Empowerment among Latina nurses in Mexico, New York and Indiana.

BACKGROUND: Increasing empowerment among nurses may help retain nurses and increase the international workforce. There are very few cross-national studies of nurse empowerment reported in the professional literature. AIM: To conduct a cross-national exploratory study testing a theoretical model of nurse empowerment. DESIGN: Descriptive survey of three convenience samples of graduate Latina nurses in Monterrey, Mexico, New York City and Indiana. METHODS: Data were collected using self-administered questionnaires. The Klakovich Reciprocal Empowerment Scale (RES) was translated into Mexican-Spanish using a translation back-translation technique. Variables for the study included empowerment, years of experience, job satisfaction and intent to stay. Frequency distributions and descriptive statistics were used to analyse the data. FINDINGS: Empowerment involves reciprocity between the leader and follower, a common vision and synergy about the work, and a sense of ownership in the work site. Mexican nurses scored significantly higher on synergy than Latina nurses in New York and Indiana. Empowerment is related to job satisfaction, age and years of employment. CONCLUSIONS: Results indicate the usefulness of the RES instrument for Latina nurses and the need for further research with larger samples. Cross-national research provides culturally sensitive information. Such research partnerships facilitate modelling the importance of nursing research to graduate nurses and students.

A new look at nurse burnout: the effects of environmental uncertainty and social climate.

As healthcare organizations deal with changes in the external environment, uncertainty in the internal environment is created. The purpose of this study was to explore the relationships among environmental uncertainty, social climate, and burnout among staff nurses. Multiple regression analysis was used to explore relationships among study variables. Perceived environmental uncertainty predicted burnout among staff nurses, although there was no significant relationship between burnout and objective measures of unit activity. The social climate of the workplace was negatively associated with burnout. The authors concluded that social networks are important during times of change and uncertainty in the work environment; in other words, a supportive workplace can protect against burnout.

Sense of belonging and new graduate job satisfaction.

This study investigated the relationship between sense of belonging and job satisfaction in the new graduate RN. Ninety-five new graduate RNs answered a survey about demographic information and work setting, as well as their satisfaction and sense of belonging in the work environment. McCloskey-Mueller's Satisfaction Scale and a modified version of the Hagerty-Patusky Sense of Belonging Instrument were used. The conceptual framework was derived from Marlene Kramer's work on Reality Shock (1974). Results showed new graduates were most satisfied with coworkers and least satisfied with professional opportunities for advancement. Sense of belonging and total satisfaction were highest in the home healthcare setting. A Pearson r was used to determine relationships between sense of belonging, total satisfaction, and satisfaction sub-scales. Sense of belonging had significant positive relationships with total satisfaction, interaction opportunities, praise, control, coworkers, and scheduling. Possible future research suggested examining how orientation and work group numbers may affect job satisfaction and sense of belonging.

Assessing the feasibility of a clinical practice guideline for inpatient smoking cessation intervention.

Although a great deal of effort has been devoted to the development of evidence-based practice guidelines at both the national and local levels, relatively few studies have explored translating these guidelines into clinical practice. The purpose of this study was to assess the feasibility of implementing an inpatient smoking cessation intervention, based on an externally developed clinical practice guideline, at a tertiary care medical center. All smokers who were referred to cardiac rehabilitation services for a 5-week period were eligible for referral to the smoking cessation program. Twenty patients participated in the bedside counseling program. The mean amount of time to deliver the intervention was 43.5 minutes. At 1 month, 14 (70%) of the participants reported continuous abstinence from tobacco. Estimated cost per patient for smoking cessation intervention was $51.14.

Chart reminders increase referrals for inpatient smoking cessation intervention.

The purpose of this study was to test the effect of a chart reminder system on referral of inpatients to a hospital smoking cessation intervention pilot program. An A1-B-A2 reversal design was used to test the hypothesis that a chart reminder to nursing staff would increase the proportion of smokers referred for smoking cessation intervention over the usual method of posted memos. In Condition A1, memos reminding nursing staff to refer smokers were posted prominently on a cardiopulmonary unit for 4 weeks. In Condition B, a reminder containing the same message was placed in the front of every patient chart for 4 weeks. Finally, in Condition A2, chart reminders were removed and posted memos were reinstated for 4 additional weeks. During Condition A1 (posted memo), only one patient out of 29 eligible smokers was referred, for a referral rate of 3.4%. In Condition B (chart reminders), 18 patients out of 52 (34.6%) were referred (chi 2 = 10.07, p < 0.01). In Condition A2, the referral rate returned to below baseline (2.1%) (chi 2 = 16.80, p < 0.001). The findings support the use of a chart reminder system for screening and referral as an important component for comprehensive smoking cessation programs in the acute care setting.

Computer use in staff development. A national survey.

The Informatics Task Force of the National Nursing Staff Development Organization (NNSDO) conducted a national survey soliciting information about computer use in staff development. More than 600 members responded to the survey, suggesting that informatics and the issues surrounding nurses' use of computers are of concern to many staff development professionals. Responses from focus groups held at the National Nursing Staff Development Organization annual convention provided additional input. The results of the survey and discussion sessions have implications for preparing nurse educators for the specialty practice of staff development in the future.

Health status and mammography use among older women.

