Recruitment and retention of healthy minority women into community-based longitudinal research.

This report examines the impact of individualized, population-based recruitment and retention approaches on the development of a subject pool, enrollment, and retention at 12 months of healthy, community-based women in three ethnic groups: African Americans, non-Hispanic European Americans, and Mexicans/Central Americans. Of 722 women contacted and screened, 346 (48%) were eligible and consented to participate. Attrition at 12 months was low (10%) compared with other published reports. The largest group of potential subjects was identified through broadcast media approaches, but this method produced the highest number of ineligible women and highest rate of attrition. Printed matter produced the next largest group of potential subjects, but ineligibility was high (53%). Face-to-face interactions enrolled the highest proportion of eligible women (84%) and lowest overall attrition (7%). Direct referral yielded fairly efficient enrollments (57%) and average attrition. Multiple approaches for recruitment can produce a diverse sample of healthy, community-based women. Face-to-face recruitment results in the highest yield of participants with the lowest attribution but is presumed to require more resources.

Evaluating advanced practice nursing care through use of a heuristic framework.

In our modification of a quality of care framework, we blended the labels of both models with respect to structure, labeling it structure/inputs. We then specified the types of characteristics in each of the 12 cells that can guide the evaluation of the areas of interest in a primary care system. The identification of characteristics of this conceptual framework and its subsequent application are important for a number of reasons. Specifically, this framework systematically organizes standardized data elements that are critical to monitoring and subsequently improving quality of care, guiding research, influencing policy, and developing nurse-sensitive patient outcomes.

Implementing a nurse information system in a nurse-managed primary care practice: a process in progress.

As part of a larger project, a nurse-managed primary care clinic (Valencia Pediatric and Family Practice) sought to implement a nursing information system for the purposes of (1) patient record keeping, (2) capturing advanced practice nursing interventions and outcomes and transforming them into standardized language, (3) project data management, and (4) evaluating advanced practice nursing care thereby improving and standardizing quality of care. This article represents the background information for selection of a data management system and early experiences of implementation.

Growing up with congenital heart disease: the dilemmas of adolescents and young adults [see comment].

Advances in diagnosis, medical management and surgical intervention have improved the longevity and quality of life for children with congenital heart disease. Despite this, research studies specifically examining the psychosocial concerns of adolescents and young adults with congenital heart disease are few. To explore the subjective experiences and dilemmas of this population during the transition from adolescence to young adulthood, we interviewed, using a semi-structured protocol, a convenience sample of nine adolescents and young adults. Using analytic procedures inherent in Grounded Theory methodology, seven themes were identified: the dilemma of normality; dilemmas in disclosure; dilemmas in strategies for management of illness; the challenge of social integration versus social isolation; the challenge of dependence versus independence; the challenge of uncertainty; and strategies for coping. An understanding of these experiences by health professionals can be beneficial in helping this clinical population as they grow up and face the challenges of an uncertain, yet promising, future.

Nurse practitioners, certified nurse midwives, and physician assistants in California.

California's health care industry includes workers prepared in many ways to perform many jobs. One significant group of health care workers prepared to provide care that often overlaps with physician-generated services is known as "nonphysician providers." Commonly, this label refers to nurse practitioners (NPs), certified nurse midwives (CNMs), and physician assistants (PAs). In this article, we will describe this group in five main areas: (1) the characteristics of the current and projected workforce and programs preparing these professionals; (2) the current skill expectations and knowledge bases of each; (3) trends in the education of these health professionals; (4) innovative models of education of these health professionals; and (5) the inclusion of NPs, PAs, and CNMs in workforce planning in a changing health care system. We conclude that, particularly in light of the overlapping functions of this provider group with many physician functions, the NP, CNM, and NP workforces must be recognized and considered when planning for the future of the physician workforce.

The dilemmas of parents of adolescents and young adults with congenital heart disease.

