From hospital to nursing facility: factors influencing decisions.

This study addresses the factors influencing decisions to send medicine-surgical (med-surg) patients home or to nursing facilities (NFs). The sample (n = 7,852) was taken from a large, urban, teaching, med-surg unit where discharges were documented and data collected over a two-and-a-half-year period. Using logistical regression, the factors found to most influence the decision were age (z = 26.99, p = .000; odds = 1.06); patients diagnosed with "musculoskeletal system" problems (z = 11.07, p = .000; odds = 5.36); and needing skilled professional care (z = -15.03, p = .000; odds = .21) or nonprofessional personal care (z = 6.62,p = .000; odds = 2.32). Having less effect, but important information for discharge planners, was being an African American (z = 3.82, p = .000; odds = .76) or Latino (z = -3.96, p = .000; odds = .54). A review of the literature found limited knowledge of the factors that influence hospital patients, family members, and professionals, including social workers, to make the decision to recommend home care or NF care.

Deconstructing stigma: perceptions of HIV-seropositive mothers and their disclosure to children.

This study addressed the perceptions of stigma and disclosure behavior of HIV-seropositive mothers. Eighty-eight HIV-seropositive women in New York City completed two independent measures of stigma, the Perceived Stigma Scale and the Devaluation-Discrimination Measure. Disclosers (67%) and nondisclosers (33%) were similar in most sociodemographic characteristics-marital status, race, religion and employment, with the exception of age and education. Significant differences were found between disclosure groups in the use of secrecy as a stigmamanagement tool and in perceived devaluation-discrimination associated with an HIV diagnosis. Nondisclosers to children were significantly more likely than disclosers to use secrecy as a stigma management tool (t =-2.76; p =.01), and to feel devalued and discriminated against as a result of HIV serostatus (t = 3.11; p =.01). Disclosure of parental HIV serostatus to children is an important aspect of continuous care and custody planning. Secrecy and perceptions of devaluation and discrimination related to HIV diagnosis should be seen as barriers to disclosure of serostatus to children.