Showing papers in "Journal of Nursing Scholarship in 2005"

Conceptual Model of Health-Related Quality of Life

Abstract: Purpose: To revise the Wilson and Cleary model of health-related quality of life (HRQoL), with suggestions for applying each of the components, and to facilitate the use of HRQoL in nursing and health care. Organizing Construct: HRQoL, based on relevant literature over the past 20 years. Methods: The original model was revised in three substantive ways: (a) indicating that biological function is influenced by characteristics of both individuals and environments; (b) deleting nonmedical factors; and (c) deleting the labels on the arrows that tend to restrict characterization of the relationships. Findings: Theoretical background is provided for each of the major components of the model, and examples of instruments to measure them, were added. Conclusions: In quality-of-life research, the current challenge is to devise models to clarify the elements of health-related quality of life (HRQOL) and the causal relationships among them. This revision of Wilson and Cleary's model includes a taxonomy of the variables that often have been used to measure HRQoL. This revision should be useful in research and clinical practice.

Clarification of social support.

Abstract: Purpose:To clarify the concept of social support. Design:Template Verification and Expansion Model. Methods:Meta-synthesis strategies. Findings:Social support is composed of emotional and instrumental support. It is an advocative interpersonal process characterized by reciprocal exchange of information, it is context specific, and it results in improved mental health. Antecedents of emotional and instrumental support include a perceived need plus a social network and climate that are conducive to the exchange of social support. Conclusions:In keeping with the nonprofessional nature of social support, nurses are advised to encourage patients to use and enhance personal support networks. For the same reason, nurses should reconsider investigating social support as a nursing intervention. Expanded efforts are needed to differentiate social support from concepts such as caring.

Hospital ethical climates and registered nurses' turnover intentions.

Abstract: Purpose: To investigate (a) the effects of hospital ethical climates on positional and professional turnover intentions of registered nurses, and (b) the relationships among demographic factors, employment characteristics, and positional and professional turnover intentions of registered nurses. Design: A cross-sectional study of randomly selected registered nurses (n=463) in Missouri, USA, conducted in 2003 and 2004. Methods: A self-administered questionnaire containing the Hospital Ethical Climate Survey, the Anticipated Turnover Scale, and the Nursing Retention Index was used to assess registered nurses' perceptions of the hospital ethical climate and their intentions to leave their position or the nursing profession. Descriptive statistics, Pearson product-moment correlations, and hierarchical regression techniques were used to analyze the data. Findings: The hospital ethical climate explained 25.4% of the variance in positional turnover intentions and 14.7% of the variance in professional turnover intentions. Together, hospital ethical climate, control over practice, the use of educational reimbursement as a retention strategy, gender, and staff sufficiency explained 29.7% of the variance in positional turnover intentions. Hospital ethical climate, patient load, and control over practice together explained 15.8% of the variance in professional turnover intentions. Conclusions: Of the variables included in this analysis, the hospital ethical climate was most important in explaining nurses' positional and professional turnover intentions.

Linking the practice environment to nurses' job satisfaction through nurse-physician communication.

Abstract: Purpose: To investigate direct and indirect relationships among the practice environment, nurse-physician (RN-MD) communication, and job satisfaction, as is posited in the nursing role effectiveness model (NREM) Design: Survey Methods: Surveys were sent to a random sample of 500 hospital nurses throughout Michigan, and 332 (66%) responded Main study instruments were the Conditions for Work Effectiveness Questionnaire-II (CWEQ-II), the Practice Environment Scale of the Nursing Work Index (PES-NWI), the ICU Nurse-Physician Questionnaire, and the Index of Work Satisfaction (IWS), Part B Inferential statistical tests included multiple regression, t tests, and one-way analysis of variance Findings: Practice environment (PES-NWI) and empowerment (CWEQ-II) scales explained 20% of the variance in RN-MD communication The combination of both environment scales (PES-NWI and CWEQ-II) and RN-MD communication explained 61% of the variance in nursing job satisfaction scores RN-MD communication was also a significant mediating variable in the relationship between structure (practice environment and empowerment scales) and outcome (nursing job satisfaction) Conclusions: Factors in the practice environment contributed both directly to nursing job satisfaction and also indirectly through RN-MD communication Study findings showed that a practice environment favorable to nurses improved both nurses' perceptions of their communications with physicians and their job satisfaction

Incorporating Documents Into Qualitative Nursing Research

Abstract: Purpose To present an overview of how documents can be incorporated as key sources of data in qualitative nursing research. Methods Analysis of the nature of documents and the distinctive features of any research strategy to analyze documents. Conclusions Many different strategies can be used in the analysis of documentary sources that are relevant to nursing practice. A systematic approach to the analysis of these textual resources, using one or several of the analytic strategies described here, can support and advance nursing scholarship.

