exercise.

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Exercise as medicine – evidence for prescribing exercise as therapy in 26 different chronic diseases

Aim A comprehensive review of the literature was performed to describe the substantive clinical areas of clinical nurse specialist (CNS) practice. Background There is lack of understanding about the role of CNSs. Debates over blending CNS and nurse practitioner roles are common, as are questions and uncertainties about new models of advanced practice nursing endorsed by the American Association of Colleges of Nursing. To better understand the role of the CNSs and plan for new models of advanced practice nursing, it is important to know what CNSs say about the nature of their work and examine research related to CNS practice. Method The following databases were searched using the terms clinical nurse specialist or advanced nursing practice: Cumulative Index to Nursing and Allied Health Literature, Medline, PsychInfo, Academic Search Premier, ProQuest Dissertations and Theses, PapersFirst, and ProceedingsFirst. Criteria for inclusion in the sample were determined a priori. Data were extracted from each article and abstract using thematic content analysis. Findings The final sample included anecdotal articles (n = 753), research articles (n = 277), dissertation/thesis abstracts (n = 62), and abstracts from presentations (n = 181). Three substantive areas of CNS clinical practice emerged: manage the care of complex and vulnerable populations, educate and support interdisciplinary staff, and facilitate change and innovation within healthcare systems. Conclusions There is a clear conceptual basis for CNS practice, which is substantiated in the literature. Clinical nurse specialists must continue to define this scope of practice to organizations, administrators, healthcare professionals, and consumers.

Substantive areas of clinical nurse specialist practice: a comprehensive review of the literature.

Stress and burnout of nursing staff working with geriatric clients in long-term care.

Psychoeducational models have been found to be effective interventions for people with schizophrenia. However, a unifying theoretical basis for these models has not been articulated. This article explicates the sense of coherence theory developed by A. Antonovsky (1987) and demonstrates its utility as a framework for conceptualizing the basis for the effectiveness of psychoeducational programs.

Antonovsky's sense of coherence: theoretical basis of psychoeducation in schizophrenia

Purpose Nursing facilities with nurse practitioners or physician assistants (NPs or PAs) have been reported to provide better care to residents. Assuming that freestanding nursing homes in urban areas that employ these professionals are making an investment in medical infrastructure, we test the hypotheses that facilities in states with higher Medicaid rates, and those in more competitive markets and markets with higher managed care penetration, are more likely to employ NPs or PAs. Design and methods The Online Survey Certification and Reporting System (OSCAR) database, Area Resource File, and information from surveys of state policies from 1993 to 2002 are used to study the employment of NPs or PAs, using a cross-sectional time-series generalized estimating equation model with surveys nested within facilities, testing several market and state-policy effects while controlling for facility and market characteristics. Results Throughout the 1990s the proportion of nursing facilities with NPs or PAs doubled, from less than 10% to over 20%. Facilities in states in the upper quartile of Medicaid reimbursement rates were 10% more likely to employ NPs or PAs. Facilities in more competitive markets, and in markets with higher managed care penetration, were more likely to employ NPs or PAs (adjusted odds ratio = 1.27, 1.20 respectively). Implications More generous state Medicaid nursing home reimbursement and higher competition may advance the investment in medical infrastructure, which in turn may positively affect the quality of care provided to nursing home residents.

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The Employment of Nurse Practitioners and Physician Assistants in U.S. Nursing Homes

As the world's population ages, increasing numbers of people can anticipate spending their latter years in long-term care settings. Many of these nursing home residents will also present psychiatric illnesses as primary or secondary diagnoses. The resulting behavioral problems may present challenges to nursing staff that they are ill-prepared to meet. This article illustrates the application of the Blake and Mouton consultation model to a Veterans Administration (VA) nursing home situation by a team of psychiatric mental health nurse specialists. The consultation is described and interpreted in terms of the Blake and Mouton model. The focal conflicts addressed in the consultation included issues of morale/cohesion, power/authority, and norms/standards. Interventions used were acceptant, prescriptive, confrontation, and theories/principles. The model provided a useful structure for conceptualizing and organizing assessment and intervention in the consultation situation.

Mental health consultation in a nursing home.

The purposes of this paper are to describe a nursing model for psychoeducation that is being implemented in the psychiatric unit of a Veterans Administration (V.A.) Hospital and to report baseline descriptive data for 19 seriously mentally ill patients. The data were collected as part of a larger study of patient, family, and treatment variables associated with community adjustment of seriously ill psychiatric patients. A convenience sample of 19 consenting patients with DSM-III-R diagnoses of schizophrenia, schizoaffective disorder, or bipolar disorder were interviewed and assessed by a clinical nurse specialist. Nine consenting family members, identified by the patient as a key family member, were also interviewed. The baseline data reported here were generated in these interviews. These data were also used to develop psychoeducational plans to meet individual patient/family needs. The patients had had an average of 12 prior hospitalizations. Their mean age was 38 years; 74% were African-American and 89% were male. Patients reported a variety of understandings of the reason for their hospitalization and techniques for management of their symptoms. The most common ways of managing symptoms were categorized as physical activity, decreasing stimuli, and use of alcohol/drugs/smoking. Practical problems arising in association with the conduct of clinical research in a V.A. psychiatric setting by a research team are also discussed.

Tempie Evans

Papers

Mental health consultation in a nursing home.

Nursing Model of Psychoeducation for the Seriously Mentally Ill Patient