Acanthosis Nigricans as an early clinical proxy marker of increased risk of type II diabetes.

Diabetes affects 6% of the national population, yet approximately 50% of persons with diabetes remain undiagnosed and receive no treatment. In specific populations, Acanthosis Nigricans (AN) may serve as an early clinical proxy marker of increased risk of type II diabetes. The results of this pilot project to screen selected school age students in New Mexico for AN indicate that a large number of these students may be at increased risk for developing type II diabetes as young adults. The future burden of diabetes on individuals, families, communities, and health care systems may be greater than previously recognized.

Coping patterns among bone marrow transplant patients: a hermeneutical inquiry.

Bone marrow transplantation (BMT) has recently become the treatment of choice for a number of malignancies. This procedure is highly technical, involving the use of radiation and chemotherapy to destroy the patient's diseased bone marrow and with it functions of the entire immune system. It is a process with toxic effects that are experienced by all patients to varying degrees. A great deal of research related to the physiological aspects of this procedure has already been done, but considerably fewer studies have examined the psychosocial aspects of the BMT procedure from the patient's perspective. Knowledge about how BMT patients understand this process and cope with its effects is important information for nurses taking care of these patients. The purpose of the study was to describe in depth the patterns of meaning employed by patients in the hospital as they coped with the experience of their BMT. Eleven patients were interviewed from one to four times a week throughout their hospitalization. Hermeneutic analysis was used to identify five major themes: physiological functioning, alertness, attitude, social relationships, and spirituality. Implications from the findings for nursing practice are discussed.

Implementation and outcomes of a community-based self-help smoking cessation program.

In a time of budget constraints, health professionals are turning to minimal-contact smoking cessation programs as the most financially feasible alternative for smoking cessation. The purpose of this study was to evaluate a program by the American Lung Association using the manual Freedom From Smoking for You and Your Family (Strecher & Rimer, 1988) in a community-based smoking cessation self-help intervention. Results showed a quit rate of 15%, and study findings were consistent with other similar studies. Those most likely to succeed were over 40 years old, better educated, and among the most confident of quitting at the onset.

A community-based smoking-cessation program: self-care behaviors and success.

Given the serious health consequences of smoking, nurses need to be well-informed on how to help various client populations with smoking cessation. Much recent research is focused upon effectiveness of various programs to enhance self-efficacy and self-management skills necessary to succeed in permanent smoking cessation. This study used a model based on Orem's Self-Care Deficit Theory to examine specific variables of importance in smoking cessation using descriptors relevant to understanding self-care actions. The model is used to examine the outcomes of a community-based smoking-cessation program. Results indicate that 15% of the final sample quit smoking and 42% reduced smoking while participating in the program. Additional findings are helpful in describing actions taken by subjects who were and were not successful in quitting. Remedies suggested by the American Lung Association booklet "Freedom from Smoking for You and Your Family" were reported by subjects to be helpful in dealing with the most common problems experienced during smoking cessation. Results are applied to public health nursing, emphasizing that smoking cessation is "a process" in which individuals learn strategies that work for them.

Noncompliance revisited: a disciplinary perspective of a nursing diagnosis.

One of the nursing diagnoses accepted by NANDA is noncompliance. However, this diagnosis has been criticized because it implies coercion and dominance by health professionals, and because of the negative stereotyping the term promotes. The authors argue that noncompliance should not be used as a nursing diagnosis because of incongruence with nursing history, philosophy, ethics, theory, and the need for clinical utility of diagnoses. Alternative diagnoses are proposed.

Job satisfaction among home healthcare nurses: what they report and what it means.

Job satisfaction has again come to the foreground as a result of the current shortage of nurses and home healthcare agency administrators need to be aware of what provides job satisfaction for their staff.

Home health nursing care: a comparison of not-for-profit and for-profit agencies.

The recent rapid growth in the numbers of for-profit and not-for-profit agencies delivering home health care raises questions about whether these agencies are serving different patient populations. Not-for-profit agencies were found to serve more indigent and medicaid patients than for-profits. Nurses from both kinds of agencies participated in this study and their patient case management activities are reported and compared for differences in their practice.

Care coordination: a resource-intensive component of home health nursing practice.

Coordinating patient care is an activity central to home health nursing practice. Nurses believe that this component of care contributes in a meaningful way to patient well-being. Yet changes in the home care environment at the patient, agency, and system levels could jeopardize nurses' care coordination activities. This study describes the nature of the care coordination activities delivered by home health nurses and explicates the amount of time expended in these activities. A convenience sample of 143 nurses, employed in 24 home health agencies in a southeastern state, participated. They recorded their time, in 15-minute intervals, for 10 consecutive working days. On average, they spent 29% of their time in direct care (i.e., home visits), 18% in travel, 18% in record-keeping activities, and 16% in care coordinating activities. New mechanisms to reimburse home care are on the horizon. Studies such as this that begin to explicate the nature of care requirements are critical if appropriate decisions are to be made about the structure of a reimbursement system for home health care.

Nursing activities and reimbursement in clinical case management.

If governmental agencies, third-party payers, and employers expect to obtain the benefits of clinical case management, then the indirect activities required for clinical case management and documented by this study must be considered in calculating home health care reimbursement rates.