Cobalt-specific T lymphocytes in synovial tissue after an allergic reaction to a cobalt alloy joint prosthesis.

Metals such as cobalt and nickel are common contact allergens. We studied the mechanisms underlying an allergic reaction with marked synovial inflammation in a patient with a cobalt alloy arthroplasty. After removing the joint prosthesis the adjacent synovial tissue was examined for cobalt-specific T lymphocytes. Synovial membrane mononuclear cells were expanded in interleukin 2 and cloned using a representative cloning protocol. T cell clones were tested for their proliferative response to cobalt and further characterized with regard to cytokine secretion, phenotype, and HLA restriction. Additionally, synovial fibroblasts were tested for their function as antigen presenting cells (APC). Almost 30% of the T cell clones reacted to cobalt, but not to the control nickel. All these T cell clones were CD4 positive. The cobalt induced proliferative response could be blocked by anticlass II antibodies. Also, synovial fibroblasts expressing class II molecules induced by interferon-gamma were able to serve as APC. However, when testing a panel of APC of HLA class II mismatched donors, no requirement for a certain HLA class II molecule could be defined. Further studies are necessary to determine mechanisms of presentation and recognition of cobalt by T lymphocytes, a prerequisite for improved prevention and treatment of metal induced allergic reactions.

Service and education share responsibility for nurses' value development.

This article examines professional values of senior baccalaureate nursing students and practicing nurses. An important finding was that practicing nurses rated behaviors reflecting values in the American Nurses Association (ANA) Code for Nurses as more important than did senior students, thereby supporting the notion that practice contributes to value formation. The ongoing development and internalization of the nursing professions' values requires active involvement by staff development educators. The phenomena of value formation and development of professional values appear to mirror the novice to expert model.

There is no disease-specific role for streptococci-responsive synovial T lymphocytes in the pathogenesis of psoriatic arthritis.

The initiation or exacerbation of psoriasis vulgaris is associated with infections by group A streptococci. T lymphocytes specific for streptococcal antigens or expressing a restricted, for streptococcal superantigens typical T cell receptor Vbeta chain repertoire have been described in psoriatic skin lesions. The aim of our study was, therefore, to clarify whether streptococci-reactive T lymphocytes played a role in the pathogenesis of psoriatic arthritis (PsA), and by which antigens they might be stimulated. Synovial membrane mononuclear cells from patients with PsA and other arthropathies, separated by collagenase digestion, were expanded in interleukin-2-supplemented medium and subsequently cloned in a representative cloning procedure. The T cell lines and about 30% of the T cell clones proliferated in response to preparations of group A streptococci but not to other bacteria as tested by [3H]thymidine incorporation assays. Interestingly, they did not proliferate in response to exotoxin-negative streptococci, but did so in response to the streptococcal pyrogenic exotoxins A and C, which are known to be superantigens. Accordingly, no HLA-DR restriction was seen for the proliferative response. The remaining 70% of the established T cell clones did not react to an antigen of group A streptococci. Our results show that in patients with PsA, osteoarthritis or rheumatoid arthritis a significant number of synovial T lymphocytes were responsive to streptococcal superantigens, but not to conventional streptococcal antigens. A disease-specific role of streptococci-reactive T lymphocytes in the pathogenesis of PsA is, therefore, unlikely.

An instrument to measure professional nursing values.

PURPOSE: To describe the Nursing Professional Values Scale (NPVS), its development, reliability and validity, and its derivation from the Code of Ethics of the American Nurses Association. DESIGN: The NPVS was tested on 599 subjects, including baccalaureate and masters' students and practicing nurses. The students were enrolled in one of 25 programs selected at random from all NLN accredited programs in the United States. Practicing nurses were randomly selected from a State Board of Nursing list. METHOD: A 44-item, norm-referenced instrument with a Likert-scale format was tested. The responses of participants to this instrument were subjected to principal axis factor analysis with varimax rotation. FINDINGS: Eight factors were identified, accounting for 58% of the total variance. The two major factors were Caregiving and Activism. CONCLUSIONS: Initial results showed a high level of reliability and validity for the NPVS. The NPVS is a useful instrument for measuring professional nursing values and enhancing professional socialization.

Use of a taxonomy to describe parish nurse practice with older adults.

Parish nursing in a new model of health care delivery in which practitioners build partnerships to extend health care from institutions into the community. The study discussed in this article focused on the applicability of the North American Nurses Diagnosis Association taxonomy and the Nursing Intervention Classification to describe parish nurse practice with older adults. Findings from this study may help develop a framework for the practice.

Describing parish nurse practice using the Nursing Minimum Data Set.

The purpose of this study was to describe parish nurses practice using the framework of the Nursing Minimum Data Set (NMDS). Nineteen parish nurses practicing in 22 faith communities collected data using standardized nursing classification systems (North American Nursing Diagnosis Association [NANDA] Taxonomy and Nursing Intervention Classification [NIC]). A database was developed for quantitative analysis. Nurses recorded 1,557 encounters for services provided to 776 individuals. Over the period studied, the nurses recorded 1,730 nursing diagnoses and 3,451 nursing interventions. The most frequent nursing diagnoses and nursing interventions are reported and emphasized health promotion and illness prevention. The parish nurse roles of educator, counselor, referral agent, and advocate/facilitator, described in the literature, were consistent with the findings of this study. A focus group of the parish nurses provided validation of the results of the database descriptions of practice. The nurses also identified issues related to the use of NANDA and NIC in documenting practice.