OBJECTIVE: To provide a better understanding of parents' experiences as their children with congenital heart disease mature through adolescence and young adulthood. DESIGN: A qualitative pilot study. SETTING: The physician practices of the pediatric cardiology service of a large university medical center. SUBJECTS: Eight parents of adolescents and young adults with congenital heart disease. INTERVENTION: Each parent was separately interviewed with use of a semistructured interview guide. RESULTS: Our study has identified seven themes--the dilemmas of normality, disclosure dilemmas, the challenge of uncertainty, illness management dilemmas and strategies, social integration versus social isolation, the impact of illness on the family, and coping--with which parents have struggled through-out their adolescent's and young adult's life. It was not possible to determine whether the experiences described by these parents are unique. CONCLUSIONS: Parents experience distress, as outlined in the seven themes. They need assistance to determine what is "normal" for their child and how to monitor their child's health and safety. Further research is needed to develop specific interventions.

Measuring parental grief after childhood cancer: potential use of the SCL-90R.

To contribute to a better understanding of the utility of the Symptom Checklist-90-Revised (SCL-90R; L. Derogatis, 1983) with bereaved samples, an exploratory factor analysis was conducted on SCL-90R responses of 97 parents 2 years after the death of their child from cancer. The factor analysis revealed one significant factor that accounted for 30% of the variance in this administration. This factor included many items that reflected the theme of somatic complaints.

Practice environment for nurse practitioners in California. Identifying barriers.

Barriers exist that prevent nurse practitioners from using their primary health care knowledge and skills. We present the incidence of and specific barriers experienced by nurse practitioner respondents in California, the state with the largest number of nurse practitioners in the nation. A January 1995 survey was sent to all nurse practitioners certified in California to elicit their experiences regarding legal or social barriers in their practice, with space for an open-ended response. Of an estimated 3,895 nurse practitioners in California, 2,741 (70%) returned surveys. Most nurse practitioner (65%) respondents in California are providing primary care. Perceived barriers to practice are lack of prescriptive authority, lack of support from physicians, reimbursement difficulties, and lack of public awareness. Current barriers to nurse practitioner practice in California are similar to national barriers discovered in 1992 data. The development of interprofessional dialogue and the recognition of the contributions of all primary care professionals are some of the steps that can be taken to reduce these barriers and increase the use and effectiveness of nurse practitioners in primary care.

The frequency and troublesomeness of symptoms associated with Alzheimer's disease.

An increased understanding of the frequency and troublesomeness of symptoms for family members who are caring for a victim of Alzheimer's disease (AD) would be helpful for nurses in working with these families. This article reports on the changes of these symptoms over time as well as the troublesomeness of these symptoms for 30 families over an 18-month period. A symptom checklist based on George's Patient Illness Symptoms Checklist (George, 1983) was used. Over time the reported symptoms reflected increased mental impairment, which is associated with AD. For some of the symptoms, there was an increase in the symptoms' frequency, but their troublesomeness did not increase. Family caregivers who reported more symptoms for each time period also reported an increase in institutionalization of the AD member.

Managed outcomes: a strategy to improve the nation's health.

Current health care delivery systems in the United States have led to high cost, uneven quality, less than universal coverage, undue emphasis on a medical/clinical model, and scant attention to primary care and prevention. In the context of health care reform, a new strategy is introduced that reverses present trends and incentives, called managed outcomes. This strategy is not specific to any particular health care delivery system. Managed outcomes encourages experimentation and flexibility in the design of health care systems and fosters primary care, health promotion, and disease prevention models. It links purchasing decisions to established specific and measurable goals that can provide quality and cost-effective services to improve health.

Correlates of fatigue in older adults with rheumatoid arthritis.

The purposes of this study were to describe the prevalence of fatigue, examine the association between fatigue and doctor visits, and identify correlates of fatigue in rheumatoid arthritis (RA). On average, a high degree of fatigue was reported to occur every day, to remain constant during the course of a week, and to most often affect walking and household chores. When controlling for disease severity and insurance coverage, respondents who reported more fatigue made more visits to the rheumatologist than those reporting less fatigue. A regression model with fatigue as the dependent variable revealed that the following variables explained a significant amount of variance: pain rating, functional status, sleep quality, female gender, comorbid conditions, and duration of disease.

