Showing papers in "Journal of Nursing Scholarship in 1999"

Defining and measuring fatigue.

Abstract: In response to a long history of problems with defining and measuring fatigue, the University of Kansas School of Nursing established a Center for Biobehavioral Studies of Fatigue Management to facilitate the study of fatigue in diverse populations. The purpose of this article is to review past efforts to define and measure fatigue and the conceptual problems relevant to currently used measures of fatigue. Several distinct characteristics and corresponding measures of fatigue are identified and a definition and framework for the study of fatigue are discussed. Future research on fatigue must attend to the conceptual distinctions among various measures and the measures of fatigue most appropriate to the goals of a study.

A Model for Change to Evidence-Based Practice

Abstract: Purpose: To describe a model that guides nurses and other healthcare professionals through a systematic process for the change to evidence-based practice. The tremendous increases in clinical research and accessibility to research findings have prepared the way for the paradigm shift from traditional and intuition-driven practice to evidence-based practice. Although several models have emerged to guide practitioners in research utilization, practitioners continue to have difficulty synthesizing empirical and contextual evidence and integrating evidence-based changes into practice. Organizing Framework: The model is based on theoretical and research literature related to evidence-based practice, research utilization, standardized language, and change theory. In this model, practitioners are guided through the entire process of developing and integrating an evidence-based practice change. The model supports evidence-based practice changes derived from a combination of quantitative and qualitative data, clinical expertise, and contextual evidence. Methods: The model was developed using sources identified on searches of Medline, CINAHL, and systematic reviews available on the Internet. Review topics were focused on evidence-based medicine and nursing, research utilization, and change process. Other sources included clinical expertise and quality-improvement information. Conclusions: Practitioners need skills and resources to appraise, synthesize, and diffuse the best evidence into practice. Patient outcomes must reflect discipline-specific and interdisciplinary accountabilities. Collaboration between researchers and practitioners within and among disciplines will enhance the diffusion of evidence-based practice innovations.

Clarification and integration of similar quality of life concepts.

Abstract: Purpose: To identify major problems that obscure understanding of quality of life; to differentiate quality of life from other closely related concepts, and to offer a definition of quality of life. Quality of life is a term frequently used, but seldom defined, in nursing research. Multiple interpretations and measures make evaluating research difficult. The need to clarify concepts, develop nursing theory, and enhance communication is significant. Concept clarification is also essential for research instrument development and evaluation. Organizing Construct and Scope: Concept analysis as proposed by Walker and Avant. Preconceived theories were avoided to keep the analysis as unbiased as possible. The analyst considered many descriptions of quality of life, but eventually included only those in the scientific literature. Sources: CINAHL, Medline, Psych-Info, ERIC, Social Science Abstracts, and reference lists from published articles in nursing, medicine, psychology, and sociology were used. Twenty-seven theory-based articles and book chapters published since 1989 and a convenience sample of 88 research articles published in 1997 were used. This sample was selected from 16,480 articles published 1993 to 1998. Methods: Concept clarification comparisons to identify the major attributes of several closely related concepts, including well-being, satisfaction with life, and functional status. Major attributes were validated by a panel of cohorts who met weekly for five consecutive weeks for the purpose of analyzing various concepts. Findings: Quality of life is comprised of subjective indicators such as well-being and satisfaction with life and objective indicators, such as functional status. Continued dialog and research is necessary to distinguish between the concepts of health and quality of life. Conclusions: A model showing the relationships among quality of life, well-being, functional status, and satisfaction with life is provided and a definition of quality of life is offered. Researchers and authors should include the definition of quality of life used in their work. Instruments should reflect the theoretic definition used. Care should be taken to clarify if functional status, well-being, satisfaction with life are the concepts under consideration as reflecting a part of overall quality of life.

