Norplant use among urban minority women in the United States.

The aim of this study was to develop a profile of urban American women who chose Norplant(R), determine factors associated with retention and early termination of implants, and to determine reasons for early removal. A total of 197 adult black and Hispanic women who had Norplant inserted were followed prospectively for up to 5 years. Interval and cumulative termination rates were calculated. Data were stratified by race and analyzed to include lost-to-follow-up (LTFU) subjects. Multivariate survival analysis was used to determine variables independently associated with termination. Cumulative continuation rates were 68% after year 1 and 13% after year 4. Significant predictors of retention included black race and lower parity. Probability of early termination increased with higher parity and Hispanic race. For black subjects, recent use of hormonal contraception was a predictor of retention. Menstrual changes and weight concerns were common reasons for removal. The Norplant 1-year continuation rate is lower than previously reported, but is higher than reported for oral contraceptives and Depo-Provera(R). Future studies should stratify by age, race, and parity, and use standardized terminology to report intervals of use.

Teen Club: a nursing intervention for reducing risk-taking behavior and improving well-being in female African American adolescents.

This article describes a nursing intervention called Teen Club that was designed to reduce risk-taking behavior and improve well-being in female African American adolescents. Participants were referred to Teen Club by their nurse practitioners, physicians, and a community health nurse who were working at an urban neighborhood health center's teen clinic. Referrals were based on factors such as parental substance abuse, lack of social and family support, and other characteristics thought to increase vulnerability to risk-taking behavior. The 2-year intervention included weekly group meetings co-led by a European American female community health nurse and a Latino American male community worker, supplemented by case management and home visits by both these persons. Findings from a retrospective group interview conducted with 11 of the 12 original participants are presented. This is the first step in a series of pilot studies designed to refine the Teen Club intervention in anticipation of a future prospective, randomized investigation of this health promotion and disease prevention model of nursing care.

Empowering staff nurses to participate in the American Nurses Association's call for quality indicators research.

The American Nurses Association (ANA) advocates establishment of a national database, which can collect, aggregate, and analyze patient data to link nursing activities to 10 quality of care outcomes. These outcomes, developed through extensive research, can highlight the essential nature of nursing, demonstrate institutional compliance with external standards, and justify registered nurse staffing patterns. Staff nurses collect and record the data that provide the foundation for the quality nursing indicators research initiative. This paper focuses on the important and unique role that staff nurses can play in advancing this agenda.

A review of nursing research on the use of unlicensed assistive personnel (UAP).

The increased use of unlicensed assistive personnel (UAP) has raised the question: "What nursing research has been conducted to evaluate the effectiveness of the UAP in relation to patient outcomes?" To answer this question, the New York State Nurses Association Council on Nursing Research conducted a literature review on the issue of UAP. The specific purposes of this article are to: (a) present an overview of the health care climate and consumer and RN reaction in relation to the UAP movement, (b) summarize reported reviews of UAP research conducted between 1988 and 1994, (c) critique and synthesize the most recent UAP nursing research conducted between 1994 and 1997, and (d) make recommendations for education, practice, and research.

Influencing health care policy: nursing research and the ANA social policy statement.

This paper describes policy formation and its relationship to nursing research, examining ways in which nursing's disciplinary research can have greater influence on American health care policy. The American Nurses Association's Social Policy Statement (1995) is discussed in its role as a guide for nursing research efforts in a health care reform environment where favorable patient outcomes are key.

Contraceptive implant use among inner city teens.

PURPOSES: This study develops a clinical profile of urban teens who selected Norplant for contraception; determines which variables identify the subjects most likely to be compliant with the method; and determines the most common reasons for early termination of use. METHODS: Demographic and health history data and reasons for termination of use were collected prospectively for 122 inner city teens who received Norplant. Life table analysis and the Mantel-Haenszel procedure were used to investigate differences between Norplant retainers and terminators. RESULTS: The sample consisted of black and Hispanic teens between the ages of 13-19 years, the majority of whom had one or more children and were in school. One and two year retention rates were 71% and 62%. The highest removal rates occurred during the 3-6 month interval after insertion. A significant finding was that teens who have experienced induced abortion were more likely to retain Norplant. Common reasons for termination of use included general and social concerns, including pregnancy desire. CONCLUSIONS: Norplant retention rates for this teen sample were greater than the compliance rates reported for other conventional methods. Similar to noncompliance with oral contraceptives, discontinuance of the method was most likely to occur in the first 6 months of use. A history of induced abortion identifies those teens most likely to retain Norplant, suggesting that these teens might evaluate contraceptive risks and benefits differently than those with no abortion history. Pregnancy desire was a common reason for terminating Norplant use.

PIP: This prospective study of 122 Black and Hispanic inner-city adolescent Norplant users recruited from a teen clinic in Rochester, New York, was the first to include a two-year follow-up period. The study period extended from June 1, 1991, to June 30, 1993. The mean age of Norplant acceptors was 17.4 years; 76% had a parity of at least one. Recorded was a one-year retention rate of 71% and a two-year rate of 62%. The greatest number of removals occurred in the first three months after insertion. There was no association between Norplant retention and age, weight, race, parity, or school status. The only significant predictor of Norplant continuation was a history of at least one induced abortion. The reasons most frequently cited by the 30 adolescents who discontinued Norplant were headache, fatigue, hair loss, nausea, weight changes, breast symptoms, and appetite changes. Menstruation irregularities were reported only by terminators in the 3-6 month use interval. Considering the high continuation rates recorded in this survey and the method's proven effectiveness, Norplant has the potential to widen substantially the birth interval between adolescent pregnancies.