A model of consequences of need-driven, dementia-compromised behavior.

Abstract: Purpose: To extend the original need-driven, dementia-compromised behavior (NDB) model by explaining the consequences of behavioral symptoms for the person with dementia. Organizing construct and methods: Literature is reviewed and the consequences of expressing needs through need-driven, dementia-compromised behaviors are posited. The consequences of need-driven, dementia-compromised behavior (C-NDB) theory is proposed as a framework to improve understanding of the person with dementia and the consequences of behavioral symptoms and unmet needs. Findings: Instead of normative verbal communication, people with significant dementia commonly communicate need via non-normative behaviors, making it difficult for caregivers to know that the person has a need and the extent of such need. Not meeting needs of people with dementia affects the person with dementia, care factors, and contextual factors. Cascading effects occur in which not meeting the original need results in new needs and behavioral symptoms. Conclusions: This framework indicates the consequences of expressing need behaviorally rather than verbally and shows that caregiver actions might moderate the events that lead to many needs being unresolved. Suggestions are made regarding future research questions deduced from the model.

Risk Perception and Compliance With Quarantine During the SARS Outbreak

Abstract: Purpose: To explore the experience of being on quarantine for severe acute respiratory syndrome (SARS) with a focus on the relationship between perceived risk of contracting SARS and reported compliance with the quarantine order and protocols. Design: Descriptive, qualitative. Methods: Semi-structured interviews were conducted with people who had been quarantined during the SARS outbreak in Toronto in 2003. Data analysis was completed using an iterative and collaborative approach of reading and re-reading the transcribed interviews, identifying common themes, and comparing and contrasting the data. Findings: To varying extents, participants wavered between fear and denial about their risk of contracting or spreading SARS. Reported compliance with the actual quarantine order was high. However, within households quarantine protocols were followed unevenly. Conclusions: This research indicates the need for greater credibility in public health communications to increase compliance with quarantine protocols and to contain outbreaks of new and deadly infectious diseases.

Nonadherence With Diet and Fluid Restrictions Among Adults Having Hemodialysis

Abstract: Purpose:To describe the prevalence of nonadherence with the prescribed diet and fluid restrictions among patients receiving hemodialysis. Methods:A multicenter cross-sectional design with 916 patients recruited from 18 dialysis centers in Germany and Belgium. The Dialysis Diet and Fluid Nonadherence Questionnaire (DDFQ) was used to measure patients' nonadherence. Findings:The results showed that many patients had difficulty following diet (81.4%) and fluid (74.6%) restrictions. Younger male patients and smokers were at highest risk for nonadherence. Higher levels of interdialysis weight gain were associated with nonadherence. Conclusions:The findings indicate the need to continue to monitor and study hemodialysis patients' adherence behavior longitudinally and to design interventions to enhance adherence.

Education as a Determinant of Career Retention and Job Satisfaction Among Registered Nurses

Abstract: Purpose: To compare job satisfaction and career retention in two cohorts of RNs, those whose highest degrees were the associate degree (AD) or the bachelor's degree (BS) in nursing. Design: Survey. Methods: Instruments included a career satisfaction scale and questions based on the ongoing U.S. Health and Retirement Survey. Three-thousand nurses in the U.S. state of Vermont were surveyed with a resulting response rate of 56.7%. Of these respondents, 878 RNs fit the study criteria. Findings: BS RNs started their nursing careers earlier, were employed longer, had held more positions, and in the largest age cohort (age 40–54), were more likely to have been in their current positions at least 10 years. BS RNs scored significantly higher in job satisfaction related to: (a) opportunity for autonomy and growth, (b) job stress and physical demands, and (c) job and organizational security. AD and BS nurses were not significantly different in their satisfaction with supervision; career, continuing education, and promotion opportunities; or pay and benefits. Conclusions: These findings indicate support of bachelor's level education for individual and social return on investment, and they show that AD education might have unintended consequences. Implications for the nursing shortage and educational policy are discussed.