Toward building an international consensus in professional values.

Although the importance of professional values has been espoused and national codes for nurses exist, there is a lack of systematic study to ascertain the commonalities of values among professional nurses. As part of a larger international study of professional values, nursing students from England and the USA (n = 130) were surveyed to determine congruence of values. The Professional Values Scale (PVS) instrument was used to collect data. Results showed a high degree of congruence among nursing students. The incongruencies found may be related to cultural differences in education and practice.

Health care delivery in faith communities: the parish nurse model.

Religious institutions and nurses have a common bond--both are committed to empowering individuals to achieve their full potential and believe in the self-care capacity of individuals. The purpose of this study was to examine parish nursing as an evolving model of care within faith communities. Annualization of monthly reports and parish nurse interviews revealed that parish nurse activities contributed to the empowerment process and to the attainment of Healthy People 2000 objectives.

Health and social support among older women in congregate housing.

This study of community-dwelling elderly women found that perceptions of positive health status and adequate social support do not decline with age, even among the old old. The relationship between health status and social support reflects the reciprocal nature of person and environment found in the ecologic model.

Reflecting professional values in the philosophy of nursing.

If nurses are to remain central in restructuring efforts, their professional values must be at the core. Nurse administrators play a key role in promulgating values. The authors examined philosophy of nursing documents to identify professional values and found them to be lacking. They discuss their findings and their implications for nurse executives.

Health care diaries of young women.

The purpose of this study was to describe young women's self-care activities related to health maintenance and symptom management. Seventy-six young adult women kept a daily health diary for 3 weeks. They reported a total of 1,213 health maintenance practices. The self-care interventions used to manage symptoms were varied and specific to the reported symptoms. The most frequently reported illness management activity was the use of over-the-counter medications. The self-care measures selected by these young women reflect deliberate approaches to their situations. The findings suggest that nurses in the community should use young adult health promoting and health maintaining behaviors as a basis for designing interventions.

Importance of professional nursing values: a national study of baccalaureate programs.

Research about professional nursing values is scarce. The purpose of this study was to determine if there were different perceptions about professional nursing values between senior baccalaureate nursing students and their faculty. The Professional Nursing Behavior Instrument (PNB) used in this research was based on the nursing role behaviors identified in the AACN's (1986) Essentials Report as exemplars of seven essential values. A national sample of 10 public and 16 private baccalaureate programs resulted in a return of 656 students (57%) and 350 faculty (70%). Faculty values were significantly higher than students' (p < .045) with faculty valuing equality, human dignity, and freedom more highly. Enrollment or employment in a public or private institution or studying ethics, theology, and philosophy did not significantly affect values. Faculty with more teaching experience had higher value scores (p < .004).

Health status, health perceptions, and health behaviors of young adult women.

A descriptive, exploratory study of 76 young adult women enrolled in a women's health course at a large, midwestern university was undertaken to identify their current health status, health perceptions, and general health behaviors. Two groups of young adult females participated, nursing students (n = 38) and non-nursing students (n = 38). The panel of young adult women in this study reported their health as good or excellent, viewed health as very important and generally used positive health practices. However, data revealed that the lifestyles of many respondents were not conducive to promoting or maintaining health. Negative health practices identified were drinking and driving, non-performance of self breast examinations, ineffective stress management strategies and poor dietary and exercise habits. No significant differences were noted between nursing and non-nursing students.

Professional values in baccalaureate nursing education.

The purpose of this study was to compare program objectives of National League of Nursing-accredited baccalaureate programs with the professional nursing behaviors that reflect the seven values identified by the American Association of Colleges of Nursing (AACN). Findings showed that most of the professional behaviors were found in program objectives. However, behaviors reflective of two essential values, truth and esthetics, were identified only in a minority of program objectives. In addition, research and life-long learning were overwhelmingly identified in program objectives, but they were not reflected in the professional nursing behaviors of the AACN document. The professional nursing behaviors were also classified according to the three major roles of baccalaureate graduates. The provider-of-care role was dominant, followed by the member-of-profession and coordinator-of-care roles.

Young adult women: lifestyle and health locus of control.

A study of 76 young adult women, 38 nursing students and 38 non-nursing students, examined their lifestyle practices and health locus of control (HLOC). Findings revealed a significant difference between reported lifestyle practices and the career choice of these young adult women. The lifestyle practice areas in which the most notable differences occurred included: use of seat belts, frequency of alcohol use, frequency of junk food intake, use of illegal drugs and hours of sleep per night. While differences in HLOC were evident between nursing and non-nursing students, no relationship was found between a young woman's HLOC and her lifestyle practices. The differences in HLOC showed that nurses were more frequently pure internal whereas most non-nurses were found to be double externals. The pure chance category had the fewest number of respondents. The difference in lifestyle practices between these young adult women can be explained in part by curriculum variations, as can the difference in HLOC patterns.

Responsiveness of the well elderly to healthcare education programs.

There is a need to focus healthcare education efforts on specific subsets within the elderly population and to intensify efforts to induce undecided elderly persons to become involved in healthcare education programs.