A systematic review of pediatric self-report symptom measures: Congruence with the theory of unpleasant symptoms.

PURPOSE: Many children and adolescents experience unpleasant symptoms due to acute and chronic illnesses. Several symptom measures specific to children and adolescents are available to assess unpleasant symptoms. What is unclear is how well these measures assess all dimensions of the symptom experience. Using the Theory of Unpleasant Symptoms (TOUS) as a guide, the purpose of this systematic review of self-report symptom measures was to examine the comprehensiveness of current symptom measures designed to assess children's and adolescents' symptom experiences. CONCLUSIONS: The TOUS did not guide the development of any of the measures studied; hence, exact parallels were not expected. Currently, no pediatric self-report symptom measures were found that assessed all dimensions of the symptom experience. Four measures captured three dimensions: intensity, timing, and distress. Only two measures assessed quality. PRACTICE IMPLICATIONS: Practitioners need to be aware of the dimensions reflected in commonly used symptom measures. Augmentation of these measures is needed in order to assess the entire symptom experience in children and adolescents.

Application of the theory of Unpleasant Symptoms in Practice: A Challenge for Nursing

Symptoms are at the heart of nursing care. Much of what nurses do for and with patients is focused on symptoms: measuring them, assessing factors that may inuence changes, developing prevention and management strategies, and helping patients with ongoing monitoring and self-management. e eory of Unpleasant Symptoms (TOUS) was developed to highlight important aspects of the symptom experience in order to improve understanding and help guide nursing research and practice. It is exciting that interest in the theory and its application has been increasing internationally.

Body mass index and pressure ulcers: improved predictability of pressure ulcers in intensive care patients.

BACKGROUND: Obesity contributes to immobility and subsequent pressure on skin surfaces. Knowledge of the relationship between obesity and development of pressure ulcers in intensive care patients will provide better understanding of which patients are at high risk for pressure ulcers and allow more efficient prevention. OBJECTIVES: To examine the incidence of pressure ulcers in patients who differ in body mass index and to determine whether inclusion of body mass index enhanced use of the Braden scale in the prediction of pressure ulcers. METHODS: In this retrospective cohort study, data were collected from the medical records of 4 groups of patients with different body mass index values: underweight, normal weight, obese, and extremely obese. Data included patients' demographics, body weight, score on the Braden scale, and occurrence of pressure ulcers. RESULTS: The incidence of pressure ulcers in the underweight, normal weight, obese, and extremely obese groups was 8.6%, 5.5%, 2.8%, and 9.9%, respectively. When both the score on the Braden scale and the body mass index were predictive of pressure ulcers, extremely obese patients were about 2 times more likely to experience an ulcer than were normal weight patients. In the final model, the area under the curve was 0.71. The baseline area under the curve for the Braden scale was 0.68. CONCLUSIONS: Body mass index and incidence of pressure ulcers were related in intensive care patients. Addition of body mass index did not appreciably improve the accuracy of the Braden scale for predicting pressure ulcers.

Predictive validity of the Braden scale for patients in intensive care units.

BACKGROUND: Patients in intensive care units are at higher risk for development of pressure ulcers than other patients. In order to prevent pressure ulcers from developing in intensive care patients, risk for development of pressure ulcers must be assessed accurately. OBJECTIVES: To evaluate the predictive validity of the Braden scale for assessing risk for development of pressure ulcers in intensive care patients by using 4 years of data from electronic health records. Methods Data from the electronic health records of patients admitted to intensive care units between January 1, 2007, and December 31, 2010, were extracted from the data warehouse of an academic medical center. Predictive validity was measured by using sensitivity, specificity, positive predictive value, and negative predictive value. The receiver operating characteristic curve was generated, and the area under the curve was reported. RESULTS: A total of 7790 intensive care patients were included in the analysis. A cutoff score of 16 on the Braden scale had a sensitivity of 0.954, specificity of 0.207, positive predictive value of 0.114, and negative predictive value of 0.977. The area under the curve was 0.672 (95% CI, 0.663-0.683). The optimal cutoff for intensive care patients, determined from the receiver operating characteristic curve, was 13. CONCLUSIONS: The Braden scale shows insufficient predictive validity and poor accuracy in discriminating intensive care patients at risk of pressure ulcers developing. The Braden scale may not sufficiently reflect characteristics of intensive care patients. Further research is needed to determine which possibly predictive factors are specific to intensive care units in order to increase the usefulness of the Braden scale for predicting pressure ulcers in intensive care patients.