Clarifying the Concept of Normalization

Abstract: Purpose: To refine and develop the concept of normalization. While firsthand accounts, clinical observation, and numerous studies suggest that parents of children with chronic conditions often strive to lead a normal family life, the distinguishing characteristics of normalization need to be understood before evaluating the feasibility and consequences. Conceptualizing these efforts as normalization, researchers have identified cognitive and behavioral strategies used by parents to normalize family life. Sources: A total of 33 articles representing 14 studies were selected through computer-assisted searches of the topic from 1966-1997, hand searches of nursing journals from 1970-1997, and analysis of reference lists. Key words in the searches included: adaptation, psychological; chronic disease; disabled persons; family; child; adolescence; parent-child relations; models, psychological; and nursing theory. Articles (N= 19) that applied and expanded the concept comprised the sample used in the analysis. A normalization construct was used. Methods: Attributes for normalization were inductively derived based on the most recent methods for refining and developing concepts, with special attention to how family and illness affect manifestations of normalization. Findings: The attributes identified in 1986 remained relevant, but required revision and expansion to reflect a contemporary understanding of normalization. Unique manifestations of normalization were identified within certain illness and family contexts. Conclusions: Knowledge synthesized from previous studies can enhance how normalization is used in future qualitative and quantitative research and in theory development. Findings indicate the need for researchers to build on the current state of knowledge and continue to further develop the concept. Understanding the findings can also sensitize clinicians to the complex process of normalizing when a child has a chronic condition.

Ethical and Methodologic Benefits of Using a Reflexive Journal in Hermeneutic‐Phenomenologic Research

Abstract: Purpose: To illustrate the importance of considering the researcher's written reflections on the qualitative research process as a valuable source of data and as a means of enhancing ethical and methodologic rigour. Organizing Construct: Excerpts from the researcher's reflexive journal are presented as evidence of an audit trail. Ethical and methodologic concerns arising during the research process are outlined and the value of reflecting on these issues is addressed. Methods: A hermeneutic-phenomenologic study, conducted in Scotland, included in-depth interviews with six problem drinkers to explore the lived experience of their suffering. The researcher was considered to be a primary data-collection tool, whose reflections on the research process added to the contextual richness of the study. For an interpretative approach to data analysis, the researcher found metaphors to convey the participants' stories to a new audience. This intuitive, creative process was analysed and reported in the reflexive journal. Conclusions: The researcher's self-awareness, fostered by the use of a reflexive journal, is mirrored by the participants' ability to reflect on the final interpretation of their stories and on the therapeutic benefits of the research process. The researcher's reflexive journal reveals previously hidden contextual information which enhances the prime ethical and methodologic aim of the study—to understand the lived experience of suffering by problem drinkers.

Persistence of self in advanced Alzheimer's disease.

Abstract: The theme of diminishing self is common in the popular and health care literature about the late stages of Alzheimer’s disease. In her narrative on the experience of having Alzheimer’s disease, Diana Friel McGowin wrote, there is “less and less of me every day” (1993, p. 33). Spouses say this is not the man or woman I married, or they describe the person as just a shell of what he or she once was (Jenkins & Price, 1996). Nursing home staff appear to believe the same thing, frequently avoiding all but task-oriented communication with people in the latest stages of the disease (Ekman, Norberg, Viitanen, & Winblad, 1991) on the assumption that the severely demented experience life as meaningless (Norberg & Asplund, 1990). Similar assumptions are found in the health care literature (Downs, 1997). A person’s attempts at speech in the later stages have been described as nonsensical and devoid of meaning or insight, contributing to the impression of a diminishing self (Bohling, 1991). Also noted is the lack of “reference to the speaker as ego” (Kertesz, 1994) leaving the same impression. The consciousness of the individual is described as gradually fading away (Lyman, 1989) or becoming “a continuously fading dream,” (Bayles, 1995, p. 362). The progressive decline associated with this disease is well known. Lyman (1989) used the term “self-deterioration” to characterize it and Cohen (1991) wrote of the death of the mind before physical death. Ronch (1996) adds, “The loss of self happens before the very eyes of the person whose self is vanishing.” (p. 25). In the last of the six phases of the subjective experience of Alzheimer’s disease proposed by Cohen, separation from self is said to occur. Humanness and a personal, subjective experience of the disease are maintained until this last stage in which the person is described as reacting only to sensory stimuli.

Depression, social support, and quality of life in older adults with osteoarthritis.

