Testing the Electronic Personal Health Record Acceptance Model by Nurses for Managing Their Own Health: A Cross-sectional Survey.

BACKGROUND: To our knowledge, no evidence is available on health care professionals' use of electronic personal health records (ePHRs) for their health management. We therefore focused on nurses' personal use of ePHRs using a modified technology acceptance model. OBJECTIVES: To examine (1) the psychometric properties of the ePHR acceptance model, (2) the associations of perceived usefulness, ease of use, data privacy and security protection, and perception of self as health-promoting role models to nurses' own ePHR use, and (3) the moderating influences of age, chronic illness and medication use, and providers' use of electronic health record (EHRs) on the associations between the ePHR acceptance constructs and ePHR use. METHODS: A convenience sample of registered nurses, those working in one of 12 hospitals in the Maryland and Washington, DC areas and members of the nursing informatics community (AMIA and HIMSS), were invited to respond to an anonymous online survey; 847 responded. Multiple logistic regression identified associations between the model constructs and ePHR use, and the moderating effect. RESULTS: Overall, ePHRs were used by 47%. Sufficient reliability for all scales was found. Three constructs were significantly related to nurses' own ePHR use after adjusting for covariates: usefulness, data privacy and security protection, and health-promoting role model. Nurses with providers that used EHRs who perceived a higher level of data privacy and security protection had greater odds of ePHR use than those whose providers did not use EHRs. Older nurses with a higher self-perception as health-promoting role models had greater odds of ePHR use than younger nurses. CONCLUSIONS: Nurses who use ePHRs for their personal health might promote adoption by the general public by serving as health-promoting role models. They can contribute to improvements in patient education and ePHR design, and serve as crucial resources when working with their individual patients.

Physically demanding work and inadequate sleep, pain medication use, and absenteeism in registered nurses.

Pain and fatigue are early indicators of musculoskeletal strain. This study examined associations among eight physical demands and inadequate sleep, pain medication use, and absenteeism in 3727 working registered nurses (RNs). Among the demands, awkward head/arm postures were associated with each outcome (inadequate sleep: odds ratio [OR], 1.96; 95% confidence interval [CI], 1.41 to 2.72; pain medication: OR, 1.65; CI, 1.12 to 2.24; absenteeism: OR, 1.60; CI, 1.26 to 2.04). A dose-response relationship was present; as the number of demands increased, the likelihood of each outcome increased. Odds ratios for eight demands versus no demands were as follows: inadequate sleep (OR, 5.88; CI, 2.30 to 15.50), pain medication (OR, 3.30; CI, 1.34 to 8.11), and absenteeism (OR, 2.13; CI, 1.15 to 3.94). Adjustment using multiple logistic regression for lifestyle, demographics, and work schedule did little to alter the findings. Interventions to promote nurses' health should limit the physical demands of the work.

Similarities of substance use between medical and nursing specialties.

This paper reviews and compares alcohol and other drug involvement findings in two professions, medicine and nursing, by specialty. Health care providers are naturally subgrouped by specialty, as this is a major work environment factor. The evidence indicates an association exists between practicing in certain medical or nursing specialties and substance use. In addition, similarities in specialty membership and substance use across medicine and nursing suggests there may be common risk factors related to substance use that could be addressed using interdisciplinary approaches.

Workplace access, negative proscriptions, job strain, and substance use in registered nurses.

BACKGROUND: Both occupational conditions and individual factors have been shown as contributors to the likelihood of substance use among health professionals. OBJECTIVES: To assess the use of Winick's (1974) model for explaining nurses' substance use, which asserts that groups with access to substances, freedom from negative proscriptions, and role strain have an increased likelihood of drug dependence. METHODS: Data were analyzed from the 3,600 working nurses participating in the Nurses Worklife and Health Study, a nationally representative survey of registered nurses in the United States. A structural equation model was tested fitting workplace access to substances (availability, frequency of administration, and knowledge), freedom from negative proscriptions (internal: religiosity; external: social network), and role strain (job demands and depressive symptoms) to the frequency of past year alcohol, marijuana/cocaine, and prescription-type drug use. RESULTS: Nurses were more likely to use substances when workplace access to substances increased (p < 0.001), with social networks containing more drug users, and when religiosity decreased (p < 0.001). Role strain (measured through job demands and depressive symptoms) also was related to substance use. Depressive symptoms were related directly and negatively to substance use (p < 0.01), whereas job demands were related indirectly to substance use through depressive symptoms. CONCLUSIONS: Winick's model has use in explaining nurses' substance use. Research and preventive initiatives should consider the multidimensional aspects of substance use in nurses.

Job strain and non-medical drug use.

In this study, the Karasek demand/control formulation of job strain, initially used in research on cardiovascular health, has been extended to drug use. Full-time nurses (n = 2375), all participants in a national anonymous mailed survey, were an estimated 1.5 times more likely to be a recent non-medical drug user if they had a high strain job as compared to nurses in low strain jobs. The psychosocial work environment might influence whether nurses become and remain non-medical drug users, over and above the risk-modifying functions related to nurses' individual vulnerabilities and their greater access to controlled substances.

