Decision-making phenomena described by expert nurses working in urban community health settings.

Decision making by expert community health nurses was explored using qualitative research methods. Each subject described a crucial incident, a clinical situation where their independent decision making made a positive difference in a client's outcome. Subjects were given instructions to record a crucial incident in writing. After completing each written incident, subjects were asked five interview questions related to the incident. Subject's verbal responses to questions were audiotaped. Content analysis methods were used to analyze data. Findings suggest that decision making in clinical practice in both a rational and intuitive process. Themes emergent from data describing decision making included the following: focus, type, and purpose of the decision making; characteristics of the decision maker; sequencing of events; data collection methods; facilitators and barriers to decision making; and nursing roles in the decision-making process. Conclusions of the study include recommendations for continued research of decision making using qualitative methods allowing flexibility necessary to explore phenomena representing the essence of nursing practice. A clearer understanding of decision making is essential now and in the next century as nurses increase independent practice roles in community health settings.

Managing clinical experiences for minority students with physical disabilities and impairments.

According to the Americans with Disabilities Act of 1990, clinical training programs cannot refuse admission to individuals with certain physical limitations. That is, an otherwise qualified person who meets program requirements in spite of a handicap must not be discriminated against. Since hypertension and renal disease affect a disproportionately higher number of African Americans than others, the numbers of students with physical disabilities as well as students of color who are also adult learners are likely to increase in clinical nursing programs. This article discusses a planning model developed and implemented by nursing faculty in a baccalaureate degree nursing program at a historically Black university which was used as a guide for the inclusion in clinical practice of students experiencing physical disabilities. A case study is presented to illustrate how the model was implemented with an immunosupressed student secondary to a renal transplantation.

Perceived impact of nursing faculty on the academic success of minority students.

This qualitative study explored perceptions held by (74) senior nursing students related to factors in the nursing program they believed most and least contributed to their academic success. Data were collected using open-end interview questions. Findings suggests that students perceive nursing faculty as one of the most important influences on their academic success. According to student reports, nursing faculty knowledge, clinical expertise and caring characteristics were most important in helping them succeed in the nursing program. Students described faculty characteristics such as flexibility, tough but fair, and supportive as beneficial to their academic achievement. Students described lack of knowledge and clinical expertise, inflexibility, biases and a stern uncaring attitude as faculty characteristics least likely to assist in achieving academic success. More research in the area of faculty and student interactions and the impact of these interactions on student academic success is recommended. Faculty development of skill and expertise in current climates in schools of nursing today and effective teaching practices are also recommended.

Isokinetic testing in patients with hemiparesis. A pilot study.

The Cybex II isokinetic dynamometer was used to measure quadriceps femoris and hamstring muscle function in 15 patients with hemiparesis. Comparisons of isokinetic data obtained at 30 degrees/sec and 180 degrees/sec were made between the involved and uninvolved side of patients and the right side of 15 healthy subjects matched by age, sex, and weight. Peak torque of both muscles on both sides of the patients was significantly less than the peak torque of muscles of healthy subjects at both speeds. Other significant differences occurred on the involved side including decreased limb excursion, prolonged time factors related to tension development and the interval between reciprocal contractions, and fatigability at high speed. Results indicated that isokinetic testing can provide objective information about quadriceps femoris and hamstring muscle performance in hemiparetic patients.

Rotational motion of the knee.

This study deals with the quantitation of axial rotation at the knee. Passive rotation of the knee was measured at various degrees of flexion on 17 subjects with normal knees and 19 patients with unilateral anterolateral rotatory instability. Normal subjects were found to have bilateral symmetric rotational knee motion at each angle of flexion tested. When the knee is in a position of flexion between 30 and 90 degrees, there are approximately 45 degrees external and 25 degrees internal rotation. Rotatory motion decreases with further extension and, at 5 degrees of flexion, the knee has 23 degrees external and 10 degrees internal rotation. The knee with a torn anterior cruciate ligament and anterolateral rotatory instability was found to have an arc of rotation similar to the contralateral knee and to the control knees between 30 and 90 degrees flexion. At 15 degrees of flexion, a slightly greater arc of rotation was measured compared to normal knees. At 5 degrees of flexion, a significantly greater range of external (to 41 degrees) as well as internal (to 14 degrees) rotation was measured.

Effect of patellectomy on the function of the quadriceps and hamstrings.

The Cybex-II isokinetic dynamometer was used to measure quadriceps and hamstrings function after unilateral patellectomy in twelve patients. The interval between surgery and testing averaged twenty-six months (range, fourteen to forty-two months). Data on isokinetic and isometric performance were compared with those of the untreated limb and with those of subjects who had not been operated on but who had been matched by age, sex, and weight. On the side that had been operated on, the peak torque of the quadriceps was significantly decreased whereas the peak torque of the hamstrings was preserved. Deficits in time factors related to the development of tension and high-speed performance were documented, revealing abnormalities in both muscle groups. Although patellectomy was successful in achieving relief of pain in these patients, the results of the study confirmed that the function of the knee muscles was compromised postoperatively. The objective findings documented alterations in muscle function that correlated well with the functional limitations described by the patients.

Evaluation of isokinetic muscle performance.

The development and availability of isokinetic testing equipment, recording systems, and systems for computer analysis have improved the quality and quantity of information about specific skeletal muscle performance. The value of both isokinetic exercise and instrumentation designed to objectively record muscle performance characteristics is becoming more widely recognized, especially by professional members of the sports medicine community. The present demand for appropriate equipment is high and new instrumentation for this purpose is being developed. Current instrumentation continues to be modified and improved. The information gained from carefully designed testing protocols is useful and necessary for understanding the role of specific muscle groups in athletic performance and for determining the readiness of the athlete to resume training or competition following injury or deconditioning. With expanded profile data about the muscle performance characteristics of various categories of athletes, training or rehabilitation programs may be adapted to meet the strength, speed, and endurance requirements of a given sport, which may enhance the quality of participation and prevent the occurrence of injury or reinjury.

Spouse similarity in newlyweds with respect to specific cognitive abilities, socioeconomic status, and education.

Newlywed spouses (N = 215 couples) were tested on 21 tests of specific cognitive abilities and responded to a questionnaire on their educational and socioeconomic (SES) background. A comparison of the present spouse correlations with those of long-standing marriages suggests that spouses resemble each other in abilities from the start and that the degree of resemblance changes little over time. The low spouse correlations for SES of origin (their parents) suggests that education is the chief SES variable by which spouse selection takes place. Spouse resemblance in education and parental SES could explain almost all of the spouse correlations in perceptual speed and spatial ability. However, a small but significant degree of spouse similarity in verbal and reasoning abilities was independent of education and SES.

Research experience in an undergraduate physical therapy program.

For the past five years, two required courses in research methodology have been presented to physical therapy students during their senior year. The overall objective was to prepare students to use the scientific method in their approach to physical therapy practice. The content of the first course included didactic instruction on the research process with emphasis on reading and interpreting the medical and scientific literature. In conjunction with this experience, students developed research proposals. During the second course, students gathered data, analyzed and synthesized results, and prepared a complete research paper. To date 67 projects have been completed. Reactions to this learning experience and samples of abstracts written by students are presented.