Training community health workers: factors that influence mammography use.

The purpose of this study was to assess factors that influence mammography use among volunteer community health workers (CHWs). Data trends indicate lower mammography rates among minority and low-income women. Although CHW interventions have been shown to promote mammography use among this population, training strategies and the use of a comprehensive needs assessment are lacking. Using a cross-sectional study design, data were collected via a mailed survey. The dependent variable was mammography use within the past 2 years. The independent variables were categorized according to the factors in the PRECEDE-PROCEED model. Predisposing factors included susceptibility, barriers, benefits, health motivation, self-efficacy, education, and age. Enabling factors included income, health insurance, and regular source of care. Reinforcing factors included physician recommendation to get a mammogram, social norms, and family history of breast cancer. Self-reported data from a mailed survey were obtained from a convenience sample of urban CHWS (N = 109) ages 40-73 with a mean age of 55 (SD = 9.43). The sample included 90% African American and 8% White women. Logistic regression results showed barriers to be predictive of mammography use among CHWs controlling for age, self-efficacy, health motivation, and social norms. The findings suggest CHW training focus on how to identify and address barriers to increase the likelihood of mammography use among CHWs. Future research is needed to identify cultural differences in barriers for minority CHWs.

Survivors' guilt following sudden traumatic loss: promoting early intervention in the critical care setting.

Survivors' guilt is a pervasive mental health issue that is often initially manifested by family members in the critical care unit. With increased awareness and enhanced targeted assessment, critical care nurses are in a unique position to begin the initial processes of adaptive coping and functional grief and bereavement in surviving family members. Because the trajectory of grief and bereavement are often complex and long term, the additional complication of survivors' guilt can lead to many psychosocial and physical manifestations and sequelae. However, with early identification and intervention relative to the underlying factors of survivors' guilt, including appropriate referral and psychoeducational intervention and resources, critical care nurses can enhance and extend their care to families in the throes of significant and sudden loss and intrapsychic trauma.

The school nurse's role in prevention of student use of performance-enhancing supplements.

An alarming trend in the United States is the use of performance-enhancing supplements by children and adolescents. These widely available over-the-counter products, often marketed as natural substances, are not regulated by the Food and Drug Administration and are thus widely available. High school and even middle school students are using these supplements because they are misled into thinking that supplements will enhance their athletic skills resulting in an improvement in their performance. Yet, the safety and long-term effects of these supplements have not been established in reputable or prevalent studies. School nurses have a unique opportunity and even an ethical responsibility to help in efforts to address this growing trend. Specific roles for the school nurse include serving as a student advocate for the health and safety of children and adolescents; identifying at-risk students; forming partnerships with teachers, parents, students, coaches, athletic trainers, and local health care providers; evaluating and refining health-oriented curricula; collecting and disseminating new knowledge; and staying abreast of new findings.

Failure rates in nonlatex surgical gloves.

BACKGROUND: The purpose of this study was to compare the frequency of glove defects for nonlatex surgical gloves while surgeons performed routine surgery and to evaluate surgeons' satisfaction with nonlatex sterile gloves. METHODS: Two brands of latex gloves and 6 brands of nonlatex gloves were tested. Gloves were collected at the end of each surgical procedure and tested for visual defects and barrier integrity using an automated calibrated water test machine consistent with FDA's recommended standards. A total of 6386 gloves used by 101 surgeons and 164 residents representing 15 surgical services were included in the analysis. RESULTS: Higher after-use defect rates occurred in nonlatex surgical gloves than in latex gloves. Higher times of use were related to higher defect rates for some surgical specialties, and both surgeons and residents were less satisfied with nonlatex surgical gloves. CONCLUSION: Intact latex and nonlatex surgical gloves provide adequate barrier protection. Nonlatex surgical gloves have higher failure rates and lower user satisfaction than latex gloves do. Both nonlatex and latex gloves should be changed after 2 to 3 hours of use because the barrier of either type of glove becomes compromised with extended use.

Using standardized patients to teach and evaluate nurse practitioner students on cultural competency.