Quality of life and the concept of "living well" with HIV/AIDS in sub-Saharan Africa.

Abstract: Purpose: To increase understanding of the meaning of quality of life for people living with HIV/AIDS in four countries in sub-Saharan Africa: Botswana Lesotho South Africa and Swaziland. Methods: Using a cross-sectional design and convenience sample we administered a survey and collected data on demographic characteristics measures of severity of illness and perceptions of quality of life. The purposefully selected sample (N=743) consisted of community-based people living with HIV/AIDS in 2002. Based on the Wilson and Cleary framework for organizing variables related to quality of life a hierarchical multiple regression was conducted with quality of life as the dependent variable. Results: The sample of 743 persons was 61.2% female with a mean age of 34 years. Approximately 62% of the sample reported having received an AIDS diagnosis. Ten predictor variables explained 53.2% of the variance in life satisfaction. Those participants with higher life satisfaction scores were less educated had worries about disclosure and finances did not have an AIDS diagnosis or other comorbid conditions had lower symptom intensity had greater functioning and had fewer health worries. None of these participants was taking antiretroviral medications at the time of this study. Conclusions: Several dimensions of the Wilson and Cleary model of quality of life were significantly related to life satisfaction for people living with HIV/AIDS in sub-Saharan Africa. Quality of life for this sample was primarily defined as overall functional ability and control over symptom intensity. These findings are similar to studies in developed countries that have shown the significant relationships among functional abilities symptom control and perceived quality of life. As antiretroviral medications become more available in these areas community members and care providers can help clients realize the possibility of living well with HIV/AIDS and can work with clients to improve functional ability and control symptom intensity to make living well a reality. (authors)

Cultural competence among Ontario and Michigan healthcare providers.

Abstract: Purpose: To examine variables associated with cultural competence among urban, hospital-based healthcare providers in Ontario (Canada) and Michigan (US). Design and Sample: A cross-sectional descriptive design with a convenience sample of hospital-based providers was used. The sample was 145 providers (n=71 Ontario; n=74 Michigan). Methods: Providers completed a survey which included the Cultural Competence Assessment (CCA) instrument. Regression analysis was used to examine associations. Findings: Providers with diversity training and higher levels of educational attainment scored significantly higher on cultural awareness and sensitivity and on cultural competence behaviors. Conclusions: Variables significantly associated with cultural competence included prior training in cultural competency and higher educational attainment among both Ontario and Michigan healthcare providers.

Disclosing genetic test results to family members

Abstract: Purpose:To describe the experiences of disclosing genetic test results to biological family members among people tested for Huntington's disease (HD) or hereditary breast and ovarian cancer (HBOC). Design:Grounded theory methodology. Methods:Open-ended, tape-recorded interviews were conducted with 29 participants—24 who had received genetic test results and 5 who had decided not to be tested. The participants were from three countries, including 15 U.S. states. Interviews occurred from 2 months to 4 years after receiving test results. Tapes were transcribed and analyzed for conceptual categories to describe the experience of disclosing genetic test results. Findings:Participants described the effects and meaning of disclosing test results to their various family members, and they selectively disclosed results to family members. The timing of disclosure was influenced by the particular disease and the person's perceived need to prepare. Disclosure of genetic test results brought the risk of HD and HBOC to the foreground, not only for the person tested but for family members as well. Conclusions:This study elucidated the perspective of the “discloser” and the consequences they anticipated and experienced.

Leadership styles and nursing faculty job satisfaction in Taiwan

Abstract: Purpose: To examine nursing faculty job satisfaction and their perceptions of nursing deans' and directors' leadership styles, and to explore how the perceptions of leadership styles relate to faculty job satisfaction in Taiwan. Methods: Descriptive, correlational, and cross-sectional study with self-administered questionnaires. The sample was recruited from 18 nursing programs, and 286 questionnaires were returned. Results: Faculty perceived that Taiwan's nursing deans and directors showed more transformational than transactional leadership. Taiwan's nursing faculty were moderately satisfied in their jobs, and they were more satisfied with deans or directors who practiced the transactional leadership style of contingent reward and the transformational style of individualized consideration. A style with negative effect was passive management by exception. Conclusions: Three types of leadership behaviors explained significant variance (21.2%) in faculty job satisfaction in Taiwan, indicating the need for further attention to training and development for effective leadership behaviors.

