Support utilization by partners of self-identified sex addicts.

This online survey examined the support resources used by partners of sex addicts. Partners (N = 92) answered questions about which sources of support they found most useful, relationship functioning, and demographic and background variables. Partners rated therapists, spirituality, support groups, and friends as most useful; and the mate, their children, and their other family members as least useful. Participants indicated that they used intrapersonal religious/spiritual activities (e.g., prayer and meditation) more than interpersonal religious/spiritual activities (e.g., religious services and support groups). Older partners sought more religious/spiritual support, and more educated partners rated therapy as more useful. Rating the mate as useful was most strongly associated with positive relationship outcomes. The authors conclude with recommendations for working with partners of sex addicts.

Hospital treatment as a foal does not adversely affect future sales performance in Thoroughbred horses.

REASONS FOR PERFORMING STUDY: Many Thoroughbred foals are intended to be sold at public auction. The impact of disease conditions necessitating hospital treatment as a foal on future sales performance is unknown. OBJECTIVES: To determine whether Thoroughbred horses that were treated in a hospital before age 125 days and presented to public auction sell for a different mean price than controls. METHODS: Foals aged < 125 days, treated at a hospital in Ireland in 2007 or 2008 and presented for sale to a public auction recorded on a publicly accessible database were selected for inclusion in the study. The sales outcome of these subjects was compared to that of 6 controls for each subject, consisting of the 3 horses that were presented to the same sale immediately before and immediately after the subject. Results were controlled for the sale at which the animal presented and the sex of the subject and controls. RESULTS: Sixty-three subjects were presented to public auction: 19 at the foal sales, 39 at the yearling sales and 5 at the 2-year-old sales. Forty-five subjects were sold. There was no difference in the mean sales price (subjects Euros 38,207; controls Euros 35,026) or percentage of animals sold (subjects 71.4%; controls 66.4%) between subjects and controls. CONCLUSIONS: If Thoroughbred horses are presented for public auction following hospital treatment as a foal, there is no impact on sales outcome. POTENTIAL RELEVANCE: This information may help commercial breeders of Thoroughbred foals make informed decisions about treatment of their foals.

The performance of fibrous peat biofilters in treating domestic strength wastewater.

Peat is an abundant resource in Ireland and has the capacity to be used in low-cost, low-maintenance wastewater treatment systems for single houses. In this study four fibrous peat columns, of varying depths were constructed and tested in the laboratory for their capacity to remove contaminants from domestic-strength synthetic wastewater. The four filters had peat depths of 0.3 m, 0.6 m, 0.9 m and 1.2 m. During the 360 day study the filters were intermittently loaded with domestic strength synthetic wastewater at a hydraulic loading rate of 180 l/m2cd. Hydrographs and residence times for each filter were examined as was their ability to remove impurities from the wastewater. Removal of 5-day biochemical oxygen demand (BOD5) and total chemical oxygen demand (CODt) were > or =96% and 84%, respectively, in all filters with almost complete nitrification (> or =99%) being recorded for each filter. The removal of total suspended solids (TSS) was excellent at > or =94% and no clogging was recorded on any filter during the study. For the 0.6 m, 0.9 m and 1.2 m deep filters, total viable counts (TVC) were less than EU surface water directive limits for Class A2 potable water sources. The systems were cheap to construct and very easy to maintain.

Lifestyle and health status in long-term cardiac transplant recipients.

OBJECTIVE: The purpose of this pilot study was to describe the lifestyle and health status of long-term cardiac transplant recipients. DESIGN AND SETTING: The study was a descriptive correlational design at a health sciences center. MEASURES: We measured lifestyle, using the Health-Promoting Lifestyle Profile-II, and indicators of health status (eg, number of medications, infections, and rejections; systolic and diastolic blood pressure; lipid profile; and percent ideal body weight) in 47 patients after an annual evaluation or follow-up visit after patients received cardiac transplantation. RESULTS: Patients were primarily male, white, 56.5 years old and 75.6 months after transplant. Spiritual growth was the most frequently reported lifestyle characteristic (mean, 27.4; SD, 4.9). The least frequently reported lifestyle characteristic was engagement in physical activity (mean, 18.4; SD, 5.7). Factorial between-subjects analysis of variance demonstrated that women had a higher high-density lipoprotein level (P =.0001) and reported healthier dietary habits (P =.02) and greater spiritual growth (P =.006) than men. African Americans reported poorer stress management behaviors (P =.04). Recipients whose heart failure was due to ischemic cardiomyopathy had a lower percent ideal body weight than those with a nonischemic cause (P =.01). Recipients with cardiac allograft vasculopathy had a higher low-density lipoprotein cholesterol level (P =.05) and lower high-density lipoprotein cholesterol level (P =.05) than those without cardiac allograft vasculopathy, and those persons who required maintenance corticosteroid therapy reported poorer interpersonal relationships than those persons not receiving corticosteroids (P =.04). CONCLUSION: Cardiac transplant recipients did not consistently include health-promoting behaviors in their lifestyles although some of the behaviors were associated with a better health status. Future research should be aimed at identifying factors that affect the ability to make and sustain changes in lifestyle and improve health status.