Abstract: Purpose: To develop an understanding of the quality of life of older adults with osteoarthritis (OA) with varying levels of depression and social supportas a basis for nursing interventions. Osteoarthritis in the United States is the number one chronic disease in late life and the major cause of disability in older adults. In addition to the functional disability and economic effect of OA, older people with this disease experience suffering, depression, and diminished quality of life. Design: For this cross-sectional survey, a convenience sample of 50 older adults with OA was recruited from two U.S. hospital-based arthritis clinics in northern Ohio for 3-months during 1995. Methods: During face-to-face interviews, the Arthritis Impact Scales, Center for Epidemiological Studies Depression Scale, Social Support Questionnaire, and Quality of Life Survey, were used to measure osteoarthritis severity, depression, informal social support, and quality of life. Findings: Although few formal social support services were used, high levels of satisfaction from the subjects' large informal networks of family and friends were reported. In addition, satisfaction with subjects' quality of life was extremely high despite depression, co-morbid conditions, pain, and functional limitation. Conclusions: Social support appeared to play an important role in moderating the effects of pain, functional limitation, and depression on these subjects' quality of life. Nurses who work with older adults are in a unique position to help them adjust to living with osteoarthritis by providing them the support needed to help them manage their disease.

Effects of home care on caregivers' psychosocial status.

Abstract: Purpose: To examine changes in the psychosocial status of caregivers of post-surgical patients with cancer, and how their status was affected by (a) whether caregivers had physical problems of their own, and (b) whether the patient received a home care intervention. Many studies in this area to date have not included sufficient measurement points to identify fluctuations in psychosocial status over time. In addition, many have used caregiver health as an outcome rather than a predictor. Design: Longitudinal, randomized trial using a sample of 161 caregivers of cancer patients being treated at one large university hospital in the northeastern United States, 1993-1996. Half the patients were randomly assigned to receive a standardized home-care nursing intervention. The population of interest was caregivers of patients who were (a) diagnosed with a solid-tumor cancer within the past 2 months, (b) age 60 or older, (c) hospitalized for surgical treatment of the cancer and expected to live at least 6 months, and (d) had a complex problem at hospital discharge. All caregivers were living with the patient at time of discharge. Methods: Data were collected in structured interviews administered at the time of the patients' discharge and approximately 3 and 6 months later. Psychosocial status was measured using the Caregiver Reaction Assessment and the CES-Depression scale. A repeated-measures analysis of variance was performed for each psychosocial measure, using as factors Time (i.e., interview 1, 2, or 3), Group (treatment and control), and Caregiver Physical Problem. Findings: Overall, psychosocial status improved from baseline to 3 months, and was about the same at 6 months. Among caregivers with physical problems, the psychosocial status of those in the treatment group declined compared to those in the control groups in the 3 months after discharge; an opposite pattern was observed in the following 3 months. Conclusions: People who are caregivers for cancer patients and have physical problems of their own are at risk for psychologic morbidity, which may have a delayed onset. This delay may reflect the replacement of an initial optimism with discouragement as the reality of long-term illness sets in. Home care may create a situation in which caregivers are required to confront the realities of long-term caregiving quickly, cutting short their initial optimism, but also preparing them for what is to come.

A Situation-Specific Theory of Korean Immigrant Women's Menopausal Transition

Abstract: Purpose: To extend the previous model of transitions by including the experiences of low-income Korean immigrant women in the United States during their menopausal transition. The extension results in a situation-specific theory of Korean immigrant women’s menopausal transition.

A classification scheme for outcome indicators.

Abstract: Purpose: To provide a framework for classifying outcome indicators for a more comprehensive view of outcomes and quality. Methods: Review of outcomes literature published since 1974 from medicine, nursing, and health services research to identify indicators. Outcome indicators were clustered inductively. Findings: Three groups of outcome indicators were identified: patient-focused, provider-focused, and organization-focused. Although investigators tend to focus on a select few outcome indicators, such as patient satisfaction, quality of life, and mortality, many indicators exist to measure outcomes. Conclusions: Selecting and integrating a wide array of outcome indicators from the various categories will provide a more balanced view of health care delivery as compared with focusing on a few common indicators or only one category.

The rhythm of relating in a paradigm of wholeness.

Abstract: The importance of relating to the rhythm of another person's interactive pattern is integral to helping people move through illness and disruptive events. At times of chaos, a person's rhythm may be irregular and difficult to sense, but transformation to higher levels of organization often occurs at far-from-equilibrium states. Nurses should develop a tolerance for ambiguity and uncertainty and "hang in there" with clients until a new rhythm emerges.

