Community health advocacy: primary health care nurse-advocate teams in urban communities.

In summary, our health advocacy program uses PHC teams in urban, underserved communities to deal with the interaction of social and health factors in solving problems related to access to appropriate (as perceived by residents) and affordable health care. This approach encourages grass-roots participation in problem identification and solution, a fundamental ingredient of community empowerment. Further, this program facilitates community identification of nurses as resource persons who encourage collaboration to improve the community's health status and as health providers who enhance the authority and autonomy of community participation in the resolution of health issues.

Health advocacy for young, low-income, inner-city women.

The Urban Women's Health Advocacy Training Project was a university-based demonstration program designed to collect data on the health status of urban women and to test nursing interventions for training community health advocates. Thirty Hispanic and black trainees between 17 and 21 years of age were selected to participate in an eight-week, 20-h/w program emphasizing women's health education, health advocacy skills, and career awareness. This project has many implications for nursing practice with young, inner-city women. Enhancing the self-care and advocacy skills of these women maximizes their potential for use of available health services and their ability to influence the expansion of the services required to meet their own and their families' health care needs. Problems in funding and conducting such demonstration projects are discussed.

Changing factors and changing needs in women's health care.

The aforementioned social trends affecting women, including women in poverty, women in the labor force, and elderly women, are all ultimately related to problems of access to health care. In almost every age group, women use more health and medical services. Women are hospitalized more often, although their stays in hospitals tend to be shorter. Women also make more visits to health care providers for preventive health care, such as examinations and dental care. Access to care, however, is tied to ability to pay for the care. Medicaid payments for medical care are related to eligibility criteria in each state. Recent cuts in federal programs targeted eligibility for welfare and Medicaid. In 1982, 725,000 welfare recipients were declared ineligible. Given the earlier discussion of the predominance of women among those labeled poor in this country and the fact that two thirds of Medicaid recipients are women, these cutbacks have serious implications for women's health. Women are less likely to have medical insurance than men. Insurance coverage as a benefit is least likely to be offered in those areas where women work: part-time employment, small businesses, and manufacturing industries. Insurance eligibility is often dependent on a woman's marital status, despite the fact that 41.5 per cent of all American women are not spousal dependents. Insurance companies frequently adjust premiums for sex, age, income, race, and workforce characteristics, a policy which works against women. As the field of women's health expands and receives more emphasis, the data reflecting the experiences of large groups of women will have to be collected and analyzed ever more carefully. Information collected should include physiologic, psychosocial, and economic factors that together affect the health status of women. These data may then be used to guide health policy decision making, as well as provide a basis for health promotion and disease prevention interventions with individual clients.

PIP: As a result of decreases in maternal mortality and infectious diseases, women's life expectancy has increased rapidly in this century and is expected to reach 83 years by the year 2000. However, there are a large number of chronic conditions that negatively affect the quality of life of women today: urinary tract infection, menstrual cycle disorders, hypertension, diabetes, osteoporosis, arthritis, eating disorders, substance abuse, and mental depression. Although women's life expectancy is 7.5 years greater than that of men, the morbidity rates are significantly higher for women. As women continue to enter the labor force in large numbers, questions are being raised regarding the physical and psychological hazards of jobs traditionally considered to be women's work, the risks associated with jobs that are physically demanding or involve exposure to toxic substances, and the association between pregnancy outcome and employment. Further research is needed on the effects of multiple role stress on women's health. Another recent trend has been the feminization of poverty: 2/3 of all US adults classified as poor are women. The lack of financial resources has a detrimental effect on nutrition, access to health care, and other preventive behaviors. Yet another social change related to women's health is the increasing number of elderly in the population. Women comprise 72% of the elderly poor, and over 80% of all retiring female workers do not have pension benefits. Access to, availability of, and payment for health care are problems for elderly women. It is important that research address the physiologic, psychosocial, and economic factors that together affect women's health status.

Ethical decision making in a bureaucratic context by senior nursing students.

This study examined the priorities reflected in the decisions reported by 775 senior baccalaureate nursing students in 16 Midwestern colleges and universities when presented a case depicting an ethical dilemma in nursing practice. In small groups of five each, the students arrived at a course of action to take in dealing with the dilemma. Categories for classifying responses were derived from the literature in nursing ethics. Categories used in content analysis of responses were: (1) patient-centered responses, (2) physician-centered responses, and (3) bureaucratic-centered responses. The small groups of students made from 3 to 17 decisions trying to resolve the dilemma, with a mean number of 8 decisions per group. Of the 1,163 decisions, 9% were in the patient-centered category, 19% were in the physician-centered category, and 60% were in the bureaucratic-centered category. Select characteristics of participants were examined for relationships to group responses. Group responses did not differ significantly by education, clinical experience, previous experience with a similar dilemma, or RN status of group members. Students agreed on the first steps to take to resolve the dilemma, but achieved no consensus about where the nurse's responsibility ended. Examining the decisions made by nurses in response to an ethical dilemma is important in arriving at a better understanding of the relationship between ethical problems in professional practice and the influence of social organizations or bureaucracies on nursing roles.