Prescription-type drug misuse and workplace access among nurses.

Access to prescription-type substances in the workplace is a unique feature of the practice of health professionals. Empirical data on the relation between workplace access to substances and prescription-type drug misuse among nurses are limited. Using an anonymous mailed survey, data were collected on three dimensions of access: perceived availability, frequency of administration, and degree of workplace control over storage and dispensing of substances. Each dimension was independently associated with increased use. When these dimensions were combined into an index, nurses with very easy access were most likely to have misused prescription-type drugs (adjusted Odds Ratio = 4.18; 95% Confidence Interval: 1.70-10.30). Level of knowledge of controlled substances was also associated with use, but did not explain the relation between access and use.

Healthcare reform. Its effects on nurses.

Healthcare reform has been a major economic and political focus throughout the 1990s. In a national survey of registered nurses about work life and health, many narrative comments addressed changes in the healthcare system. This qualitative study an analysis of these comments, identified themes related to nurses' perceptions of changes and the effect of healthcare reform on the practice of nursing.

Work schedule characteristics and substance use in nurses.

BACKGROUND: In order to promote the health of nurses while maintaining performance and patient care safety standards, better research bases on the association of work organization with health are needed. METHODS: Work schedule components (shift, shift length, weekends, and overtime) in a nationally representative sample of employed registered nurses participating in an anonymous mailed survey (n = 3,917) were examined in relation to past year alcohol, smoking and drug use. RESULTS: Schedule components examined separately showed modest associations with substance use. Combinations of shift and shift length interacted in association with substance use, so that nurses working night shifts > 8 hr had the highest likelihood of alcohol use and smoking and those working rotating shifts > 8 hr were more likely to report alcohol use. Among women, the likelihood of substance use under adverse conditions varied by family/home demands. CONCLUSIONS: Administrative attention to the interplay of work schedules on workers along with consideration of competing family/home demands could lead to more healthful scheduling. In addition to substance use, working longer night and rotating shifts might be related to other health behaviors and conditions that should be examined in the future.

Substance use among nurses: differences between specialties.

OBJECTIVES: Valid data on factors that increase a health care worker's likelihood of substance use are integral in ensuring professional standards and quality health care for consumers. This study explored the association between nursing specialty and past-year substance use. METHODS: In an anonymous mailed survey, a balanced stratified sample of registered nurses (n = 4438) reported their use of marijuana, cocaine, and prescription-type drugs, as well as cigarette smoking and binge drinking. RESULTS: Prevalence of use of all substances was 32%. Rates varied by specialty, even when sociodemographics were controlled. Compared with nurses in women's health, pediatrics, and general practice, emergency nurses were 3.5 times as likely to use marijuana or cocaine (odds ratio [OR] = 3.5; 95% confidence interval [CI] = 1.5, 8.2); oncology and administration nurses were twice as likely to engage in binge drinking; and psychiatric nurses were most likely to smoke (OR = 2.4; 95% CI = 1.6, 3.8). No specialty differences appeared for prescription-type drug use. CONCLUSIONS: Certain nursing specialties were more likely than others to be associated with substance use. The differences were not explained by demographic characteristics. Inasmuch as a comparison of these results for nurses with prior work on physicians found considerable agreement by specialty, preventive initiatives should consider inter-disciplinary approaches to substance use education.

Collecting substance use data with an anonymous mailed survey.

Because mailed surveys minimize personal contact, they are useful for collecting sensitive data on substance use, as long as the problems of achieving adequate response rates can be conquered. To address these issues, we report on an anonymous mailed survey of substance use with a 78% response rate, including data collection and survey methods. Analysis of sociodemographic effects on responding found certain groups required additional contacts. Substance use estimates were not affected by non-response bias, suggesting that anonymous mailed surveys can be a feasible means of collecting data on substance use.

Relationship of specialty and access to substance use among registered nurses: an exploratory analysis.

Substance use patterns among nurses and women in general are understudied, especially how substance use relates to the work environment. Using an anonymous survey mailed to a population based random sample of registered nurses, this study presents the first empirical evidence that working in a critical care specialty combined with easy workplace access to drugs is associated with a high likelihood of illicit drug use among nurses (O.R. = 6.2).

The prevalence of substance abuse among registered nurses.

The purpose of this research was to estimate the prevalence of substance abuse and depression among a population-based sample of registered nurses. In addition, to estimate the degree to which substance abuse and depression were associated with nurses, a comparison was made between nurses and other employed individuals. Respondents were obtained from a probability sample of households that were part of the National Institute of Mental Health Epidemiologic Catchment Area Program (ECA). Of the adults interviewed as part of the ECA, 143 were under age 65 and currently working as registered nurses. These nurses were matched by neighborhood of residence (census tract) and gender to a comparison group of non-nurses from the ECA who were also employed at the time of interview. Estimates of the odds of substance use and depression among the nurses (n = 143) and non-nurses (n = 1410) were calculated. Nurses were no more likely to have engaged in illicit drug use or to have experienced depression than non-nurses. Nurses were also less likely to have experienced problems with alcohol abuse than non-nurses.