Sleep patterns of sheltered battered women.

Abstract: Purpose: To describe sheltered battered women's sleep patterns and resulting daytime fatigue. The model for symptom management framed this study to describe one component of the model—symptom experience. Beginning evidence suggests that sheltered battered women experience disturbed sleep and fatigue that can interfere with vital activities. Design: Descriptive using a convenience sample of 50 ethnically diverse women residing at least 21 days in battered women's shelters located in one western U.S. city. The study was done in 1997. Methods: The Pittsburgh Sleep Quality Index (PSQI), the Mini Motionlogger Actigraph, a sleep diary, the Visual Analogue Scale for Fatigue, and an open-ended interview were used to collect data. Descriptive and inferential statistics were used to analyze the quantitative data. Qualitative data were analyzed to determine patterns and themes. Findings: Seventy percent of the women had global PSQI scores of greater than five indicating poor sleep and 17 (34%) had a sleep efficiency index of 80% or less. Fourteen (28%) of the women went to bed very fatigued (>66 mm) and 20 (40%) woke up very fatigued (>33mm). Conclusions: The majority of sheltered battered women experienced disturbed sleep and daytime fatigue. Both personal and environmental variables were found to significantly affect sleep patterns. Sheltered battered women can benefit from information about sleep disturbances and sleep enhancing self-care strategies.

Research- based Practice with Women Who Have Had Miscarriages

Abstract: Design: The research program included three phases: interpretive theory generation, descriptive survey and instrument development, and experimental testing of a theory-based intervention. Methods: Research methods included interpretive phenomenologE factor analysis, and ANCOVA. Findings: A theory of caring and a model of what it is like to miscarry were generated, refined, and tested. A case study shows one woman’s response to miscarrying and illustrates clinical application of the caring theory. Conclusions: The Miscarriage Model is a useful framework for anticipating the variety of responses women have to miscarrying. The caring theory is an effective and sensitive guide to clinical practice with women who miscarry.

Religious faith in Mexican-American families dealing with chronic childhood illness.

Abstract: Purpose: To explore Mexican-American family experiences with chronic childhood illness, from the perspective of parents, and report findings about the influence of religious faith on families' spiritual and secular responses to illness. Mexican-Americans are often characterized as religious, fatalistic, and passive, but families' perceptions of the consequences of their daily faith and its meaning in the face of chronic childhood illness is not well understood. Design: Descriptive. The sample included 25 parents from 19 families living with children with a variety of chronic conditions. Data were collected in 1995–1996. Methods: Interpretive, using symbolic interaction as the framework, and in-depth interviewing for data collection. Findings: Parents professed a variety of beliefs and devotional practices. Six unifying dimensions of religious faith were related to parental caretaking and decision making for the family: (a) God determined the outcome of the child's illness, (b) God and health care for the child were closely linked, (c) parents took an active role in facilitating God's will, (d) families had obligations to God, (e) intercession with God by others was often sought by or offered to the family, and (f) faith encouraged optimism. Conclusions: Families were not fatalistic in the sense of feeling outcomes were predetermined and unalterable. Family members took spiritual and secular actions to assure the best possible familial and professional care for their child and sought to influence God's good will on behalf of the child and family.

Lucian Leape on the Causes and Prevention of Errors and Adverse Events in Health Care

Abstract: In December 1998, I interviewed Lucian L. Leape, MD, a health policy analyst at the Harvard School of Public Health whose research has been focused on identifying and preventing errors in health care. As one of the major contributors to the application of scientific methods to identify and analyze errors, few are better suited to offer insights on a topic that is beginning to have a profound effect on improving health care.

Comfort in labor and midwifery art.