Development and evaluation of a moral distress scale.

AIM OF THE STUDY: This methodological research developed and evaluated the moral distress scale from 1994 to 1997. BACKGROUND/RATIONALE: Although nurses confront moral questions in their practice daily, few instruments are available to measure moral concepts. The methodological design used a convenience sample consisted of 214 nurses from several Unites States hospitals. The framework guiding the development of the moral distress scale (MDS) included Jameton's conceptualization of moral distress, House and Rizzo's role conflict theory, and Rokeach's value theory. Items for the MDS were developed from research on the moral problems that nurses confront in hospital practice. The MDS consists of 32 items in a 7-point Likert format; a higher score reflects a higher level of normal distress. RESULTS: Mean scores on each item ranged from 3.9 to 5.5, indicating moderately high levels of moral distress. The item with the highest mean score (M=5.47) was working where the number of staff is so low that care is inadequate. Factor analysis yielded three factors: individual responsibility, not in the patient's best interest, and deception. No demographic or professional variables were related to moral distress. Fifteen percent of the nurses had resigned a position in the past because of moral distress. CONCLUSION: The results support the reliability and validity of the MDS.

Outcome survey of early intensive behavioral intervention for young children with autism in a community setting.

This article presents findings from an outcome survey of the effects of early intensive behavioral intervention (EIBI) for young children with autism in a community setting. Results from both individual case reviews and parent questionnaires are presented, with the data failing to support any instances of'recovery' while still yielding a high degree of parental satisfaction with the treatment. Moreover, a follow-up inquiry into the type of services each child was receiving in his or her post-EIBI setting documents continued dependence on extensive educational and related developmental services, suggesting that the promise of future treatment sparing did not materialize. Limitations of the survey in evaluating community-based EIBI services are discussed along with the need for further research designed to document the effectiveness of services provided to young children with ASD in the community.

Detection of infectious bursal disease vaccine viruses in lymphoid tissues after in ovo vaccination of specific-pathogen-free embryos.

Control of infectious bursal disease virus (IBDV) by vaccination is important for poultry production worldwide. Two vaccines, an IBDV immune complex (ICX) vaccine and an IBDV-2512 vaccine, were administered at 100 mean embryo infectious dose to specific-pathogen-free 18-day-old broiler embryos in ovo. At 3, 6, 9, 15, and 21 days post in ovo vaccination (PIOV), bursa, spleen, and thymus tissues were collected and analyzed for virus protein by antigen capture chemiluminescent enzyme-linked immunosorbent assay (ELISA). Chicks were bled and antibody titers were determined by the antibody ELISA. At 21 days PIOV, chickens were challenged with a 1:500 dilution of an antigenic standard IBDV strain. At 28 days PIOV, birds were euthanatized and bursa weight:body weight ratios were determined. Embryos vaccinated with either vaccine exhibited 92% hatchability; however, within 1 wk of hatch, birds vaccinated with IBDV-2512 showed 56% mortality, whereas those given IBDV-ICX had only 3.2% mortality. Both IBDV-ICX and IBDV-2512 vaccines were detected in bursa, spleen, and thymus at day 3 PIOV. A 5-day delay in virus replication was observed with IBDV-ICX vaccine. By day 15 PIOV, the IBDV-ICX was no longer detectable in the bursa and spleen but persisted in the thymus. The IBDV-2512 vaccine persisted in the spleen and thymus on day 15 PIOV. By day 21 PIOV, neither vaccine virus was detected in any lymphoid organ. This assay can be useful in the early detection of vaccine virus in the tissues of chickens vaccinated via the in ovo route. Both vaccines caused bursal atrophy at all times PIOV. The IBDV-2512 caused splenomegaly at day 6 PIOV, whereas splenomegaly was not seen in IBDV-ICX-vaccinated birds until day 9 PIOV. Thymus atrophy was observed in IBDV-2512-vaccinated chicks from day 3 PIOV, whereas this occurred on day 15 PIOV in IBDV-ICX-vaccinated birds. Bursa weight: body weight ratios in IBDV-ICX-vaccinated unchallenged and vaccinated challenged birds were not different (P < 0.05).