The Practice Doctorate in Nursing: an idea whose time has come.

The practice-focused doctorate is an important alternative to research-focused doctorates in nursing. The goal of this article is to provide the reader with an understanding of the nature and potential benefits of the practice doctorate. After discussing the background of this doctoral degree and the development of the degree by the American Association of Colleges of Nursing (AACN) Task Force on the Practice Doctorate in Nursing, the article will describe patterns in practice-focused doctoral education and issues considered by the task force in developing the position paper on the practice doctorate in nursing. A look ahead provides an update on current steps being taken by AACN and others toward implementing the task force's recommendations.

Context of care or provider training: the impact on preventive screening practices.

BACKGROUND: While MD adherence to U.S. Preventive Services Task Force guidelines has been found to be uneven, nurse practitioners (NPs) and their adherence to guidelines have not been closely examined. METHODS: A retrospective chart review of new patients (n = 1339) in an NP primary health care center, four MD primary health care centers, and one private NP practice. Screening and counseling were compared for NPs and MDs. RESULTS: When patient populations, resources, and administrative policies were similar in the NP and MD primary health care centers, NPs were more likely than MDs to perform primary prevention; however, MDs were more likely to document the delivery of secondary prevention screening. Private practice NPs' performance was more congruent with practice guidelines than either NP or MD primary health care center providers. Private practice NPs were more likely to perform screening, assessment, and counseling. CONCLUSIONS: When context, patient population, and productivity requirements were the same, NPs and MDs differed in their use of preventive measures, and not as expected. When NPs are not constrained by productivity requirements, and when their patient population has more resources and higher expectations, NPs perform better than their primary care center counterparts, particularly in secondary prevention and assessment and counseling.

Primary care outcomes in patients treated by nurse practitioners or physicians: two-year follow-up.

This study reports results of the 2-year follow-up phase of a randomized study comparing outcomes of patients assigned to a nurse practitioner or a physician primary care practice. In the sample of 406 adults, no differences were found between the groups in health status, disease-specific physiologic measures, satisfaction or use of specialist, emergency room or inpatient services. Physician patients averaged more primary care visits than nurse practitioner patients. The results are consistent with the 6-month findings and with a growing body of evidence that the quality of primary care delivered by nurse practitioners is equivalent to that by physicians.

Diabetes care processes and outcomes in patients treated by nurse practitioners or physicians.

PURPOSE: The purpose of this study was to compare selected diabetes care processes and outcomes of nurse practitioners (NPs) and physicians (MDs) in the primary care of adults with type 2 diabetes. METHODS: Adults with type 2 diabetes and no regular source of primary care were enrolled from the emergency room and randomized to an NP or MD practice. Chart reviews were conducted to assess processes of care; patient interviews and hemoglobin A1C (A1C) testing were performed to measure patient outcomes. RESULTS: NPs were more likely than MDs to document provision of general diabetes education and education about nutrition, weight, exercise, and medications. They were more likely to document patient height, urinalyses results, and A1C values. No differences were found in documenting current medications; alcohol, illicit drug, or tobacco use; depression; weight and blood pressure; foot and cardiovascular exams; blood glucose and creatinine testing; or referral to ophthalmologists. No differences were found in patient outcomes. CONCLUSIONS: This study provides preliminary evidence of interdisciplinary differences in the processes of care employed by primary care NPs and MDs in caring for patients with type 2 diabetes. NPs documented the provision of diabetes education and selected monitoring tests more frequently than MDs; however, these differences were not reflected in 6-month patient outcomes.

Reliability of transportable instruments for assessment of infant length.

Transportable instruments for use in home and field settings have been used for decades on the basis of assumed reliability. This article describes a study that compares two portable devices for measuring length, the tape measure and the Measure Mat, against a clinical standard stadiometer with two convenience samples of Hispanic and African-American infants in an urban general pediatrics practice setting. Mean net difference between the stadiometer and the tape measure was 1.68 inches in the first sample and 0.92 inches in the second; the difference between the stadiometer and the Measure Mat was 0.92 inches. The least variability and random error (SD = 0.57 inch) was shown in the paired measurements using the stadiometer and the Measure Mat. Bland-Altman plots showed positive bias for both portable devices across the range of measurements.