A conceptual model of cognitive deficits in chronic heart failure.

Abstract: Purpose:To describe a conceptual model to guide studies of cognitive deficits among patients with heart failure. Organizing Framework:The conceptual framework of cognitive deficits in chronic heart failure is based on theoretical and empirical literature about (a) the pathophysiology of heart failure, (b) the pathophysiology of cognitive deficits, and (c) health-related quality of life. Other variables that may cause or contribute to cognitive deficits include age, the relative contributions of multiple comorbid conditions, hypertension, and depressive symptoms. Covariates that might influence cognitive deficits (medications, gender, and education) are also included in the model. The most prominent cognitive deficits are believed to occur in domains of attention, working memory, memory, learning, executive function, and psychomotor speed. The main outcome variable is health-related quality of life, which is believed to be influenced by circulatory insufficiency and cognitive deficits. Conclusions:The conceptual model described in this paper is a framework for testing cognitive deficits that occur in heart failure. After validation through empirical testing, the model may be useful in developing interventions for patients with heart failure whose care is complicated by cognitive deficits.

Organizational attributes valued by hospital, home care, and district nurses in the United States and New Zealand.

Abstract: Purpose:To determine whether hospital-based, home care, and district nurses identify a core set of organizational attributes in the nursing work environment that they value as important to the support of professional practice. Design:Survey data, collected in 2002–2003 from 403 home care nurses in the United States (US) and 320 district nurses in New Zealand (NZ), were pooled with an existing data set of 669 hospital-based nurses to conduct this descriptive, nonexperimental study. Methods:The importance of organizational attributes in the nursing work environment was measured using the Nursing Work Index-Revised (NWI-R). Frequency distributions and analysis of variance were used to analyze the data. Findings:At least 80% of hospital-based, home care, and district nurses either agreed or strongly agreed that 47 of the 49 items comprising the NWI-R represented organizational attributes they considered important to the support of their professional nursing practice. Mean importance scores among home care nurses, however, were significantly lower than were those of the other two groups. Conclusions:Overall, hospital-based, home care, and district nurses had a high level of agreement regarding the importance of organizational traits to the support of their professional practice. The intensity of the attributes' importance was less among home care nurses. Further research is needed to determine whether this set of organizational traits, measured using the NWI-R, is associated with positive nurse and patient outcomes in home care and district nursing practice, as has been shown in acute care settings.

Design and Psychometric Evaluation of the Psychological Adaptation to Genetic Information Scale

Abstract: Purpose:To develop and psychometrically evaluate the Psychological Adaptation to Genetic Information Scale (PAGIS). Design:A cross-sectional, Web-based survey of participants (n=323) recruited via Internet electronic mailing lists or Websites for people affected by genetic diseases. Methods:Item analysis, confirmatory principal components analysis, and internal consistency reliability using Cronbach's alpha were used to construct the 26-item PAGIS. Findings:Five factors (nonintrusiveness, support, self-worth, certainty, and self-efficacy) explained 57.7% of the variance in psychological adaptation to genetic information. The internal consistency reliability of the total PAGIS was .90, and the subscale reliabilities ranged from .77 to .87. Conclusions:Psychological adaptation to genetic information is a multidimensional phenomenon comprised of nonintrusiveness, support, self-worth, certainty, and self-efficacy. The PAGIS has initial reliability and validity for use in future research.

Developing a scholarship community.

Abstract: Purpose To report the results of a multidisciplinary, interinstitutional writing support group established to facilitate faculty scholarly productivity.