The prevalence and self-reported consequences of cocaine use: an exploratory and descriptive analysis.

In this study, prevalence rates for cocaine use were estimated by sex and race, as well as for selected social role and lifestyle characteristics, including educational level, martial status, living arrangements, job type and employment status. Prevalence rates were based on an estimation procedure that made the age-race-sex distributions balanced to that of the nation as a whole. Data were gathered from a multi-site probability sample of adults interviewed in 1981-1984 as part of the National Institute of Mental Health Epidemiologic Catchment Area Program (ECA) (n = 14,333). In addition to prevalence of use, rates of self-reported consequences of cocaine use were generated, by level of cocaine use. Striking differences in prevalence were found by education and marital status, which remained after controlling for age of respondent. Respondents who were employed full-time had a higher prevalence of cocaine use than those who were not. Individuals residing in households at the time of interview had a 6.4% lifetime prevalence of cocaine use, vs. hospitalized respondents (22%) and incarcerated respondents (40%). Cocaine use consequence rates varied greatly across survey sites, with self-reported tolerance (28%-51%) and withdrawal sickness (8%-33%) figuring prominently among sustained daily users.

Gender differences in initiation of psychotherapeutic medicine use.

It has been shown that women are more likely than men to have used prescription psychotherapeutic medicines. Gender differences in the determinants of such use have also been identified. In an earlier study of adult household residents aged 18-44, we found that antecedent illicit drug use was associated with prescribed psychotherapeutic medicine use, independent of psychiatric symptoms. In this study, we explore these predictive relationships separately for males and females. For both males (n = 604) and females (n = 933) illicit drug use was associated with psychotherapeutic medicine use, although the relationship was stronger among males. Psychiatric symptoms did not account for this relationship for either gender. Among males, symptoms and illicit drug use each increased the likelihood of psychotherapeutic medicine use. Among females, no additional likelihood of psychotherapeutic medicine use over and above that for illicit drug use resulted when psychiatric symptoms were also present. Help-seeking was strongly associated with prescription psychotherapeutic medicine use among both genders.

Predictors of the initiation of psychotherapeutic medicine use.

This study examined the hypothesized predictive association between illicit drug use and the onset of prescribed psychotherapeutic medicine use. The effect of psychiatric symptoms on this relationship was also explored. Data were gathered retrospectively, through standardized household interviews conducted in 1981 for the Baltimore site of the National Institute of Mental Health Epidemiologic Catchment Area Program. For this analysis, the sample was restricted to 1,716 respondents ages 18-44 at the time of interview, drawn by probability sampling area household residents of all adult ages. Using Cox proportional hazards models, the onset of psychotherapeutic medicine use was modeled as a function of illicit drug use and psychiatric symptoms, both defined as time-dependent covariates. Newly observed in this analysis was an independent association of illicit drug use with psychotherapeutic medicine use, which was unexplained by psychiatric symptoms (relative hazard = 2.61, 95% confidence interval (CI) = 2.15, 3.18). Adjustment for age of onset of alcohol intoxication did not alter the impression that illicit drug users were more likely to initiate use of prescribed psychotherapeutic medicines (relative hazard = 2.52, 95% CI = 2.02, 3.11).

Epidemiologic issues pertinent to international regulation of 28 stimulant-hallucinogen drugs.

This paper examines selected epidemiologic issues raised by the consideration of 28 stimulant-hallucinogen drugs for international drug control. New epidemiologic evidence on these drugs is presented, based on laboratory analysis of drug samples obtained from unauthorized channels of distribution in the United States. A proposal is made for experimental evaluation of international drug controls. The proposed approach is to select some of the stimulant-hallucinogen drugs which are not currently responsible for substantial drug-related morbidity and mortality, but which appear suitable for control on the basis of presumed potential for abuse and other characteristics. Then, randomly assign one-half of this group for new drug regulations, leaving the others without new regulation. If proper epidemiologic surveillance were in place, this experimental trial would produce data to help substantiate inferences about drug control efficacy. Difficulties in implementing this proposal are discussed, with emphasis on surveillance measurement problems. Some of these problems are related to the non-medical character of much stimulant-hallucinogen drug use. However, other problems such as response inconsistency may affect research in drug epidemiology generally. Data from a recent panel study of psychotherapeutic medicine use are presented to illustrate this possibility.

Poisoning hospitalizations and deaths from solids and liquids among children and teenagers.

Twenty-four deaths and 4,271 hospital admissions due to poisoning occurred in the 0-19 year age group in Maryland during 1979-82. Four-fifths of the deaths (83 per cent) and two-thirds of the admissions involved teenagers. Among teenagers, four out of five admissions and deaths were of suicidal or undetermined intent. Black males had the highest hospitalization rate among young children, and White females among teenagers. The most common poisons ingested by children aged 0-4 years were aspirin, solvents and petroleum products, tranquilizers, and iron compounds. Among teenagers, aspirin, tranquilizers, sedatives, and antidepressants were the most common substances ingested, with antidepressants and stimulants most common among the fatalities. Reducing the availability and toxicity of the most hazardous drugs is important if morbidity and mortality from poisoning are to be prevented.