Well-being and concerns of patients with peripheral arterial occlusive disease.

Peripheral arterial obstructive disease (AOD) affects an estimated 2.4 million persons in the United States, resulting in disability, morbidity, and even death in the elderly. Insight into the general well-being (GWB) of patients who have AOD can enhance the comprehensiveness of nursing care provided to these patients. GWB was examined in a study of 170 patients with peripheral AOD treated at a Veterans Affairs Medical Center (VAMC). The GWB instrument constructed by Dupuy and used extensively by the Rand Corporation was administered to provide an objective measure of well-being. Two open-ended questions regarding patients' concerns associated with their AOD provided more subjective information. The mean GWB score for the VAMC patients was lower than the mean score reported by the Rand Corporation for a group of healthy individuals, and this lent support to the construct validity of the instrument. The general health and vitality subscales appeared to have the widest difference in mean scores. Within the VAMC patient sample, GWB did not vary among age groups but did vary slightly in an inverse direction with the severity of the circulatory impairment. The concerns noted included fear of increased pain, lack of mobility, and fear of amputation.

PVD: nurse--patient interventions.

The intervention program described began with teaching patients in simple terms about PVD, associated risk factors, and why change is important. Teaching aids such as posters and booklets were used to supplement discussion. Positive reinforcement was emphasized. Phone calls, follow-up visits, encouragement and praise were frequent. Newsletters focusing on different aspects of the various risk factors were developed and mailed monthly. Patients were encouraged and helped to develop an individualized program of change based on discussions and practicality. They were encouraged to start slowly and increase gradually. Emphasis was placed on reinforcement, self-help, and praise for efforts. Patients were encouraged to keep a brief daily log of progress and thoughts. Regularly scheduled physical assessments provided a tool to assess change and provide tangible evidence of their ability to set a goal, follow through, and make life-style change.

A national survey to identify evaluation criteria for programs of health care for homeless.

We know that programs to deliver health care to the homeless are springing up all over the nation, but are they effective? Hunter, Crosby, Ventura and Warkentin attempt to get a sense of what data is being collected. In doing so, they identify the difficulties in collecting data on this transient population.

Increasing productivity by developing alliances.

Collaborative alliances among nurses may provide a feasible and satisfying opportunity to increase the productivity of nurses. Inherent in successful alliances are the development of trust, compatibility, commitment, and mutality of benefits. The development of collaborative relationships among clinical research nurses, a research methodologist, and a nurse educator resulted in several federally funded grants and publications. The alliances described here cross disciplines and institutions and demonstrate the enhanced productivity that can result from such efforts.