Menarche, sexual practices, and pregnancy: model testing.

Rates of adolescent pregnancy and childbearing, while in slight decline in the United States since 1992, remain high enough to warrant significant national concern. Birth rates, however, remain particularly high for minority adolescents. One hundred fifty-two records of African American and Latina adolescents receiving prenatal care from nurse midwives at an inner city university clinic were reviewed to partially test a developmental maturity model of pregnancy using logistic regression. The relationships between age at menarche to sexual practices and age at first pregnancy were examined. Mean age of the sample was 16.5 years, mean age at menarche was 12.2 years, at first coitus was 14.6 years, and at first pregnancy was 15.6 years. Thirty percent of the girls were experiencing second pregnancies. Birth control use by the adolescents was inconsistent, with only 20 percent using birth control at first coitus. Multiple regression analyses produced a model explaining 50 percent of the variance in age at first pregnancy. The predictor variables in the model were age at first coitus, age at menarche, race/ethnicity, and use of birth control at first coitus. Further analyses indicate that for childbearing adolescents, age at first coitus is a classic intervening variable between age at menarche and age at first pregnancy. Early physiologic maturers appear to lack the psychological and cognitive maturity required to cope with their emerging sexuality resulting in early unprotected coitus and pregnancy. Findings provide guidance to healthcare providers for the development of interventions to prevent unplanned pregnancies.

Standardizing faculty evaluation of nurse practitioner students by using simulated patients.

Biases related to variations among patients and settings may be reduced by having faculty evaluate the clinical skills of students as they interact with simulated patients. The Student Clinical Performance Scale is a rating scale developed to standardize assessment of videotaped simulated patient encounters with family nurse practitioner students. In a pilot study of faculty interrater reliability, correlation coefficients for independent scoring by faculty pairs using the Student Clinical Performance Scale varied widely among six case studies, and several scenario- and faculty-related factors served as systematic sources of faculty variability. The findings demonstrate the importance of a rigorous approach to developing and testing instruments that guide measurement of clinical competence. The use of simulated patients to evaluate nurse practitioner students provides opportunities to assess a wide range of attributes and holds promise for assessing advanced clinical skills in controlled educational environments.

Interpersonal styles of nurse practitioner students during simulated patient encounters.

Evaluation methods are needed to assess nurse practitioners' (NPs') interpersonal skills and provide students with systematic, qualitative feedback. The purpose of this study was to identify characteristics and styles of students' interpersonal behavior from patients' perspectives during simulated encounters. The 29-item Clinical Encounter Q-Set for NPs was generated pertaining to patients' perceptions of their interactions with NP students. Using Q-methodology, simulated patients (SPs) sorted the items immediately after each of their encounters with 45 NP students. Items were rank-ordered along a continuum, ranging from "most like my feelings regarding the encounter" to "least like my feelings." Three interpersonal styles were identified. "Nonjudgmental professionalism" characterized student behavior during the simulation portraying a patient with a sexually transmitted disease. "Competence/confidence" and "empathy/respect" were predominant styles exhibited during the hypertension simulation. The potential value of this method for teaching and evaluation is discussed.

Family nurse practitioner clinical competencies in alcohol and substance use.

The prevalence of substance use among patients presenting to primary health care settings mandates clinical competency in the area for nurse practitioners (NPs). An educational intervention with an evaluation component is described. The effect of incorporating substance use content into a Family Nurse Practitioner (FNP) curriculum was tested with a convenience sample of 16 FNP students and 8 practicing NPs. Students' knowledge increased significantly; however, differences in students' and practicing NPs' knowledge did not reach significance. Students' clinical competency increased significantly, as demonstrated by standardized patient clinical evaluations, and was significantly better than the practicing NPs in the skill domains of evaluation and record keeping. Educational intervention can improve NP identification of substance-abusing patients in primary health care settings.

The substance abuse pandemic: determinants to guide interventions.

The substance abuse pandemic calls for a comprehensive model from which nurses can organize the vast array of drug and alcohol knowledge required for practice in the community. The model health for all: a model for nursing's contributions provides a framework for organizing factors that affect health status into four determinants: biologic, sociocultural, medical-technologic-organizational, and environmental. The model serves as an organizing mechanism to present key information about alcohol and drug abuse.