A randomized clinical trial of nursing care for recovery from cardiac surgery.

OBJECTIVE: To determine the efficacy of a psychoeducational nursing intervention in patients who receive coronary artery bypass graft and valve repair surgery. DESIGN: A cluster-randomized controlled trial design. SETTING: Two hospitals in the western United States--a large community hospital with an active cardiovascular surgery practice and a health-sciences research center. SUBJECTS: 156 patients between 25 and 75 years of age, 125 (81.1%) men, and 31 (19.9%) women, all with primary care givers. OUTCOME MEASURES: Self-efficacy expectations, activities (behavior performance), quality of life, mood state. INTERVENTION: Supplemental in-hospital education followed by telephone contact from discharge to eighth week after discharge. RESULTS: Patients in the experimental group reported significantly greater self-efficacy expectations for walking and behavior performance for walking, lifting, climbing stairs, general exertion and, where applicable, for working. CONCLUSION: This trial suggests that a low-intensity psychoeducational nursing intervention can promote self-efficacy expectations for walking in recovery and is associated with more self-reported walking and lifting behavior after cardiac surgery.

Predictors of general activity 8 weeks after cardiac surgery.

In this secondary analysis, the influence of mood states and self-efficacy beliefs on recovery of general activities 8 weeks after cardiac surgery were investigated. Study data were taken from a randomized clinical trial with 156 subjects who were either in an efficacy enhancement nursing care group (n = 75) or in a routine care group (n = 81). It was found that self-efficacy beliefs at time of hospitalization regarding ability to resume general activities after discharge, measured tension/anxiety at 4 weeks after surgery, and experimental group status explained 21% of the variation in self-reported recovery at 8 weeks.

Family nursing research: precepts from paragons and peccadilloes.

The authors present 10 precepts that address the successes, as well as complexities and shortcomings, found in family nursing research as it has been conducted over the past decade. Problems with methodology, data collection and aggregation, random variables, and consistency with the unit of analysis all present challenges to the proper conduct of family nursing research. The authors cite these and other concerns in a critical analysis illustrated by examples from the growing body of family nursing literature.

The family dimension of cardiovascular care.

Cardiovascular disease, like many other life-style-related health problems, is argued to have its origins related in part to health practices first learned in the family. Further, empirical work has shown that the responses of family members to the onset of acute cardiac symptoms contribute significantly to how quickly care is sought. Finally, considerable empirical evidence exists to suggest that families both aggravate and are affected by acute and chronic cardiac illness. Nonetheless, the involvement of the family in cardiac preventive or curative activities remains limited, and the ability of most nurses to appreciate the family as a unit and treat it as a client even more so. This paper describes the nature of family nursing vis-a-vis a cardiovascular event.

Family nursing research, theory and practice.

The absence of critical dialogue regarding what constitutes family nursing prevents the further development of the specialty area of family nursing. In this essay, the author issues nine challenges faced by those who would contribute to the development of family nursing.

Patterns of fecal coliform contamination in day-care centers.

During a six-month period, on four separate occasions, six licensed day-care centers had cultures taken from environmental surfaces as well as the hands of children and teachers. Fecal coliforms were recovered from 64 (9.5%) of the 675 surfaces sampled. Recovery rate was not influenced by a center's socioeconomic status, time of year, or presence of children who were not toilet trained. Recovery rates did differ significantly in different areas, with the kitchen showing a relatively high recovery rate (19%), and toys and toilets showing remarkably low rates (2% and 4%). Centers with formal hand-washing procedures had lower recovery rates than those without such practices. We also demonstrated a high recovery rate from hands of staff (16%); 6% of children had positive cultures. Contamination of hands and classroom objects is a potential source for the transmission of enteric diseases for children in day-care centers. A program directed at reducing contamination would be important in preventing the spread of diarrheal illness.