Abstract: Purpose: To examine the phenomenon of comfort in the context of childbirth. Enhancement of comfort for laboring women is a valued outcome of nursing and midwifery care. Interventions that increase comfort during labor support a woman’s effort to participate more fully in the birth thereby keeping her more aware of her bodF emotions, and experience. Organizing construct: The concept of comfort is analyzed and defined in the context of laboring women. Comfort studied from a feminist perspective is suggested. Sources: A literature review of nursing, midwifery, and medical texts from the 7 920s to 1998 provides information about labor, pain in labor, and goals of providers caring for laboring women. Research articles focusing on comfort are identified as they relate to the concept of comfort in labor. Writings of contemporary feminist authors provided the ideas for designing the study of comfort from a feminist perspective. Methods: To develop a theory of comfort during labor, early nursing and midwifery texts were searched to identify goals of care. The meaning of comfort was analyzed from the early 7920s to the present by concept analysis. Validation of findings was sought from publications on comfort research. Findings: Comfort can exist in spite of great pain and nurses and midwives may be able to assist laboring women to achieve a level of comfort during labor. Intervening to promote the comfort of faboring women can empower these women during birthing. Conclusions: For clinicians caring for birthing women, particularly midwives, promotion of comfort is a high priority. Increasing comfort can redefine the meaning of pain in childbirth. Increasing comfort may create a decreased need for medical interventions and lower costs. IMAGE: JOURNAL OF NURSING SCHOLARSHIP, 1999; 31 :1, 77-81.01 999 SIGMA THETA TAU INTERNATIONAL.

Maintaining an Adequate Supply of RNs in California

Abstract: Purpose: Over the past 2 years, concerns have arisen about the adequacy of the supply of RNs in California and the rest of the United States. Nurse leaders have called upon the California State Legislature to respond to concerns by increasing funding for RN education at public colleges and universities. Design: Descriptive—to ascertain whether California faces a shortage of RNs and whether greater state government funding of RN educational programs is necessary to alleviate such a shortage. Secondary data from several sources were analyzed. Methods: Cross-sectional analysis of data from the 1996 National Sample Survey of Registered Nurses concerning California RNs' demographic characteristics and employment patterns was conducted. Longitudinal analysis of data was examined for trends in California's population, utilization of RNs, and graduations from RN education programs. Findings: Approximately 230,000 RNs lived in and were licensed to practice in California; 77% of California RNs were employed in nursing (70% working full-time; 30% part-time). Only a small number of California RNs were not currently working in nursing but were likely to enter the labor market. Most RNs who were not working were older retired women. Conclusions: A large increase in the RN workforce is needed to keep pace with the rapid growth of California's population. For California to maintain a stable ratio of RNs to population, we estimated an additional 43,000 RNs will be needed by 2010, and an additional 74,000 will be needed by 2020. Educators, employers, and state policymakers should implement concerted and coordinated efforts to avert a shortage. The magnitude of the impending shortage of RNs in California is too large for the RN labor market to resolve. State government should provide additional resources for basic RN education programs.

A model for cognitive-behavioral interventions in cancer pain management.

Abstract: Purpose: To propose a model for predicting success with cognitive-behavioral interventions in cancer pain management. Practice guidelines are useful, however nurses currently have little theoretic or empiric basis for choosing one particular strategy over another. Moreover, nurses have no way of knowing if a particular intervention is likely to work. Organizing construct: The model indicates characteristics of a person in relation to interventions including skill and ability, outcome expectancies, perceived credibility, history of use, preferred coping style, and pain outcomes. Sources: The model was developed using sources identified through a literature search of relevant topics in MEDLINE, CINAHL, and Psychlit (1996-1997), as well as through clinical experience. Conclusions: Continued empiric testing of the model is necessary to confirm proposed relationships and to assess accuracy of the model's predictions with various cognitive-behavioral interventions. With this testing, the model can help nurses select appropriate interventions for individual patients.

Mothers' Responses to Care Given by Male Nursing Students during and after Birth

Abstract: Purpose: To describe the rationale maternity patients use in determining whether to accept care by a male student nurse. Information about the activities that women are comfortable having male nursing students perform is inconsistent and the reasons for women's comfort or discomfort are unclear. Furthermore, little is known about what factors patients consider when assigned a male nursing student. Yet, knowledge of such factors can enhance understanding and guide the selection of students in maternity units. Design: Focused ethnography using a purposive convenience sample of 32 women, aged 20 to 40 years, who spoke English, and who had given birth to normal newborns in one small community hospital in the mid-Atlantic region of the United States. Patients were excluded if they or their infants were in an unstable physical or mental condition. The study was conducted in 1995. Methods: The women were interviewed using a semi-structured format. Findings: Data from participants pertained to personal and contextual factors. Personal factors were perception of postpartum self and personal feelings. Contextual factors were student characteristics, establishment of relationships, nursing care activities, and partner viewpoint. Conclusions: Women during and after giving birth have definite thoughts about male student nurses caring for them. Nurse educators should consider these when assigning men. Educators should encourage professionalism and competence in their students.