Chemotherapy: how safe for the caregiver?

Antineoplastic drugs are routinely administered by nurses in the home setting. The potential for nurse occupational exposure to these drugs is increased by an inadequate understanding of the risks inherent in administering these agents. This article addresses issues related to safe administration of these drugs in a home environment.

Older women. Sexually transmitted diseases and acquired immunodeficiency syndrome.

Increasingly, American women aged 50 and over are afflicted with sexually transmitted diseases (STDs) and acquired immunodeficiency syndrome (AIDS). In order to meet the US Public Health Services' Health Objective for the Year 2000, health care workers must address the issues that impact on the older woman's ability to protect herself and others from these highly stigmatized diseases. Nurses must be aware of the potential for STDs and AIDS in this population and appropriately refer individuals for screening and follow-up care. Older women must be empowered economically, legally, and politically so they can assume an assertive role in their own health promotion. Cultural and societal barriers need to be overcome to change stereotypic attitudes about older women's sexuality. Only then can access to health information, health care, and research be assured.

The Apgar score: evolution, limitations, and scoring guidelines.

The Apgar score has been useful for nearly four decades in focusing on five physiological signs (heart rate, respiratory effort, reflex irritability, muscle tone, color) that denote the condition of an infant during the first critical minutes of life. Before the development of the system, narcotic analgesia and sedation during labor, and general anesthesia for vaginal deliveries were commonly used. Research of the scoring method has focused on the effects of these interventions on the fetus and newborn and has been a major impetus for change in obstetric practices. The Apgar score has been used as a predictive index for neonatal mortality and morbidity and for later neurologic or developmental disability. Both the one- and five-minute scores are predictors of mortality in normal-birthweight infants, whereas in high-risk low-birthweight infants their score is limited. The score is an insensitive predictive index of long-term neurologic or mental handicap, and lacks both sensitivity and specificity to reflect accurately the degree of acidosis. It can be used effectively, however, if these limitations are understood and considered.

Sexually transmitted diseases in the elderly--issues and recommendations.

The incidence of sexually transmitted disease (STD) in the elderly population is significant for both newly acquired disease and for residual complications from preceding infections. Every health-care practitioner needs to assume responsibility for the primary prevention of STDs, which focuses on avoiding infection. Primary health education is imperative in the presence of an escalation of sexually transmitted infection for which there is no known curative therapy. The sexual history is an integral component of the routine data base for all geriatric patients. Diagnosis of AIDS in the generally low risk elderly population may be unexpected. Health-care practitioners must be aware of its many forms of presentation.

The AIDS pandemic: a nursing model.

The pandemic of acquired immunodeficiency syndrome (AIDS) calls for global cooperation to develop strategies for interventions both to prevent the disease and to care for persons with it. The conceptual framework "Health for all: A model for nursing's contributions" provides guidance for the processes of assessment, diagnosis, planning, implementation of care, and evaluation of mortality and morbidity related to AIDS. The disease challenges the biologic, sociologic, medical-technical, and environmental determinants as they affect health. Specific recommendations for health care interventions are relevant to each determinate, with community health status as the focus.

Cardiovascular risk assessment in school-age children: a school and community partnership in health promotion.

There is little doubt that the primary prevention of cardiovascular disease is a pediatric problem that nursing must address. Cardiovascular health-promotion activities for children have generally used an ecologic model, providing community-based education programs in the schools. The purpose of this study was to identify changes in cardiovascular risk among sixth-grade cohorts over eight years. Four variables known to be associated with such risk--weight (obesity), pulse rate recovery index, blood pressure, and total cholesterol level--were measured on 4900 students, and changes in their prevalence were analyzed. The data presented in this paper were compiled from a screening program conducted by a local health department in partnership with a school district's health-education program. Although the school-based health-education program has been in existence for eight years, the prevalence of cardiovascular risk in sixth-grade students has not declined, suggesting the need for nurses to target the children at risk, and address more directly the motivational and affective domains in addition to cognitively focused programs.