A decade of distance education: RN to BSN.

TELETECHNET represents a major commitment on the part of the university. The university's strategic plan and resource allocations indicate that this educational strategy is a growing enterprise. Although challenges exist in implementing a nursing education program by television, the TELETECHNET program provides opportunities for the place-bound student to achieve advanced education.

Home healthcare and client outcomes.

This study examined the outcome measures of readmission to the hospital and change in functional status/quality of life. Patients were admitted to the hospital most commonly by the 15th visit indicating complications arise soon after home care initiation. Implications for more specific data related to acuity, family support, and outcomes are suggested to develop and evaluate strategies for cost-effective care. The potential for preventing hospitalizations may be diminished due to the cost containment strategies currently used by agencies in response to PPS.

High-resource hospital users in an integrated delivery system.

OBJECTIVES: With decreasing healthcare reimbursement, nurse administrators need to aggressively manage care for high-resource users of hospital services to ensure the viability of their healthcare organization. The objective of this study was to (1) investigate frequent Medicare inpatient admission and emergency department users, (2) investigate Medicare day outliers, and (3) examine Medicare reimbursement/charge ratios. BACKGROUND: Although much research has focused on patients who have been readmitted frequently to the hospital, little research has examined patients who are frequent users of both emergency departments and inpatient services. METHODS: In this study, all 4,920 elderly Medicare inpatient admissions and emergency department visits for 1 year in a 222-bed general hospital were included. Patient profiles of two categories of high resource users were created. RESULTS: Results showed the frequent high user group (n = 75), who had six or more combined emergency department and inpatient admissions per year, had cardiac, diabetic, and chronic respiratory conditions, and came to the hospital from their homes. The day outlier profile (n = 148) consisted of older patients who have neoplasms, and respiratory and circulatory diseases. The mean Medicare reimbursement/charge ratio varied for high volume diagnosis-related groups (DRGS.) IMPLICATIONS: From the study, implications include refining case management, monitoring high-resource patients by computer tracking, analyzing high-user trends by several different methods, incorporating many facets of an integrated healthcare delivery into their care, expanding patient, outpatient, and community support programs, and continually monitoring revenue for organizational viability.

Use of the SF-36 to identify community dwelling rural elderly at risk for hospitalization.

The SF-36 has been identified as a generic measure of health-related quality of life outcomes which is not age, disease, or treatment specific and is deemed appropriate for monitoring the results of care as well as a measure of outcomes from the patient's perspective. The purpose of this study was to use the SF-36 to assess the general health status and health promotion activity of rural elderly 1 year following participation in a community-based health promotion project. Eighty participants from the original sample of 222 (190 community-based and 32 home-based) were contacted by telephone and the SF-36 was administered. Results found that 76% of the study participants were correctly predicted for past hospitalization. While this project studied elderly in a rural community, the administration of this instrument can be useful in identifying a variety of populations at risk for hospitalization.

Identifying health status and health risks of older rural residents.

Older rural residents are vulnerable in both health status and access to health services. This descriptive study was designed to assess the general health status and risk factors of older rural residents age 65 and over. Cluster analysis methods were used to group older adults into unique clusters of individuals with similar health risks. Although strategies are generally targeted at those with limitations in two or more activities of daily living, community health nurses might need to initiate interventions much earlier. Findings of this study can help community health providers, policymakers, and administrators strategically plan to meet the health care needs of various groups of at-risk older rural populations.

Rural mobile health unit: outcomes.

The Mobile Health Unit was implemented to increase access to nursing services, to improve and/or maintain functional status and health status, and to increase health promotion behaviors of rural elderly residents experiencing difficulty obtaining health care due to illness, transportation problems, or financial factors. For 222 project participants 1,773 encounters were completed, with a mean number of visits per individual of 7.9. Participants in the project demonstrated increased breast and cervical cancer screenings, increased immunization rates for influenza, pneumonia and tetanus, and decreased utilization of the emergency room. This project represents an alternative model of health care delivery in a rural area with limited resources and health care providers.

Rural elderly present need for nursing continuity.

Over 25% of the elderly reside in rural areas. Elders residing in rural areas have incomes that are approximately 20% less than their urban counterparts. One year of data on the 1,972 admissions of Medicare patients to a 150-bed rural hospital was studied to seek the commonalties marking four LOS categories of patients, including their 17+ day LOS outliers. Sixteen percent of all the Medicare admissions who tended to be older, have chronic illnesses and needed multiple services, fell into the 17+ day LOS group where reimbursement covered only one-third of the actual cost of care provided. ICD-9 codes associated with the cardiac diagnostic category dominated, with 21.5% of those included in this resource-intensive group. In preparing for capitated reimbursement, all efforts to develop systems to decrease ED visits and hospital stays, while enhancing quality of life for the chronically ill, must be implemented.