Experiencing Control in Caregiving

Abstract: Purpose: To describe the experience of control as perceived by family caregivers who care for relatives with dementia to determine how caregivers manage care at home. The ability to manage care effectively at home is important because of the rise in the number of family caregivers. Design: Descriptive using secondary analysis of qualitative data. The sample was 21 family caregivers of relatives with dementia, 4 men and 17 women, from one medium-sized city in Canada. Methods: Grounded-theory methods were used for the secondary analysis of data completed in 1997 from a previous 1995 study of caregivers. Results: The experience of control was related to how caregivers managed or coped with their caregiving situations. The dimensions of control were characterized as either “maintaining control” or as “lacking control” with each dimension relating to caregivers' beliefs about caregiving. Conclusions: Results of this study can help nurses intervene more effectively with family caregivers by recognizing how caregivers manage and whether they need assistance to continue to provide care. The proposed model is a starting point for further research on control and coping; it also provides direction for practice.

Women dwelling with violence.

Abstract: Purpose: To explore the Heideggerian concept of dwelling as revealed in the lives of women who have experienced sexual violence. Sexual violence against women by men known to them is a significant health problem, yet little is known about how such violence affects women's everyday experience. Methods: Phenomenologic, integrating (a) data collected in 1996 and 1997 from 10 American women who had experienced sexual violence, (b) Heideggerian philosophy, (c) other literature, and (d) excerpts from the communications media. In-depth, open-ended interviews with women, followed by analysis of transcripts using Heideggerian hermeneutics. Findings: Women “dwelling with violence” were living among and inseparable from violence, abuse, and maltreatment. Violence resulted in their “living-in-exile”—feeling uprooted, unsettled, unprotected, and distrustful. Yet their stories were about “preserving and sparing amidst violence”—caring for things they value, creating a safe place for themselves, guarding that which is essential to their nature, and seeking to protect others. Conclusions: Sexual violence can profoundly affect the lives of women. Women's narratives indicate complex and creative responses to living in a violent environment. Nurses who seek to understand the effects of violence on a woman's daily life should focus not only on symptomatic responses to a single violent event, but also should consider her life history, the social context of her daily experiences, the degree to which violence has alienated her from others, and her unique way of responding to violence.

Physicians' neonatal resuscitation of extremely low-birth-weight preterm infants.

Abstract: Purpose: To examine the perceptions of physicians who make delivery room decisions to resuscitate extremely low-birth-weight (ELBW) neonates at marginal viability Nurses, parents, economists, and ethicists have questioned resuscitation of ELBW neonates, many of whom experience high levels of morbidity and mortality Yet no systematic studies were found that addressed physicians' perceptions and delivery room decisions Design: Descriptive, using naturalistic inquiry A national US convenience sample was obtained in 1996-1997 of 54 physicians in five perinatal subspecialties who resuscitated ELBW neonates Methods: Tape-recorded and transcribed interviews were analyzed using NUD* IST software and line-by-line constant comparison Findings: Despite awareness of the high morbidity and mortality, 96% of the physicians offered resuscitation to all ELBW neonates in the delivery room The main factors affecting their decisions were “the role of physician;” having been “trained to save lives;” the belief that “if called, I resuscitate;” the inability to determine gestational age; requests from parents to “do everything;” and the need to move from a “chaotic” delivery room to a controlled neonatal intensive care unit Six major themes were: role expectation, uncertainty, awareness, internal and external forces, burden, and continuing quandaries Physicians were burdened by the devastated and dying babies, by their inability to predict which neonates had a chance for intact survival, and by conflicts with colleagues about viability Statistical probability of survival, legal constraints, and cost of care did not appear to affect greatly their decisions Physicians asked that society and national policy makers set parameters for resuscitation Conclusions: The American Academy of Pediatrics' Neonatal Resuscitation Protocol needs revision to delineate the ethical criteria for resuscitation Early prenatal education for families which clearly teaches the margins of viability and outcomes of early deliveries is also recommended Physicians must be supported in changing the recessitation paradigm

Slow growth in the United States of the number of minorities in the RN workforce.