Analysis of Integration in Nursing Science and Practice

Abstract: Purpose:To clarify the definition of integration and to identify universal aspects of the experience of integration related to healing, health, and nursing care. Design:An integrative review concept analysis method was used. Relevant reports were identified by a computer-assisted search using the keyword integration in CINAHL from 1966 to 2004 and by reviewing the reference lists of retrieved reports. The final sample included 56 reports; 36 were empirical and 20 were theoretical. Methods:Data were extracted from primary sources on the definition of integration, aspects of the process, antecedents, consequences, and facilitators. Data display matrices were used and were iteratively compared to derive a process model of integration related to health. Findings:A wide range of primary sources indicated that integration is an important aspect of healing or recovery from illness. Integration is defined as a complex person-environment interaction whereby new life experiences (i.e., illness) are assimilated into the self and activities of daily living, thereby contributing to overall life balance. Conclusions:Results of this analysis indicate the importance of the concept of integration to the science and practice of nursing. The process of integration appears to be a significant phase that occurs between a diagnosis of illness and subsequent physical and emotional healing.

Genomics in nursing education.

Abstract: Purpose:To review international efforts to incorporate genetics content into nursing education curricula. Organizing Framework:A discussion of the progress in nursing education programs in selected countries to educate students for genomics-based health care. Information is based on review of the literature and curriculum change efforts by the authors. Conclusions:The lack of agreed-upon minimum competencies impedes efforts to educate nurses for genomics-based health care. Nationally and internationally recognized documents are useful for collaborative efforts to establish minimal competencies in knowledge, skills, and attitudes for nurses with basic and advanced education. Curriculum change that incorporates minimum competencies will require nursing faculty to improve their knowledge base in genomics-based health care. Partnerships among nurses in different countries are needed for successful genomics education programs for faculty.

Symptom interactions as mechanisms underlying symptom pairs and clusters.

Abstract: Purpose:To present a summary of the potential shared or interactive mechanisms underlying an exemplar symptom pair: sleep disturbances and pain. Organizing Construct:Understanding of the multidimensional shared and interactive mechanisms underlying symptoms pairs and clusters has the potential to enhance symptom management. Methods:Reviews of the literature were conducted to search for information on shared or interactive mechanisms underlying sleep disturbances and pain; minimal data were available. Relevant information about individual symptoms was outlined and categorized in areas often used to describe the multidimensional nature of symptoms, including the physiological, psychological, behavioral, and sociocultural domains. This information was examined for relationships and commonalities. Conclusions:Many potential shared and interactive mechanisms underlying the symptom pair of sleep disturbances and pain were identified. These results indicate the need for further work and theory development in this area. The symptom interactional framework is a beginning conceptual perspective designed to facilitate this work. Implications for interdisciplinary translational research designed to optimize symptom management are discussed.

Describing use of nursing interventions for three groups of patients.

Abstract: Purpose:To describe the nursing interventions used most frequently during an acute hospital stay for three patient groups. Methods:Analysis of nursing interventions documented by use of the Nursing Interventions Classification (NIC) contained in an electronic clinical database obtained from 33 general inpatient units in one large health care facility from July 1, 1998, to June 30, 2002. The numbers of hospitalizations for each sample in the analyses were: 1,435 in the heart failure group, 567 in the hip fracture procedures group, and 11,756 in the fall prevention group. Findings:The mean number of interventions done at least once during a single hospitalization ranged from 18 to 22 for the three samples. For the total number of patient hospitalizations for each group, the number of interventions ranged from 94 for the hip fracture procedures sample to 182 for the fall prevention sample. Seven interventions were done twice or more a day in at least 20% of the sample in all three groups. Patterns of interventions during the first 6 days of care differed by intervention and sample, indicating that nursing care was individualized. Conclusions:The results indicate the types of information that can result from analysis of actual clinical nursing data documented with standardized language (Nursing Interventions Classification) in a nursing information system. The knowledge of nursing interventions used in clinical practice has major implications for staff development and nursing education. The information is also useful in making staffing decisions for different types of patient populations.

Testing an intervention to reduce negative thinking, depressive symptoms, and chronic stressors in low-income single mothers.