Continuous measurement of backrest elevation in critical care: a research strategy.

OBJECTIVE: To develop and test a procedure for continuous measurement of backrest elevation in critical care for enhancing the precision of this measurement for research purposes. DESIGN: Descriptive, correlational. SETTING AND MEASUREMENTS: Backrest elevation, defined as the height of the head of the bed in degrees of elevation above horizontal, can be continuously monitored by using two transducers, one attached to the bed frame just distal to the head of the bed gatch and another attached to the bed frame at the top of the bed. By monitoring the differential head pressure between the two pressure channels, the height of the head of the bed can be calculated. A total of 30 random measurements of backrest elevation, from 0 degrees to 60 degrees, were taken by using the backrest elevation measurement on the bed frame, a handheld protractor, and the pressure differential between two transducers attached to the bed frame. Data collectors recorded one measurement independent of the other measurements. All measurements were conducted on the same bed. RESULTS: When the transduced method was compared with measurements by using a protractor, the Bland-Altman analysis technique yielded upper and lower limits of agreement of 8.93 degrees and -5.91 degrees, respectively. The bias was 1.51 degrees, and the precision was 3.71 degreees. CONCLUSIONS: The measurement technique described here was developed for research purposes to add precision to research studies examining the appropriate height of the backrest. However, the procedure could be used in a continuous quality improvement process to enhance compliance with patient care procedures involving backrest elevation or to confirm actual nursing practice and its correlation with patient outcome. In light of the risks associated with the use of supine positioning in critically ill and mechanically ventilated patients, the information gained from continuous measurement of backrest position could be an extremely valuable research tool.

Attitude, self-image, and quality of life of living kidney donors.

The purpose of this research was to assess the attitude, self-image, and quality of life of living kidney donors. This research employed an exploratory design. Instruments included Simmons and colleagues' (1977, 1987) measures on donor attitude and self-image, Ferrans and Powers (1992) scale on quality of life, and Cantril's (1965) ladder of life. Social desirability was also measured. Fifty-five living kidney donors from one transplant program participated in the research. Donations had been made recently or as long as 25 years ago. The research determined that men were significantly more ambivalent about donating than women. Significantly higher levels of predicted self-esteem and independence were found in African-American donors, those with higher levels of education, and those who had recently donated a kidney. Scores on quality of life were high for all donors, and they expected that their quality of life would improve in the next 5 years. Social desirability scores were high for 65% of the donors. The quality of life of donors is high and similar to other healthy persons from reported research. The findings in the difference in self-esteem and independence between those who donated before and after 1990 as well as the social desirability scores are reasons to conduct further research on living donors.

Hostility toward caregivers as a selection criterion for transplantation.

Researchers have focused on hostility and aggression of psychiatric patients but little is known about what effects transplant candidates' hostility toward their caregivers has on the care the candidates receive. Hostility is defined as any verbal, nonverbal, or physical behavior which threatens persons or property. Although hostility may be one of the precipitating factors in the need for an organ transplant, it may also be a response of the patient to his or her condition. This study focused on whether transplant coordinators felt that hostility should be used as a criterion for accepting or rejecting a transplant candidate. A nonexperimental descriptive survey design targeted 559 organ transplant coordinators who were members of the North American Transplant Coordinators Organization. Many coordinators in this study (62%) felt that a hostile candidate should not receive an organ transplant. Different methods of caring for hostile patients should be explored, especially for those who are antagonistic and who exhibit aggressive behaviors. Given the scarcity of donor organs, ethical principles must guide the allocation of these organs and the selection of transplant recipients.