Abstract: Purpose: To assess the extent to which the number of minority RNs has grown during the past 20 years, and to identify and compare key trends in personal and professional characteristics among minority groups and between minority and majority populations of RNs. Nursing education programs, employers, philanthropic organizations, and governments have expended considerable effort and resources to increase the number of minorities in nursing. Design: Longitudinal analysis of trends in the number, education, employment, and earnings of minority RNs from 1977 to 1997. Methods: Descriptive analysis of data from the U.S. National Sample Surveys of the Population of Registered Nurses, 1977-1996; and data from the U.S. Bureau of the Census Current Population Survey (CPS) Outgoing Rotation Croup Annual Merged Files, 1977-1997. Findings: In the past 20 years, the number of minority RNs has grown from 87,386 (or 6.3% of the total supply of RNs) in 1977 to 246,364 RNs (9.7%) in 1996. The number of Black (nonHispanic), Asian Pacific/Islanders, and American Indian/Alaskan Native nurses nearly tripled in this period while the number of Hispanics doubled. Although these rates of growth are impressive, the percentage of minorities in nursing lags considerably behind the percentage (18.3%) who are teachers, and the percentage (28.2%) in the U.S. population. Conclusions: Studies are needed to determine the barriers that exist in nursing education programs, health care organizations, and society in general that deter minorities from a nursing career. Without this understanding, efforts to design and implement ideas to attract, educate, and retain minorities in nursing education and later in the workplace are hampered.

Adults seeking presymptomatic gene testing for Huntington disease.

Abstract: Purpose: To describe the expectations of those seeking presymptomatic gene testing for Huntington disease (HD). Identification of the gene for HD makes it possible to conduct testing to determine if a healthy person with a family history of HD has a mutation in this gene. Presymptomatic gene testing reveals the likelihood that a person will develop an inherited disease in the future. Understanding expectations allows for more complete assessment and counseling before presymptomatic gene testing for genetic diseases. Design: Descriptive qualitative. The population was people with a family history of HD. The sample was 17 asymptomatic adults with a positive family history of HD who requested presymptomatic gene identification atone tertiary genetic counseling program, 1995 to 1996. Methods: Semi-structured interviews concerning expectations of adults seeking presymptomatic genetic testing were conducted by telephone. Interviews occurred after the individuals had requested presymptomatic gene identification but before results were reported. Content analysis was used to identify the expectations and questions of those who had decided to seek presymptomatic testing. Findings: Common expectations included anticipating relief from uncertainty, hoping to plan for their future health care and life decisions, wanting to know if their children were at risk of developing HD, anticipating loss of family support from relatives, expecting relief from self monitoring, venturing into the unknown, and planning for disclosure. Participants attempted to avoid their loss of genetic privacy by withholding the decision to seek testing from their primary care providers. Conclusions: Participants seeking presymptomatic HD gene testing consider the effect of gene identification on themselves and their families. A desire to limit insurance or employment discrimination contributes to subjects not seeking input from health care providers in their decision making.

Ethnomethodologic Analysis of Accounts of Feeding Demented Residents in Long‐Term Care

Abstract: Purpose: To describe the self-organizing activities and the unspoken knowledge that nursing assistants employ in performing the work of feeding as a routine part of their activities. In U.S. long-term care facilities, activities related to medical and nursing care are frequently based on the ability of nursing assistants to successfully accomplish the work of feeding. Nurses are not always aware of the difficulties involved in feeding nor the means by which food is offered and intake calculated. Design: Qualitative phenomenologic. Methods: Observations were conducted during 12 weekday mealtimes, October and November 1994. Data were collected using participant observation of mealtimes in the congregate dining room of one licensed long-term care facility. Data were analyzed using the framework of ethnomethodology to indicate the methods nursing assistants used to make sense of their interactions with demented residents. Findings: Nursing assistants used several common behaviors: grouping the “difficult feeders” together; “marking the borders” by maintaining a tidy tray; and “loading the spoon” to maximize the amount of food given at one time. Estimations of the quantity of intake varied according to ideas about the nutritional content of various foods. Conclusions: Unsuccessful feeding interactions have implications for the quality of life for the demented. When inadequate intake leads to significant weight loss, medical and nursing interventions should be implemented.