Prenatal factors and birth outcomes in the public health service: a rural/urban comparison.

To determine whether predictors of birth outcomes differ for women in rural versus urban areas, data were obtained from the health records of women who received prenatal care through the Public Health Departments of a rural (N = 364) and urban (N = 415) setting. The rural group was more apt to be single, less educated, African-American, and have a lower income than the urban group. Rural women also had a higher incidence of low birth weight infants, which may be related to poor nutrition and low weight gain during pregnancy. Urban women had more maternal and neonatal complications, which may be related to a higher incidence of drug use and smoking. Membership in a rural or urban population did not predict low birth weight. Race, weeks gestation at first prenatal visit, number of total visits, and adequacy of diet and weight gain were significant predictors of birth weight. Neonatal complications were higher in the urban group and best predicted by poor diet, alcohol intake, and race. Both rural and urban women received inadequate prenatal care, as indicated by late entry into care and total number of visits. Alternative models of care which explore strategies to individualize care, while providing comprehensive care, should be investigated.

Community outreach: rural mobile health unit.

With the increased emphasis on cost containment, hospital administrators are investigating community outreach projects to remain economically viable. The authors describe the planning and implementation of a mobile health unit for rural elderly residents. This project represents an alternative model of healthcare delivery in a rural area with limited resources and healthcare providers.

Hospital readmissions for rural elderly. 1992-1993.

The ill elderly are more at risk for recurrent hospitalizations than any other segment of the population. What is known about hospital admission readmission of chronically ill older adults and how can this information be used to develop cost-effective strategies? The authors found variation in percent reimbursement (43% to 93%) of overall average charges, which indicates that further examination of low reimbursement major diagnostic categories can be useful. Hospital readmission data should be used to improve quality of care while containing hospital costs.

Cancer detection: how effective is public education?

The American Cancer Society has been educating the public about cancer detection methods since 1922. Originally, only two warning signs were published; however, for more than 40 years, there have been seven cancer warning signs. In an attempt to evaluate the public knowledge of cancer detection and prevention, this pilot study examined the attitudes, knowledge and behaviors of 172 laypersons. The instrument used consisted of four sections and was designed by the investigator and the graduate nursing research class. The first section contained 30 questions about the individual, health practices, and risk status in a forced-choice format. Ability to identify the seven cancer warning signals was the second section. Attitudes toward Cancer Detection methods were evaluated in a semantic differential format as the third section. The list section contained 24 Likert-formatted statements of beliefs about the importance of cancer detection. Before data analysis, a Cronbach's alpha was obtained on each scale and ranged from 0.8031 to 0.8897. Eighty nine (52%) of the respondents were women and 83 (48%) were men. The sample was 85% white, 11% African-American, and 4% other ethnic groups. Ninety-four percent of the population had some form of health insurance. Gender was not significantly related to scores on the Attitudes toward Cancer Detection or the Beliefs about Cancer Scale. Race was significantly related to scores on the Attitudes toward Cancer Detection Scale. Nineteen percent of the sample could not identify any of the cancer warning signs. The median number of warning signs correctly identified as warning signals was three. Thirty-two items were incorrectly listed as warning signs. Survival of cancer is linked with early detection. The inability to influence changes in knowledge and practices over the past 50 years is examined. Implications for nurses and teaching related to cancer warning signs are explored.

Breastfeeding: perceived barriers and benefits/enhancers in a rural and urban setting.

This study investigated differences in perceived benefits/enhancers and barriers between women who planned to breastfeed, those who were uncertain, and those who did not plan to breastfeed. The volunteers were obtained from rural (60) and urban (82) public health department prenatal clinics. Fifty-three percent of the women were married, the average age was 23 years, 25% had not graduated from high school, 38% were black, and 46% were planning to return to work. The breastfeeding inventory consisted of 13 items to measure benefits and enhancers, 15 to measure barriers, and an open-ended question. Cronbach's alphas for internal consistency for benefits and enhancers and barriers were 0.88 and 0.83 respectively. Analysis of variance found significant differences among the three groups on perceived benefits and barriers. Rural and urban differences existed in perceived benefits/enhancers, but not in perceived barriers. In a multiple discriminant function analysis that included demographic characteristics, the most important predictor of breastfeeding decision was perceived benefits.