Geriatric functional assessment in acute care: a pilot project.

This experimental pilot project examined 33 acute care patients over age 70 to determine if length of stay, cost of stay, and functional decline during hospitalization could be reduced through early assessment. A gerontological clinical nurse specialist (GCNS), using three established instruments, scored all patients within 72 hours of admission to the study unit in relation to mental status, physical functioning, and ability to perform activities of daily living. The instruments included the (a) Mini-Mental State Exam (MMSE), (b) PULSES Profile, and (c) Katz Index of Activities of Daily Living (Katz ADL). The GCNS's assessments and recommendations for care were documented in patient charts. Subjects were randomly assigned to experimental or control groups. Those in the experimental group received GCNS monitoring, which included daily (except weekends) patient visits to assess newly developed problems, response to interventions, and follow-through on previous recommendations. Other patients received only the usual care. Subjects were retested prior to discharge. The differences between change scores from admission to discharge were not statistically significant. However, the GCNS observed several positive trends in medical and nursing staff practices in relation to increased staff awareness of geriatric care needs. Replication of this study using a larger sample of high-risk elderly patients is needed to further delineate the potential benefits of the unit-based model.

Toward a hierarchy of adaptation to biomedical technology.

The article attempts to derive a hierarchy of patient adaptation for a variety of technologic devices that are used in medical and nursing care. A review of related literature on some existing taxonomies of biomedical technology and an empiric foundation based on Roy's Adaptation Model suggest that patient adaptation to biomedical devices is affected by at least two factors--the degree of invasiveness and automation--that are inherent in all bedside devices. It appears that patients' need for adaptation to technology is more apparent as automation decreases and invasiveness increases. Further research is necessary to determine whether this relationship holds for all types of technology and to identify additional factors that might contribute to the development of an adaptation hierarchy for technologic devices. The nurse's role as a mediator of stress between the patient and technology is also explored.

Patient adaptation to technology: an application of the Roy model to nursing research.

Structured interviews were used to explore 75 medical-surgical patients' reactions to intravenous (invasive) and telemetry (noninvasive) attachment. Dependent variables operationalizing constructs of comfort, self-esteem, patient role, and social relationships derived from Roy's four effector modes were organized into 19 adaptation items. It was hypothesized that patients attached to invasive technology would report more stimuli and need for behavioral responses than those attached to noninvasive technology. In keeping with the exploratory nature of the study and use of a new adaptation interview tool, item-by-item analysis was used to test the hypotheses. Most support for the hypotheses occurred when patients were attached to only one invasive device and for less than 3 days. Findings also provide new insights on how technology connections might put patients at risk for coping difficulties.

Updating the nurse's bedside manner.

The current tendency for nurses to be on a first name basis with their patients and to wear less professional clothing provides new metaphors for interpreting nurses' work status. We argue that this prevailing social informality in communications and dress perpetuates themes that diminish the professional image of nurses, masks the cognitive nature of their work, threatens nurses' therapeutic effectiveness, and continues to reinforce the hierarchical relationship between nurses and physicians. Strategies are presented to help nurse educators, administrators, and clinicians transform nurses' work environments into clinical settings that enhance their professional presentation.

Nurses' attitudes toward conventional and automated vital signs measurement methods.

The acceptance and assimilation of new medical technologies into the health-care arena is a complex process involving financial, humanistic, and clinical considerations. This experimental research compared nurses' attitudes regarding the clinical acceptability of conventional methods of measuring vital signs with their attitudes toward a new, automated method, using the IVAC Model 4000 Vital-Check. Two studies were conducted, at different university-affiliated hospitals, involving different nursing-care-delivery models. The 102 nurses who participated in the studies generally favored the automated method with respect to provider convenience, patient acceptance, and the opportunity to simultaneously perform other nursing assessments. Conventional techniques were preferred for patients on isolation precautions and in some very specific clinical situations such as those requiring detection of abnormalities in the heart rhythm. Interviews of patients were also conducted at both sites and their comments supplemented and supported the quantitative findings for the nurses. Patients seemed to adapt very well to the new technology. They were particularly interested in being better able to monitor their own measurements with the automated process.

Barriers to physician-nurse collegiality: an anthropological perspective.

This paper discusses social and cultural factors that impede collegial interaction of physicians and nurses. While physicians encourage a form of 'team work' in which nurses are subordinate, nurses seek mutual collegiality with physicians. This phenomenon is apparent in various degrees between all educational categories of nurses and physicians. We suggest that nurse expectations of status enhancement through increased knowledge and skill--the nurse practitioner model--fail to consider the deeply rooted structures of hierarchy, in particular gender hierarchy, that pervades medical care. Physician-nurse collegiality does offer benefits to patients; to achieve it nurses must devise methods to alter these structural barriers.