Stories of growing up amid violence by refugee children of war and children of battered women living in Canada.

Abstract: Purpose: To explore how two groups of children who grew up amid violence “make sense” of their experience. As violence has become a common element of some societies, growing numbers of children have been forced to live in dangerous environments. Although considerable research has been conducted with children who are abused or neglected, the needs of those who witness violence have been largely overlooked. Design: Critical narrative and descriptive. Data were collected. 1995–1996, in Canada from a convenience sample of 16 refugee children of war and 16 children of battered women. Methods: Participants were asked open-ended questions about the violence in their lives, their feelings about what occurred, their thoughts about the reasons for violence, and their ways of surviving and growing. Common themes were identified and validated. Findings: Despite differences in the children's stories, many parallels were evident. Both groups of youngsters endured pain, suffering, and feelings of betrayal. Both used creative strategies to survive. The way the children endured growing up amid violence was mediated by social, political, and cultural constructions of violence. Because these meanings were unique, violence was experienced in several ways. Conclusions: Although the children showed remarkable strength and insight, they face many challenges. Despite a common perception that children are unable to talk about deeply troubling experiences, this research demonstrated that children not only want to discuss their experience, but also welcome the opportunity to do so.

Accessing young adolescents and their families for research.

Abstract: Purpose: To describe the strategies used to obtain and retain a sample of young adolescents and their families. Methods: The sample was 847 families with young adolescents aged 11 to 14 years who resided in a large urban Midwestern community of the U.S. The first design strategy was becoming credible within the community. For 5 years before conducting the intervention research in the community, surveys were conducted of the needs of middle-school students as they entered adolescence, and programs were delivered to meet the assessed needs. The second design strategy was instituting developmentally appropriate recruitment and retention strategies based upon direct consultation with groups of young adolescents. The consultants recommended referring to young adolescents as young adults and holding the training sessions in sites not associated with schools. The third design strategy was setting up participation methods that were nonburdensome to schools and families. Conclusions: The successful recruitment of over 800 families and the retention of 80% of them for survey participation and 77% of them for the intervention protocol can be attributed to three major strategies: (a) community involvement; (b) adherence to principles of adolescent development; and (c) ease of participation for school personnel and families.

A model of chronic dyspnea.

Abstract: Purpose: To present an overview of dyspnea, differentiate chronic dyspnea from acute dyspnea, critique models of dyspnea found in the nursing literature, and propose a new model of chronic dyspnea to guide the care and evaluation of chronic dyspnea in patients living with chronic obstructive pulmonary disease (COPD) Dyspnea is the major symptom that impairs quality of life for nearly 16 million Americans who have COPD Methods and Sources: Review of scholarly literature on dyspnea by searching CINAHL and MEDLINE (1980-1998) using dyspnea and chronic obstructive lung disease as key words The search produced studies conducted by a variety of health care professions including those in nursing, medicine, exercise physiology, and respiratory therapy Findings: The existing models fail to differentiate between acute and chronic dyspnea These models were found to be inadequate for guiding interventions to decrease the long-term adverse consequences of chronic dyspnea Conclusions: A useful model of chronic dyspnea defines chronic dyspnea as distress with varying levels of intensity and long-term physical, psychologic, and sociocultural consequences The proposed model has implications for both research and clinical practice by identifying the consequences of chronic dyspnea as outcome measures of the effectiveness of treatment

Non-Pharmacologic Pain Management for Postoperative Coronary Artery Bypass Graft Surgery Patients

Abstract: Some patients are dissatisfied with the pain relief they receive in the immediate postoperative period (Donovan, 1990). Some researchers believe that non-pharmacologic nursing interventions, used in combination with analgesics, can help decrease pain. The purpose of this study was to document how frequently non-pharmacologic methods are being implemented and who is responsible for encouraging patients to use these methods.