Abstract: Purpose:To test the effectiveness of a cognitive-behavioral group intervention in reducing depressive symptoms, negative thinking, and chronic stressors in low-income, single mothers at risk for depression. Design and Methods:A randomized, controlled prevention trial was conducted with 136 low-income, single mothers with children between the ages of 2 and 6 years. Each participant was screened before enrollment and was determined to be at risk for depression. Participants were randomly assigned to either the control or experimental group. The experimental group was invited to participate in a 4- to 6-week cognitive-behavioral group intervention. Data on depressive symptoms, negative thinking, and chronic stressors were collected via self-report questionnaires from control and experimental groups at baseline, 1 month, and 6 months after the intervention to assess the effects of the intervention. Findings:Compared with those in the control group, women who received the intervention had a greater decrease in depressive symptoms, negative thinking, and chronic stressors; these beneficial effects were maintained over a 6-month period. Conclusions:The findings indicate the effectiveness of this cognitive-behavioral group intervention and show the beneficial effects of reducing negative thinking via the use of affirmations and thought-stopping techniques.

A Framework for Integrating NANDA, NIC, and NOC Terminology in Electronic Patient Records

Abstract: Purpose:To describe the methods used in design of a framework that (a) encompasses nursing knowledge, (b) functions as a cognitive map for clinicians, and (c) increases the efficiency of using the North American Nursing Diagnosis Association (NANDA), Nursing Intervention Classification (NIC), and Nursing Outcome Classification (NOC) terminologies together in the electronic patient record. Methods:The taxonomies of the NANDA, NIC, and NOC terminologies were integrated to form a preliminary structure of domains and classes. New concepts and collocations of concepts were constructed using Walker and Avant's (1983, 1988) method for concept synthesis. The framework was validated using an expert group and clinical testing. Results:A framework organized as a taxonomy with eight domains (Physiological, Functional, Psychocognitive, Safety, Existential, Lifestyle, Family, and Environment) and 29 classes. Conclusions:The framework has the potential to enhance the quality of nursing documentation, contribute to nursing research and education, and reduce job stress.

Processes of Mental Health Service Use by Adolescents with Depression

Abstract: Purpose: To begin development of a substantive theory of the processes of mental health service use by adolescents who are depressed and by their families. Design: Grounded theory. Methods: Open-ended interviews were conducted with 52 young adults who were depressed as adolescents, four of their parents, and eight professionals who work with adolescents who are depressed. The constant comparison method was used to analyze the data. Findings: Adolescents who are depressed and their families perceived several “treatment pitfalls” associated with formal mental health services: (a) “They'll (mental health clinicians) think I'm crazy,” (b) “They'll tell my business,” and (c) “They won't have a clue.” The adolescents and their families interacted with the mental health care providers by engaging in the psychosocial process of “venturing through the system,” that is, proceeding despite possible dangers and risks by steering clear, holding back, and letting it take hold. Conclusions: Mental health service use by adolescents with depression involved complex and fluid interactional processes among the depressed adolescents, their parents or caretakers, and mental health care providers. Strategies are needed to avoid creating the pitfalls that concern adolescents and their families.

An International Survey of Nurse Editors' Roles and Practices

Abstract: Purpose :T odescribe the editorial practices of nurse editors, including proprietary arrangements, manuscript processing systems, and editorial review, and to ascertain editors’ opinions on effective editorial practices. Design :A descriptive study in which an author-designed 108-question survey was distributed and collected by e-mail. Of 177 international nursing editors identified, 164 e-mail addresses could be located, and 137 nurse editors expressed willingness to participate. Ninety journals were represented in the final purposive convenience sample, including 71 published in the US and 19 outside the US. Data were analyzed using descriptive statistics, t test, chi square, and content analysis. Findings :O fthe 90 journals, 78 were characterized by their editors as scholarly journals. Fifty-two were official journals of associations. The nurse editors’ average age was 53, with over 20 years of experience in nursing and 8 years as editor. Although practices and compensation at U.S. and international journals did not differ significantly, scholarly journals and “other” publications such as magazines and newsletters were managed differently. Blinded peer review was in place at 98% of journals. Editors generally used manuscript reviewers as advisors rather than as voters; only 30% of editors thought their ultimate decision must agree with the majority of reviewers. Nurse editors often needed 3‐5 years to feel comfortable in the role. Editors of association journals often reported struggling with the issue of editorial independence versus association control. Editors believed their role was influential in maintaining scholarly excellence and evidence-based practice, but many noted the constant pressure of deadlines and dealing with poor writing from authors as challenges of the work. Conclusions: The role of nurse editor is not part of the formal preparation of nurse scholars or clinicians; standards for nurse editors are not readily apparent, and nurse editors often work in isolation, lacking professional support. This survey included data by which nurse authors and readers of nursing journals can understand how nurse editors work and make decisions about manuscripts, ultimately influencing knowledge dissemination in nursing journals. Nurse editors can use this information to compare their practices with that of others, and advocate for adequate preparation, compensation, and assistance with production.