Using after-shelter case management to improve outcomes for families with children.

Homelessness and living in shelters have complex and multiple adverse effects on children that lend urgency to assisting families with children to leave shelters and to achieve independent and stable living arrangements. Some shelters offer only short-term housing with no additional support services. Others offer long stays with a comprehensive range of social and economic support services. While living in a shelter, families are faced with such major challenges as finding employment that is adequate to meeting the family's financial needs and locating permanent housing. Because shelter or street living may exacerbate children's health and developmental problems, families with children should move from them into a stable home situation as quickly as possible. The researchers examined some of the specific effects of living in a shelter for homeless families with children in Virginia Beach, VA. They focused on whether the policy of offering families after-shelter case management services for 1 year decreased their average length of the time in the shelter, and whether case management of families with children for 1 year after leaving a shelter increased the proportion of families who obtained permanent housing. A non experimental descriptive design was used. In case management after the shelter stay, an advisor worked intensively with families, helping to locate resources and serving as a resource link, assisting with application processes, providing transportation when necessary, and acting as advocate and support person. Some families needed minimal assistance, while others needed more intensive assistance. The findings suggest that case management services for families following discharge from a homeless shelter effectively reduces the length of stay ina shelter and increases housing stability after discharge from the shelter. For this sample, the average shelter stay was reduced from 31.1 to 22.8 days.

A strategy for health promotion at multiple corporate sites.

1. The logistical problems associated with delivery of health promotion programs at multiple corporate sites can be addressed through the use of health education packets. 2. The role of the nurse or health coordinator is critical in assisting and guiding the employee as the health plan is executed. 3. Problematic areas related to implementation of programs at remote sites can be alleviated through careful planning and extensive communication. 4. Advertising, input from employees and staff, and follow up are important in the success of a program.

Factors associated with participation or nonparticipation in a workplace wellness center.

The aim of this project was to compare characteristics and factors that distinguished those individuals (n = 101) who participated in a worksite wellness program from those who did not (n = 100). This project was unique in that the majority of subjects were bluecollar workers. Factor analysis of a 35-item questionnaire resulted in six factors: perceived benefits of health promotion behaviors, perceived physical barriers of health promotion, perceived self-efficacy for health promotion behaviors, perceived psychological barriers, situational components relating to convenience of the wellness facility, and the need for social support. Discriminant analysis revealed that self-efficacy was the most useful factor in distinguishing between the two groups. Participants identified more benefits and fewer barriers to health promotion activities. Nonparticipants were older, less educated, and tended to view their age, their perceived lack of fitness, and perceived poorer health status as deterrents to regular physical activity. Nonparticipants also identified shift work, working overtime, responsibilities at home, and distance from work as important barriers to health promotion activities. Self-efficacy factors appear to warrant further investigation in future attempts to explain health promotion behaviors in this high risk group.

Workplace health promotion and the blue collar worker.

Considerable evidence supports the claim that blue collar workers are at risk in terms of their health. Health promoting lifestyles have improved in the white collar segment of western society, but behaviors such as physical inactivity, cigarette smoking, and alcohol and drug abuse have increased in blue collar groups. Perceived health status is known to be associated with positive health behaviors. Management must demonstrate an ongoing commitment to the support of health promotion activities and consider restructuring the work environment to encourage health promotion behaviors.

Goal setting and health risk reduction.

The effectiveness of client participation in goal selection aimed at health risk reduction was compared with the effectiveness of provider-selected goals and of no goal setting. No difference in goal attainment was found between the two groups with goals. However, analyses of covariance for selected subsamples of individuals at risk revealed a significant difference between goal-setting groups for weight reduction, with the collaborative goal-setting group being more effective. Covariance analyses for other subsamples at risk showed significant differences between the goal-setting groups for current health age and potential for life expectancy increase; the provider goal-setting group proved to be more effective. Paired t tests within groups revealed that the provider goal-setting group made significant change in alcohol intake, seat belt use, and exercise as well as in global measures of current health age, estimated life expectancy, and potential for life expectancy increase. For the collaborative goal-setting group, significant change was found in weight reduction, exercise levels, and the global measures of estimated life expectancy and potential for life expectancy increase. The control group made a significant change in exercise, but not in any of the global measures of risk reduction.

Monitoring cardiovascular status with noninvasive techniques.

Useful information regarding a patient's cardiovascular status can be gained through noninvasive monitoring techniques. Health assessment skills developed over a period of time by the nursing practitioner will aid in identifying problems, planning care, and understanding the total patient profile more comprehensively.