Handling missing data in nursing research with multiple imputation.

BACKGROUND: In the data analysis phase of research, missing values present a challenge to nurse investigators. Common approaches for addressing missing data generally include complete-case analysis, available-case analysis, and single-value imputation methods. These methods have been the subject of increasing criticism with respect to their tendency to underestimate standard errors, overstate statistical significance, and introduce bias. OBJECTIVES: This article reviews the limitations of standard approaches for handling missing data, and suggests multiple imputation is a useful method for nursing research. METHOD: Secondary analysis was conducted to examine the effect of a public policy on the health of women using a data set that had a large degree and complex patterns of missing data. DISCUSSION: In the example, accommodation of the incomplete data was critical to making valid inferences; however, complete-case, available-case, or single imputation could not be defended as an adequate method for dealing with the missing data patterns. Alternative methods for dealing with incomplete data were sought, and a multiple imputation approach was selected given the missing data pattern. Nurse researchers confronting similar complex patterns of missing data may find multiple imputation a useful procedure for conducting data analysis and avoiding the bias associated with other methods of handling missing data.

Reinvesting in social justice: a capital idea for public health nursing?

Social justice is a core ethical principle of public health nursing; yet, nurses' work as social activists has largely diminished over the past century. Reengagement in social justice activities is essential to change the current social, economic, and health differentials perpetuated by market justice ideologies. Social capital has emerged in the public health literature as a promising concept for developing community interventions that diminish disparities. Public health nurses, however, must be wary of uncritically adopting social capital as a panacea for inequalities; advocating for interventions seeking to build social capital may be as harmful as the inequalities themselves.

Evidence-based cognitive rehabilitation: recommendations for clinical practice.

OBJECTIVE: To establish evidence-based recommendations for the clinical practice of cognitive rehabilitation, derived from a methodical review of the scientific literature concerning the effectiveness of cognitive rehabilitation for persons with traumatic brain injury (TBI) or stroke. DATA SOURCES: A MEDLINE literature search using combinations of these key words as search terms: attention, awareness, cognition, communication, executive, language, memory, perception, problem solving, reasoning, rehabilitation, remediation, and training. Reference lists from identified articles also were reviewed; a total bibliography of 655 published articles was compiled. STUDY SELECTION: Studies were initially reviewed according to the following exclusion criteria: nonintervention studies; theoretical, descriptive, or review papers; papers without adequate specification of interventions; subjects other than persons with TBI or stroke; pediatric subjects; pharmacologic interventions; and non-English language papers. After screening, 232 articles were eligible for inclusion. After detailed review, 61 of these were excluded as single case reports without data, subjects other than TBI and stroke, and nontreatment studies. This screening yielded 171 articles to be evaluated. DATA EXTRACTION: Articles were assigned to 1 of 7 categories according to their primary area of intervention: attention, visual perception and constructional abilities, language and communication, memory, problem solving and executive functioning, multi-modal interventions, and comprehensive-holistic cognitive rehabilitation. All articles were independently reviewed by at least 2 committee members and abstracted according to specified criteria. The 171 studies that passed initial review were classified according to the strength of their methods. Class I studies were defined as prospective, randomized controlled trials. Class II studies were defined as prospective cohort studies, retrospective case-control studies, or clinical series with well-designed controls. Class III studies were defined as clinical series without concurrent controls, or studies with appropriate single-subject methodology. DATA SYNTHESIS: Of the 171 studies evaluated, 29 were rated as Class I, 35 as Class II, and 107 as Class III. The overall evidence within each predefined area of intervention was then synthesized and recommendations were derived based on consideration of the relative strengths of the evidence. The resulting practice parameters were organized into 3 types of recommendations: Practice Standards, Practice Guidelines, and Practice Options. CONCLUSIONS: Overall, support exists for the effectiveness of several forms of cognitive rehabilitation for persons with stroke and TBI. Specific recommendations can be made for remediation of language and perception after left and right hemisphere stroke, respectively, and for the remediation of attention, memory, functional communication, and executive functioning after TBI. These recommendations may help to establish parameters of effective treatment, which should be of assistance to practicing clinicians.

The health of women in transition from welfare to employment.

Although numerous studies of welfare policy exist, studies of women's health within the context of U.S. welfare reform policy have been limited. From an ecological health perspective, welfare policy shapes the immediate environment in which women live. The environment has long been recognized by nursing as a major determinant of health status. Using data from the Washington State Family Income Study (FIS), this research examined women's psychosocial health when making the transition from welfare receipt to employment. No differences in psychosocial health were found between women leaving welfare for employment and those remaining on welfare (p > .05 on depression, self-esteem, self-efficacy, and emotional support). This finding is consistent with earlier qualitative research, which indicates the life circumstances of women leaving welfare for paid employment rarely improve. To better understand how public policies such as those related to welfare affect the lives and health of women, additional research is sorely needed.

Nephrotic syndrome secondary to amyloidosis.

Nephrotic syndrome represents a constellation of symptoms including hyperalbuminuria, hypoalbuminemia, edema formation, hypercholesterolemia, hypertension, hypercoagulopathy, and increased infection risk. The hallmark of this syndrome is proteinuria greater than 3.5 grams per 24 hours, and the clinical features are secondary manifestations of an underlying primary glomerular or systemic disease. The objectives of treatment are threefold: correcting the primary disease, decreasing the symptoms and secondary effects associated with this syndrome, and preventing complications. This article presents a case report of a man diagnosed with nephrotic syndrome secondary to amyloidosis. The clinical aspects of the disease processes, the diagnostic evaluation, the treatment course, and disease management are discussed.

The consequences of welfare reform for women's health: issues of concern for community health nursing.

Community health nurses confront the health effects of public policies on a daily basis, particularly with respect to low-income populations. Despite this, the effects of public policies are often attributed to problems that are more proximal in the environment than the broad-ranging scope of "public policy." This article argues the need for a broader perspective of environment that encompasses public policies, and provides an example of how specific aspects (time limits and the Medicaid eligibility process) of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 may have harmful consequences for the health of low-income women. Finally, implications for community health nursing practice and the need for further nursing research are reviewed.