Translating infant safe sleep evidence into nursing practice.

The authors describe a 4-year demonstration project (2004-2007) to reduce infant deaths related to sleep environments by changing attitudes and practices among nurses who work with African American parents and caregivers in urban Michigan hospitals. An approach was developed for creating sustainable change in nursing practice by implementing nursing practice policies that could be monitored through quality improvement processes already established within the hospital organization. Following the policy change effort, nurses changed their behavior and placed infants on the back to sleep.

Attitudes, experiences, and interest in geriatrics of first-year allopathic and osteopathic medical students.

A cross-sectional survey was designed to assess interest in geriatric medicine of allopathic and osteopathic medical students and to determine whether their career interests were related to past experiences with and current attitudes toward older adults. The study was conducted at an allopathic and osteopathic medical school with 231 first-year medical students. Experiences with elderly people were measured using survey questions assessing amount and quality of experiences with grandparents, as well as experiences caring for, volunteering with, or having a paid position working with older adults. Attitudes were measured using the University of California at Los Angeles Geriatric Attitudes Scale, revised for applicability to medical students. Interest in geriatrics was measured using a 4-point scale. Overall, students expressed positive attitudes toward older adults. Past experiences, including positive relationships with older relatives (P<.001) and experiences providing care for older adults (P<.001), were related to more-positive attitude scores toward elderly people. Students had low interest in geriatric medicine, but those with more-positive attitudes were more likely to consider geriatrics as a career (odds ratio=8.18, P<.001). Furthermore, having prior experience caring for older persons increased interest in the field (P=.001). No significant differences were found between allopathic and osteopathic student interest in geriatrics or attitudes toward older adults. Efforts toward increasing the pool of future geriatricians and increasing positive attitudes toward older patients could be improved by providing quality experiences caring for and interacting with older adults before medical school training.

Sense of community in clubhouse programs: member and staff concepts.

Psychological sense of community within psychosocial rehabilitation clubhouse programs was examined using concept mapping with 18 members and 18 staff from 10 programs. Members identified four concepts: Recovery, social connections, membership, and tasks and roles. Members described hope and healing as aspects of recovery. Members' views on sense of community focused on the rehabilitation and social nature of the program. Staff also identified four concepts: Affiliation and support for members, shared experiences, clubhouse organization, and task and roles. The staff concept of clubhouse organization, which incorporated the ideas of leadership and organization of physical space and the concept of task and roles, was based on ideas of shared responsibility and clubhouse procedures. Staffs' views on sense of community strongly reflected their formal training in clubhouse principles. The relation of these concepts to McMillan and Chavis' theoretical framework for sense of community is discussed and recommendations for practice provided.

Involvement in 12-step programs among persons with dual diagnoses.

Although many people with substance use problems are referred to Alcoholics Anonymous (AA) or Narcotics Anonymous (NA), few studies have examined characteristics of persons who comply with such referrals. In particular, little is known about self-help meeting attendance by persons with dual diagnoses. This study examined rates of AA and NA attendance among 351 persons with dual diagnoses who were treated in a hospital setting. It also explored the relationship between diagnosis and meeting attendance. Ten months after hospitalization, the study participants demonstrated rates of AA or NA attendance that were similar to those of persons who were diagnosed as having substance use disorders without severe mental illness. However, patients with schizophrenia or schizoaffective disorders reported significantly fewer days of AA or NA meeting attendance.