Emergency Department and Community Health Center Visits and Costs in an Uninsured Population

Abstract: Purpose:To assess how a Community Health Center (CHC) influenced access to care for uninsured people and to describe the economic effect on the local hospital. Design:A framework on access to health care was used in this community-level, descriptive study. Methods:Data were collected on emergency department (ED) use before state funding of the CHC, 1988 and through 2001. Information included insurance status, charges, diagnosis, and complexity of services received. This study is a population study, and descriptive statistics were used to analyze the data. Findings:Within 3 years after state funding of a CHC began, uninsured visits to the local hospital ED decreased by almost 40%. After 10 years, uninsured ED visits remained 25% lower than before state funding began, whereas insured visits had almost doubled (98%). The decrease in number of uninsured visits saved the hospital and uninsured patients almost $14 million. Conclusions:After establishment of the CHC, ED visits by uninsured patients declined. Although a causal link cannot be made between the CHC and ED, the descriptive data provide information about a linkage between the decline of uninsured ED visits and the CHC.

Nurses and the Genomic Revolution

Abstract: Purpose :T oincrease nurses’ genetics and genomics literacy through a series of articles focused on genomic research discoveries and their importance for nursing education, practice, policy, and research. Organizing Framework: “Genomics for Health” is one of three themes, along with genomes to biology and genomes to society, emanating from applications of the Human Genome Project (HGP). Methods :I nthis series of articles, nurse scientists who are experts in genetics and genomics sciences explain terminology, provide background information about the HGP, discuss clinical examples, and recommend changes in nursing practice, education, and research. Conclusions: The HGP has already led to major changes in clinical practice, research, education, and policy, and even more dramatic changes are predicted for people throughout the world. Mastering this information is necessary for nurses globally because genomic information will ultimately pervade all of health care.

Factors influencing the use of registered nurse overtime in hospitals, 1995-2000.

Abstract: Purpose: To assess nurse overtime in acute care general hospitals and the factors that influence overtime among various hospitals and in the same hospitals from year to year. Methods: Staffing data from 1995 to 2000 from 193 acute general hospitals in New York State were used to examine hospital characteristics (size, location, RN unionization, hospital ownership, and teaching status) to determine whether they were associated with nurse overtime. Results: The average weekly overtime RNs worked was 4.5% of total hours, varying from almost none to 16.6%. At mean overtime levels, nurses were working less overtime than the mean for manufacturing workers, but, at the extreme, nurses were working more than 6 hours overtime per week. Significant differences were observed in the use of overtime by hospital ownership and by union status. Nurses in government hospitals worked less overtime than did those in nongovernment hospitals. Nurses in unionized hospitals worked slightly more overtime than did nurses in nonunionized hospitals. Conclusions: Hospitals varied dramatically in their overtime use. That some categories of hospitals (e.g., government-owned) used little overtime indicates that hospital management can find substitutes for overtime to meet fluctuating staffing needs. The finding that hospitals with similar characteristics varied greatly in their number of overtime hours also supported this conclusion.

Hopelessness as a response to physical illness

Abstract: Purpose: To analyze hopelessness as a psychological response to physical illness, differentiate hopelessness from depression, and discuss measures of hopelessness. Organizing Framework: Walker and Avant's (1995) concept analysis strategy. Method: A review of the literature from 1983 to 2004 was completed, with a focus on hopelessness theory and measurement. Findings: Although hopelessness is closely related to depression, distinct characteristics of hopelessness were identified. A continuum of attributes of hopelessness and depression was derived. Hopelessness has been examined in a variety of populations with several different instruments. One established measure was selected for discussion. Conclusions: Continued study of hopelessness as a psychological response to physical illness is needed, including the continued differentiation of hopelessness from depression, further analysis of the continuum of hopelessness and depression, and the differentiation of state from trait hopelessness. Research to validate this conceptualization will enhance accuracy of the diagnosis of hopelessness and testing of nursing inteventions.