With the increasing diversity in the American population, it is imperative that nurse practitioners learn to manage patients with varying healthcare beliefs and needs. In order to develop culturally competent nurse practitioners, a number of methods have been developed. Many of the current methods focus on improving the awareness and knowledge of nurse practitioners regarding diverse populations. However, very few of the current programs focus on improving the skills and increasing the encounters the students have with diverse populations. This paper focuses on providing nurse practitioner students with diverse encounters using culturally enhanced standardized patient scenarios. The standardized patient programs provide nurse practitioner students with the opportunity to develop knowledge and skills related to cultural competency in a safe environment where the students can practice communication and physical assessment skills as they receive feedback from the patients they are seeing.

Health care workers: risk factors for nonlatex and latex gloves during surgery.

This study examined glove failure and related factors in both nonlatex and latex surgical gloves after routine use. A federally funded research study was conducted to collect surgical gloves from those directly involved in surgical procedures. All gloves were examined in the laboratory for both visual defects and barrier integrity. A total of 11,118 usable surgical gloves were examined. The overall defect rate was 7.8%; nonlatex gloves were significantly more likely to fail (8.4%) than latex gloves (6.9%). The majority of defects in the latex gloves (90%) and nonlatex gloves (70%) were not detected by visual examination. Separate logistic regression models examined predictors of defects for the gloves. The only factor that increased the odds of a defect for a latex glove was duration of use over 6 hours. Factors increasing the odds of a defect in nonlatex gloves included gloves worn by a scrub person and gloves used in certain surgical services. Scrub persons had a higher defect rate despite wearing their gloves for a significantly shorter time than other health care workers. Latex and nonlatex gloves fail under different conditions. Latex gloves fail primarily due to length of use, whereas nonlatex gloves are more sensitive to conditions of us (e.g., type of health care worker and type of surgery). Providers can help guard against glove defects by double gloving and by changing gloves often, especially when using nonlatex gloves in higher-risk surgeries.

How physicians feel about assisting female victims of intimate-partner violence.

PURPOSE: To assess the feelings of physicians about assisting female victims of intimate-partner violence (IPV), and to examine factors related to positive and negative feelings about assisting victims of IPV. METHOD: In 1998, a total site sample of 150 physicians practicing in a large general hospital in the area of Virginia Beach, Virginia, was surveyed by questionnaire via the mail. Four specialties were represented: emergency medicine, family practice, obstetrics-gynecology, and psychiatry. The questionnaire asked about medical training and training in assisting victims of IPV. The physicians' feelings about working with victims of IPV were measured on a nine-item, five-point semantic differential scale. RESULTS: A total of 76 physicians responded to the questionnaire (response rate = 51%). Only a minority (11%) had overall positive feeling scores about assisting victims of IPV. While most physicians reported that it was "significant work," the great majority also felt that it was difficult, low-paying, and stressful. Training in assisting victims of IPV, in medical school or afterwards, did not appear to influence feelings about assisting victims of IPV. However, physicians who were white and who were married (the majority of the respondents) were significantly more likely than the other respondents to feel negatively about providing services to victims of IPV. CONCLUSION: Graduate medical education and training programs need to address the association of negative feelings with helping women harmed by IPV, because these feelings may interfere with the appropriate screening, referral, and treatment of these victims.

Management of respiratory syncytial virus with lower respiratory tract infection in infants and children.

Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infection in infants and children requiring pediatric hospitalizations. Infants with chronic lung, cardiac, or neuromuscular conditions are at increased risk for RSV infection. Early RSV is associated with subsequent diagnosis of reactive airway disease. The management of RSV with lower respiratory track infection in infants and children remains controversial. Bronchodilators may have some short-term benefit, but are not recommended as standard practice for infants and children. Antiviral therapy may be used for high-risk and severely ill patients. Corticosteroids may be effective in cases of moderate to severe RSV with lower respiratory track infection. Monoclonal antibodies have shown some promise in achieving passive immunity for those at greatest risk, including preterm infants younger than 1 year or infants younger than 2 years with chronic lung disease. Emergency management remains primarily supportive, with vigilant monitoring of oxygenation and hydration status. Interventions include supplemental oxygen therapy, ventilation, and fluid and nutrition therapy. Respiratory syncytial virus prophylaxis for high-risk patients includes intramuscular injections of palivizumab (Synagis) each month during RSV season, from November through April. Prevention strategies include washing hands, cleaning environment surfaces, and isolating infants and children with RSV in the emergency care area.