Nursing research priorities of the National Black Nurses Association.

The purpose of this article is to describe the nursing research priorities of the National Black Nurses Association (NBNA). The NBNA is a professional nursing association representing more than 150,000 black nurses throughout the United States and the Eastern Caribbean. This article describes knowledge gaps in nursing research and presents various findings from research studies aimed at defining research priorities in nursing. Recommended research priorities are discussed that are directed toward improving the health of African Americans and other vulnerable populations. The NBNA urges the National Institutes of Health to increase funding to support research initiatives with an emphasis on women's health, particularly the health of women from diverse cultures. Nursing research programs are steadily yielding results, which enable the nursing profession to meet the goal of using the programs include identification of research priorities, acknowledging the vast disparity in nursing research today.

A response to California's mandated nursing ratios.

PURPOSE: To explore the need for evidence-based health policy, as illustrated by the mandatory staffing bill passed by the California state legislature in 1999. DESIGN: Prospective data were collected from a voluntary sample of California acute care hospital representatives to describe selected patient safety and clinical outcomes and nurse staffing variables at the patient-care unit level. METHODS: Data for descriptive analysis were collected on hospital nurse staffing, patient falls, and pressure ulcers from 257 medical, surgical, medical-surgical combined, step-down, 24-hour observation units, and critical care patient care units in 38 California acute care hospitals from June 1998 to June 1999. FINDINGS: Nursing staffing ratios varied among the 257 units. RNs provided 91% of the nursing care in critical care units. Patients in medical-surgical units received 59% of their care from RNs, 11% from licensed vocational nurses, and 30% from other caregivers. Preliminary data showed no relationships between reported staffing ratios in these hospitals and the incidence of patient falls or hospital-acquired pressure ulcers. CONCLUSIONS: California Nursing Outcomes Coalition (CalNOC) data showed wide variations in staffing ratios, patient falls, and hospital-acquired pressure ulcers among nursing units and hospitals. These early findings indicate the need for additional research before determining minimal RN staffing requirements. Analysis of multiple sources of data may be necessary to determine safe staffing ratios and to provide evidence-based data for public policy.

Community health collaboration models for the 21st century.

The development of partnerships with physicians and other health professionals is a key strategy to improving the community's health. This article reviews the role of nurse leaders as advocates for health care improvement and leading community improvement efforts.

National Black Nurses Association community collaboration model.

In 1991, the National Black Nurses Association was awarded a contract from the Division of Nursing, United States Department of Health and Human Services to develop a community education program addressing eight Healthy People 2000 objectives. Healthy People 2000 is the United States Public Health Services's statement of national priorities for improving the health of all Americans. It provides a framework to reduce preventable deaths and disabilities, and equalize disparities in health status for specific populations. The NBNA Board of Directors chose to address five priority areas: infant mortality, HIV/AIDS, cardiovascular disease, cancer, and recruitment and retention of Blacks in nursing. For each area, specific nursing responsibilities were identified: health promotion, health protection, disease prevention, preventive clinical services, and surveillance and data requirements. The authors developed a model for implementation of the NBNA's Healthy America Report recommendations. The model and data from program implementation are presented with commentary on the efficacy of community partnership models to achieve preventive health goals.

Ten steps for managing organizational change.

Managing interdepartmental relations in healthcare organizations is a major challenge for nursing administrators. The authors describe the implementation process of an organization-wide change effort involving individuals from departments throughout the medical center. These strategies can serve as a model to guide effective planning in other institutions embarking on change projects, resulting in smoother and more effective implementation of interdepartmental change.

Barriers to influenza vaccine acceptance. A survey of physicians and nurses.

The Immunization Practices Advisory Committee (ACIP) recommends that health care providers who contact high-risk patients receive influenza immunization annually. There are few available data on hospital employees' acceptance of these recommendations or their attitudes about influenza immunization. In a hospital where no formal influenza immunization program was in place, a survey of 193 nursing personnel and physicians showed that only 2.1% received the 1986-1987 trivalent influenza vaccine and 3.2% the monovalent A/Taiwan/1/86 vaccine before the 1986-1987 influenza season. An influenza-like illness developed in a total of 35.3% of hospital employees during the influenza season, and 76.6% of them cared for patients while ill. Fear of adverse reactions, avoidance of medications, and the inconvenience of vaccine administration were frequently cited reasons for declining immunization. Hospital employees would be more inclined to receive future influenza immunization if vaccine administration were more accessible and if they were informed that immunization were a national health care policy. During the influenza season, nurses and physicians should be considered a uniformly susceptible reservoir of infection capable of transmitting influenza to patients. Moreover, ACIP guidelines alone probably will not lead to acceptable immunization rates among health care providers; organized institutional efforts to promote immunization of health care providers may be required.

Occupational exposure to influenza--introduction of an index case to a hospital.

The epidemiology of influenza in the hospital is frequently confounded by failure to separate community-acquired from nosocomial transmission. An 83-year-old woman was hospitalized one day after returning from Asia with complications resulting from acute influenza A (H3N2) infection; she was the first culture-confirmed case in the region during the 1987-1988 influenza season, and her illness antedated other influenza cases in the area by at least four weeks. The patient shed virus at least four days after admission and transmitted influenza to her primary physician; both had received trivalent influenza vaccine four weeks earlier. Surveillance data from the 28 health care providers (HCPs) in contact with the index case (mean age: 34.5 years; median time of contact: four hours, none receiving vaccine) revealed no evidence of transmission as detected by paired type-specific complement-fixation antibodies and throat culture (20 subjects) or acute serologies and culture (7 subjects). No febrile respiratory illnesses were detected among other patients on the same ward, although three were reported among HCPs. Thus, neither secondary spread of influenza from infected patient to hospital HCPs nor nosocomial transmission apparently took place, although transmission did occur to the primary physician.

Nursing practice and the National Cholesterol Education Program guidelines for detecting, evaluating, and treating high blood cholesterol in adults.

Recently published guidelines, The Report of the Adult Treatment Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, have tremendous implications for the practice of nursing. This paper presents key elements from that report and discusses how these guidelines can be used to enhance clinical practice among nurses treating and counseling patients with elevated blood cholesterol levels. In addition to discussing the major treatment modalities of diet and drugs, this paper considers implications for nurses working with Black patients.