OBJECTIVE: To assess the extent to which an age-associated reduction in mammography use can be explained by declining self-reported health status. DESIGN: We analyzed data from the 1992 National Health Interview Survey (NHIS) and Cancer Control Supplement. Logistic regression analysis was used to evaluate the association between age, health status (self-reported health and limitations in major activity), and other variables potentially related to mammography use within the past 1 year (recent mammography). PARTICIPANTS: Of 12,035 NHIS respondents we restricted our analysis to the 1,772 women aged 50 years or older who reported one or more lifetime mammograms. We excluded women without a mammogram (n = 937) because we were interested in factors related to recent use versus past use of mammography. MEASUREMENTS AND MAIN RESULTS: The percentage of women with a recent mammogram declined with increasing age, and the age association was independent of other factors including health status (adjusted odds ratio [OR] comparing women aged 75 years or older with those aged 50 to 64 years was 0.54; 95% confidence interval [CI] 0.41, 0.70). This age effect persisted in an analysis restricted to women reporting good or better health (adjusted OR was 0.60, 95% CI 0.44, 0.80). CONCLUSION: The observed decline in recent mammography use with advancing age was not explained by variation in health status. Because healthy elderly women may live long enough to realize the potential benefit of screening mammography, factors responsible for its reduced use should be identified. Doing so will allow for the selective promotion of screening mammography among those older women most likely to benefit.

Developing and testing a prototype patients care database.

The purpose of the two pilot studies described in this article was to develop and evaluate a database for managing patient care information. A retrospective review of medical records for 67 patients was used for capturing nursing information. Three categories of data were obtained: (1) patient problems, (2) nursing interventions, and (3) patient outcome achievement. A total of 439 patient problems was identified. A total of 4541 discrete nursing interventions were coded, with assessment and surveillance activities accounting for 26% of the total. The degree to which targeted patient outcomes were achieved was assessed by analyzing documentation of patient outcomes in the medical record. Of 2326 expected patient outcomes identified, only 55% (1272) were documented as "met" in the medical records. Potential uses for the database include outlier analysis and outcomes assessment in specific patient populations.

A study of pediatric brain tumors and their association with epilepsy and anticonvulsant use.

OBJECTIVES: To evaluate the risk of childhood brain tumor occurrence in relation to epilepsy and anticonvulsant use. STUDY DESIGN: As part of a multicenter case-control study of pediatric brain tumors, maternal report on epilepsy occurrence before diagnosis of her child's brain tumor was collected for 540 cases and compared with 801 control children. Mothers also reported on any long-term (> or = 2 weeks) use of medications by her child before the date of tumor diagnosis (or a comparable reference date for controls) and these medications were classified according to whether they contained barbiturates. RESULTS: As expected, because seizures are often an early brain tumor symptom, a strong association was observed between epilepsy and brain tumor occurrence (odds ratio, OR = 6.2; 95% confidence limit, CL = 2.9, 14). The association remained elevated even after a > or = 10-year interval between diagnoses of epilepsy and brain tumor (OR = 4.7; CL = 0.8, 48). Elevated odds ratios were observed both for epileptic children who were treated with anticonvulsants containing barbiturates (OR = 5.8; CL = 2.2, 18) and for those not treated with barbiturates (OR = 7.9; CL = 1.7, 74), relative to nonepileptic children. CONCLUSION: Whereas most of the brain tumor risk associated with epilepsy may be due to occult tumors, the finding of an elevated risk many years after diagnosis of epilepsy is of interest.

Head injury as a risk factor for brain tumors in children: results from a multicenter case-control study.

We evaluated the risk of brain tumor occurrence in relation to previous head injury in a population-based case-control study of 540 children with a primary brain tumor and 801 control children. The risk of a brain tumor among children with a previous head injury that resulted in medical attention was slightly elevated when compared with children with no reported head injury [odds ratio (OR) = 1.4; 95% confidence limits (CL) = 1.0, 1.9]. This effect was stronger when we restricted the head-injured group to the few children with loss of consciousness (OR = 1.6; 95% CL = 0.6, 3.9) or an overnight admission to a hospital (OR = 1.7; 95% CL 0.7, 4.6), relative to those with no head injury. We observed no appreciable association between brain tumor occurrence and birth injury involving the head or a forceps delivery. Among the few children with either a birth injury or forceps delivery and a subsequent head injury, we observed approximately twofold elevations in risk. The OR was 2.6 (95% CL = 1.1, 6.9) for those with a birth injury and subsequent head injury, relative to those with neither a birth injury nor head injury. Our results provide only weak evidence in support of head injury as an etiologic agent for brain tumor occurrence in children, although most of our exposed group had only mild head injury.

Nurses' attitudes toward caring for patients with acquired immunodeficiency syndrome.

The purpose of this study was to examine nurses' attitudes toward caring for patients with acquired immunodeficiency syndrome (AIDS) and factors that might be related to these attitudes. One hundred thirty-eight (138) registered nurses responded to an anonymous mail survey. The survey instrument assessed the subjects' attitudes toward caring for AIDS patients along five dimensions: (1) fears and concerns relating to caring for AIDS patients, (2) attitudes toward health care utilization by AIDS patients, (3) attitudes toward caring for terminally ill patients, (4) attitudes toward homosexuality, and (5) attitudes of significant others toward AIDS patients. The data obtained were analyzed using frequency distributions, independent t tests, and analysis of variance. Results of this study indicated that educational background is not related to nurses' attitudes toward caring for patients with AIDS; however, nurses who have had experience caring for patients with AIDS have more positive attitudes towards health care utilization by AIDS patients (P < .05) and more positive attitudes toward homosexuality (P < .04) than nurses who have not cared for AIDS patients.

Using generalizability theory for the estimation of reliability of a patient classification system.

This article discusses the measurement issues associated with estimating the reliability of patient classification systems (PCSs). Generalizability theory is proposed as an approach to overcome the limitations of traditional methods of estimating reliability of PCSs. The results of a demonstration study in which generalizability theory is used to support the reliability of a PCS are reported. A coefficient of generalizability, analogous to the reliability coefficient, was computed based on the variance components estimated. The generalizability coefficient for the total PCS score was .034, which increased to .650 when one item was deleted. The generalizability coefficient for individual items ranged from .053 to .961. Suggestions for further instrument development are offered.