A proposed framework for differentiating the 21 Pew competencies by level of nursing education.

Now nearly a decade old, the original Pew Health Professions Commission Competencies have stood up well to the test of time. The competencies were designed to provide all health professionals, from physicians to physical therapists, with a general guide to the values, skills, and knowledge they would need to be successful in the health care system that was beginning to emerge in the late 1980s. They have been used across the range of health professions and in many practice settings to create a framework for curricular change, work redesign, and assessment of professional competence. The interpretation of the competencies offered here should prove to be a useful tool to nurses and health system leaders as they carry on the hard work of adapting the current model of nursing practice to the demands and realties of the contemporary and continually evolving health care environment. This work is important for two reasons. First, many of the skills and attributes of the professional nurse are not adequately used or valued by the health care system because the profession is both fragmented and poorly differentiated and articulated. Without markers that define and promote collaborative practice within nursing, the full potential of nurses at all levels of preparation will continue to be inadequately and inappropriately deployed. This model exacerbates the current nursing shortage because it fails to use nurses in appropriate, well-delineated, and challenging roles. Without this kind of differentiation, one that can be owned and supported by all nurses, there will continue to be suboptimal use of the nursing workforce in the United States. The framework of differentiated Pew competencies and the companion teaching-learning strategies proposed here offer one approach to rationalizing both nursing education and practice, with the potential for improving the quality of care, and reducing fragmentation, cost, and public confusion.

Hardiness, social support, and health status: are there differences in older African-American and Anglo-American adults?

The article reports a study examining the relationships among hardiness, social support, and health status in older African-American and Anglo-American adults (n = 110). The theoretical framework of the study was based on the interrelationships of the personal resources of hardiness, social support, health status, and sociodemographic factors, including race. Pearson's correlation coefficients and t tests were performed to examine the relationships among the variables. Hardiness correlated significantly with greater social support, better perceived health status, increasing age, and lower income. Social support correlated significantly with better perceived health status, increasing age, and higher income. Perceived health status correlated significantly with lower age. Older Anglo-American adults had significantly higher scores on hardiness, whereas older African-American adults had significantly higher scores on social support. Implications for holistic nursing practice are discussed.

Health care and nursing in Romania.

Health care and the nursing profession have been affected dramatically by political and socio-economic conditions in Romania. The Romanian Ministry of Health has recognized the health problems and barriers to care delivery which exist in the country, with several goals identified to improve the status of Romanian health care. This paper explores the critical issues which have impacted on health care and nursing in Romania.

Do clinicians use diagnostic labels to direct intervention selection?

The authors report a descriptive, correlational study that evaluated the relationship between accuracy in selecting diagnostic labels and nursing interventions, and the relationship between accuracy in selecting outcome statements and nursing interventions. An instrument developed by the authors was used, based on previously published case studies. For two case studies, respondents (N = 17) were asked to indicate how important the nursing problem, the intervention, and the outcome statement would be in patient care. No relationship between accuracy in diagnostic label selection and accuracy in intervention selection was found. A positive correlation between accuracy in outcome selection and accuracy in intervention selection was found for one of the cases.

Social support, quality of life, immune function, and health in persons living with HIV.

The purpose of this study was to examine the relationship between social support and quality of life in individuals with HIV. Using a descriptive, correlational design, data were collected from 50 HIV-positive individuals who were: (a) participants in support groups at a behavioral medicine unit, (b) inpatient or respite care patients with HIV, or (c) respondents to advertisements at AIDS service organizations. Instruments used for data collection were the Personal Resource Questionnaire 85-Part 2 (Weinert, 1987), measuring perceived social support, and the Quality of Life Index (QLI) (Ferrans & Powers, 1985), measuring the sense of well-being in life including the satisfaction with and importance of life domains with four subscales: health and functioning, socioeconomic, psychological/spiritual, and family. The results of the study indicated that social support was significantly correlated with quality of life (r = 0.81, p < 0.0001). Further, HIV status (asymptomatic HIV, symptomatic HIV, AIDS) was significantly related to quality of life (p < 0.01). However, HIV status was not significantly related to social support. No significant relationship was found between CD4 counts and HIV status, CD4 counts and social support, or CD4 counts and perceived health status. However, CD4 counts were significantly correlated with scores on the QLI. The findings of the study indicate that social support and quality of life are significantly intercorrelated and that higher CD4 counts are related to quality of life in this sample of persons living with HIV. Further areas for research include evaluation of quality of life over the span of HIV disease and interventions aimed at enhancing or maintaining quality of life in persons across the spectrum of HIV disease.

Prevalence and characteristics of pain in persons with terminal-stage AIDS.

A retrospective chart review was undertaken to collect and report data on the prevalence and characteristics of pain in persons with terminal-stage AIDS. A convenience sample consisting of 50 patient charts at a residential AIDS hospice was utilized. Data were collected from the McCaffery Initial Pain Assessment Tool (IPAT) (1983) which was completed at the time of each hospice admission. The IPAT is composed of 10 sections that collectively describe the patient's pain experience. Demographic and AIDS-related pathology data were also collected. Data were analysed using descriptive statistics to examine the incidence and characteristics of pain. Pain was experienced by a majority of the subjects in the sample. Pain levels for 'present pain', 'worst pain gets', 'best pain gets' and 'acceptable level of pain' are reported. Characteristics of pain including location, causal factors and verbal descriptors are reported. Implications for nursing practice and suggestions for further research are discussed.

A collaborative program for international education.

A collaborative educational program for Japanese nurses was developed, which merged the resources of the practice and education settings at the Massachusetts General Hospital (MGH) and the MGH Institute of Health Professions. Two concurrent programs were developed--Adult Health and Maternal-Child Health. These concurrent programs focused on content reflecting key areas in the realm of nursing practice and education in both Japan and the United States. Complementary clinical tours were an integral part of the program. This dyad of lecture and clinical experiences provided a forum to focus on issues relevant to nursing worldwide.