Use of backrest elevation in critical care: a pilot study.

BACKGROUND: Use of lower backrest positions occurs frequently and is a factor in the development of ventilator-associated pneumonia. OBJECTIVES: To determine the usual bed elevation and backrest position in a medical intensive care unit and their relationship to hemodynamic status and enteral feeding. METHODS: Data were collected in a 12-bed medical respiratory intensive care unit for 2 months. A protractor was used to measure the elevation of the head of the bed. Hemodynamic status was defined by systolic, diastolic, and mean arterial blood pressure measurements retrieved from each patient's flow sheet. RESULTS: The sample included 347 measurements of 52 patients. Mean backrest elevation was 22.9 degrees, and 86% of patients were supine. Backrest position differed significantly (P = .005) among nursing shifts (days, evenings, nights) but not for systolic (r = -0.04, P = .49), diastolic (r = 0.01, P = .83), or mean arterial blood pressure (r = -0.01, P = .84). Backrest elevation did not differ significantly between patients who were receiving enteral feedings and patients who were not (P = .23) or between patients receiving intermittent versus continuous nutrition (P = .22). CONCLUSIONS: Use of higher levels of backrest elevation (> or = 30 degrees) is minimal and is not related to use of enteral feeding or to hemodynamic status. The rationale for using lower backrest positions for critically ill patients may be based on convenience, the patient's comfort, or usual patterns in the unit. However, the dangers of supine positioning and its relationship to aspiration and ventilator-associated pneumonia should not be minimized.

Rationing organs using psychosocial and lifestyle criteria.

The role of patient psychosocial and lifestyle characteristics in decisions about the allocation of scarce health care resources has not been examined. In this national survey using the Criteria for Selection of Transplant Recipient (CSTR) Scale, organ transplant coordinators (N = 559) identified the psychosocial and lifestyle criteria they believe should be considered in patient selection/rejection for organ transplant. Using factor analysis to reduce the data, six factors were identified: current lifestyle/psychiatric problems, family/socioeconomic issues, habits, controlled lifestyle/psychiatric issues, cost, and stigmatized conditions. Patients who were in prison for a serious crime, used cocaine, had AIDS, or were HIV positive (criteria making up the Stigma factor), were more likely to be labeled for exclusion from transplant than those with other psychosocial/lifestyle characteristics. When transplant coordinators perceived that patients' psychosocial and lifestyle problems were under control or corrected, they were more likely to consider them for a transplant. For all but the cost factor, criteria were most stringent for heart transplants. Although over 90% of the coordinators assessed patients and participated in patient selection for transplant, master's prepared nurses were more likely than nurses with other educational preparation to be involved in organ recipient selection. These findings can serve as a prototype for how decisions are made for allocating other scarce health care resources.

Ethical dimensions of nurse-physician relations in critical care.

Recent research findings highlight the importance of nurse-physician collaboration for more positive patient outcomes. Nowhere is this more important than in addressing the ethical aspects of critical care practice. Differences in values, communication, trust, and responsibilities can precipitate conflict between nurses and physicians over ethical components of care. Strategies to address these ethical conflicts and improve nurse-physician collaboration are needed at both the organization and policy level.

The dark side of nursing: impact of stigmatizing responses on patients.

The current emphasis in nursing is on caring, what it involves and why it is the profession's responsibility. This article focuses on the opposite behaviors--the "dark side of nursing" (Jameton, 1992). By developing a fuller understanding of nurse behaviors labeled the "dark side of nursing," the profession can better comprehend what caring involves and develop innovative ways to reduce dark-side behaviors. Although marginalizing, labeling and stereotyping, and stigmatizing are related, the focus will be on stigmatizing responses to patients. A number of investigators document nurse stereotyping of suicidal patients, persons with AIDS, racial/ethnic groups, and sex offenders and the impact on patients. Social psychological theories on stereotyping and deviant behavior provide some explanation for the nurse's behavior. The organizational perspective, however, has not been employed to enhance our understanding of nor to eliminate this phenomenon. Combining an organizational perspective with the social psychological theory of negative stereotyping (stigmatizing) and philosophical theory involving ethics provides a more comprehensive theory for understanding the "dark side of nursing" and designing interventions to reduce the occurrence of this damaging behavior.

Environmental turbulence: staff nurse perspectives.

The purpose of this qualitative study was to explore staff nurses' perceptions of how turbulence in the internal environment affected their ability to provide patient care. The themes that emerged from the data point toward multiple factors impinging on a staff nurse's ability to provide quality care in today's healthcare environment. The authors discuss these factors, the consequences for staff nurses, patients, and the organization, and the implications for nursing administrators and their colleagues in hospital administration.

Techniques in evaluating nursing expert systems: A case study.

This study addresses the problems in evaluating nursing diagnostic artificial intelligence (AI) expert systems. Two separate experiments (N = 49) were conducted using a computer expert system. The first experiment, the "white box" experiment (n = 9), compared the diagnostic techniques applied by experience RNs against the programmed techniques used by the expert system. The second experiment, the "black box" experiment (n = 40), compared diagnostic results of beginning nurses against the computer expert systems results. In some cases the computer outperformed the nurses and vice versa. The evaluation techniques, as applied in both experiments, enhance the ability of nurses to evaluate and select AI expert systems to be used in computer-assisted diagnosis of nursing problems.

Endotracheal suctioning: ventilator vs manual delivery of hyperoxygenation breaths.

BACKGROUND: Despite a large number of studies on endotracheal suctioning, there is little data on the impact of clinically practical hyperoxygenation techniques on physiologic parameters in critically ill patients. OBJECTIVE: To compare the manual and mechanical delivery of hyperoxygenation before and after endotracheal suctioning using methods commonly employed in clinical practice. METHODS: A quasi-experimental design was used, with twenty-nine ventilated patients with a lung injury index of 1.54 (mild-moderate lung injury). Three breaths were given before and after each of two suction catheter passes using both the manual resuscitation bag and the ventilator. Arterial pressure, capillary oxygen saturation, heart rate, and cardiac rhythm were monitored for 1 minute prior to the intervention to obtain a baseline, continuously throughout the procedure, and for 3 minutes afterward. Arterial blood gases were collected immediately prior to the suctioning intervention, immediately after, and at 30, 60, 120, and 180 seconds after the intervention. Data were analyzed with repeated measures analysis of variance. RESULTS: Arterial oxygen partial pressures were significantly higher using the ventilator method. Peak inspiratory pressures during hyperoxygenation were significantly higher with the manual resuscitation bag method. Significant increases were observed in mean arterial pressure during and after suctioning, with both delivery methods, with no difference between methods. Maximal increases in arterial oxygen partial pressure and arterial oxygen saturation occurred 30 seconds after hyperoxygenation, falling to baseline values at 3 minutes for both methods. CONCLUSION: Using techniques currently employed in clinical practice, these findings support the use of the patient's ventilator for hyperoxygenation during suctioning.

Moral distress of critical care nurses.

BACKGROUND: Constraint of nurses by healthcare organizations, from actions the nurses believe are appropriate, may lead to moral distress. OBJECTIVE: To present findings on moral distress of critical care nurses, using an investigator-developed instrument. METHODS: An instrument development design using consensus by three expert judges, test-retest reliability, and factor analysis was used. Study participants (N = 111) were members of a chapter of the American Association of Critical-Care Nurses, critical care nurses employed in a large medical center, and critical care nurses from a private hospital. A 32-item instrument included items on prolonging life, performing unnecessary tests and treatments, lying to patients, and incompetent or inadequate treatment by physicians. RESULTS: Three factors were identified using factor analysis after expert consensus on the items: aggressive care, honesty, and action response. Nurses in the private hospital reported significantly greater moral distress on the aggressive care factor than did nurses in the medical center. Nurses not working in intensive care experienced higher levels of moral distress on the aggressive care factor than did nurses working in intensive care. Of the 111 nurses, 12% had left a nursing position primarily because of moral distress. CONCLUSIONS: Although the mean scores showed somewhat low levels of moral distress, the range of responses revealed that some nurses experienced high levels of moral distress with the issues. Research is needed on conditions organizations must provide to support the moral integrity of critical care nurses.

Patient and nurse criteria for heart transplant candidacy.

The criteria nurses and patients believe should be used to allocate hearts for transplantation were explored and compared in a descriptive study. Although the majority of both groups agreed that patients with AIDS or who are HIV positive should not receive a transplant, the two groups agreed very little on the other criteria. This research has implications for clinical care and ethical decision making.