Age, developmental, and job stage influences on nurse outcomes.

This descriptive study surveyed 412 nurses in three hospitals and found that older nurses and nurses in more mature developmental stages showed greater job satisfaction, productivity, and organizational commitment. Job stages of entry, mastery, and disengagement were examined, and 24% of nurses reported being disengaged from their jobs, with lower satisfaction and commitment. Implications include the compelling need for nurses and organizations to do career planning together to avoid disengagement of nurses so critical to patient and organizational outcomes.

Correcting deficiencies in HIV/AIDS care for transgendered individuals.

Studies suggest that transgendered individuals are at high risk for acquiring HIV through injection drug use and sexual risk behaviors. Beginning efforts are being directed to identify the unique needs and concerns of these individuals and to develop culturally sensitive programs that will be successful in recruiting and retaining these individuals in drug abuse and HIV treatment services. These efforts include examining the available and needed services from the perspectives of both the transgendered community and health care professionals. This article reviews the phenomenon of transgenderism and the social context that places these individuals at risk for HIV. Additionally, this article proposes some guidelines for those who are in positions responsible for designing, evaluating, and implementing existing health care services to transgendered populations.

Building culturally sensitive substance use prevention and treatment programs for transgendered populations.

Studies show that transgendered individuals are at high risk for substance use problems. It is important to identify the unique needs and concerns of these individuals and culturally sensitive programs that will be successful in recruiting and retaining these individuals in drug abuse treatment services. This involves incorporating the needs of services from the perspectives of both the transgendered community and health-care professionals. It is the purpose of this article to discuss transgenderism as well as the substance use problems and difficulties within substance use treatment that transgendered men and women may face. This article presents guidelines for the design and evaluation of health-care services to transgendered populations.

Can hospital structural and financial characteristics explain variations in mortality caused by acute myocardial infarction?

Each year 1 in 160 people in the United States suffers from acute myocardial infarction (AMI). Of these more than 1.5 million cases annually, 500,000 end in fatalities. This study's purpose was to describe and evaluate the role hospital characteristics play in rates of mortality caused by AMI in acute-care California hospitals. Characteristics evaluated include structural characteristics--i.e., teaching status, percentage of board-certified physicians, registered nurse hours per patient day (RN hours/patient day), volume of cases, technological resource availability, and urban density; and financial characteristics--profit status and total operating expenses per patient day. Although part of a larger investigation correlating mortality and length of stay, this article reports only the results for significant influences on mortality.

Quality of life in women with symptomatic HIV/AIDS.

Despite the increasing incidence of cases of human immune deficiency virus (HIV) infection and of acquired immune deficiency syndrome (AIDS) in women, there is a serious lack of information about those women's quality of life (QoL). The purpose of this exploratory descriptive study was to describe QoL using an HIV-specific instrument (the HOPES) every 2 months over a 4-month period in a convenience sample of 44 women with symptomatic HIV/AIDS. Changes in physical, psychological, social, sexual dimensions, and overall QoL were evaluated along with the frequency of the most prevalent distressing items. The mean scores of the global QoL, physical and psycho-social summary scales were significantly different over the 4-month data collection period: quality of life improved. The most prevalent disruptions were in the psycho-social domain, including financial problems, worry about the family, distress about losing others from HIV, and worry about disease progression. The most prevalent physical disruptions included reduction in energy, difficulties with daily activities and frequent pain. Married women appeared to be more vulnerable to disruptions in QoL over time. In addition to the use of conventional disease-specific parameters for the ongoing follow-up of women with HIV/AIDS, the systematic use of a QoL assessment can provide a focused approach to monitoring problems and targeting interventions. Such an approach is especially important for nurses who assist women living with the symptoms of HIV/AIDS.

Demystifying the influence of hospital characteristics on inpatient mortality rates.

Death, although not the only measure of adverse outcome, has been studied more than any other single occurrence. The authors discuss the findings of these studies and propose a conceptual framework to explain the relation between several hospital characteristics (e.g., profit status, RN ratios) and inpatient mortality rates. These studies raise the issue of whether some hospital characteristics are distal contributors and others, such as RN ratios, are more proximal explanatory variables of the mortality rate. Implications for understanding the relation of nursing's role in the array of potential contributors are discussed.

The relationship of hospital structural and financial characteristics to mortality and length of stay in acute myocardial infarction patients.

This ex post facto correlational study reports the influence of eight hospital structural and financial characteristics on mortality and length of stay (LOS) in acute myocardial infarction patients in 373 California hospitals. Significant results include: registered nurse hours/patient day (RN hours/pt. day) were inversely related to mortality in bivariate and regression analyses and to LOS in regression analyses. Total operating expenses/patient day (TOE/pt. day) were positively related to mortality (regression analyses) and LOS (bivariate analysis). The authors discuss implications for research and administration.

Women with HIV: living with symptoms.

This exploratory study used a semistructured interview to describe women's experiences coping with HIV-symptoms, their descriptors of their worst and best days, and their attempts to control symptoms. A convenience sample of 44 women, largely women of color, of lower socioeconomic status, unemployed, seeking treatment in one of six outpatient clinics in Los Angeles, were interviewed. Fatigue, the most frequently reported worst symptom, was present in 98% of these women. Feeling physically sick and having negative mood were mentioned most often in descriptions of worst days; being active, feeling physically healthy, and having positive mood were descriptors of best days. Of the total, 59% used rest/sleep to control symptoms, and this often was used in conjunction with healthy diet. The results of this study reveal aspects of women's day-to-day experiences with HIV-related symptoms.

Emotional distress in women with symptomatic HIV disease.

This article describes emotional distress in 44 women with Human Immunodeficiency Virus (HIV) symptomatic disease. Measures of self-reported symptoms of anxiety and depression revealed that emotional distress was prevalent in this group and may be sufficiently robust to warrant clinical diagnoses. Limits to functioning and disruptions in physical well-being were found to be associated with both anxiety and depression. Additionally, level of optimism was inversely related to anxiety and depression, and social support was inversely related to anxiety. These findings indicate that emotional distress in women with HIV disease is associated with, and could be ameliorated by, interventions targeted at functional status, social support, and level of optimism.

Emotional distress in men with life-threatening illness.

This descriptive survey explored the relationship of health status, functional status, stressful life events, stress resistance resources and emotional distress in 60 men with life-threatening illness (N = 30 with cancer and N = 30 with AIDS). Sixty-two percent met CES-D criteria for clinical depression. This study's results supported the hypotheses that poorer functional status and greater negative stressors are associated with both higher levels of hopelessness and depression. Twenty-four patients constituted a group with severe emotional distress. This group was significantly different from the less vulnerable group with poorer functional status (KPS), a greater number and severity of negative stressors, less satisfaction with social support, and less hopefulness.

Personality hardiness, work-related stress, and health in hospital nurses.

Personality hardiness is a set of beliefs about oneself and the world one lives in. Hardier persons take control of their lives, believe that commitment to goals will result in positive outcomes, and perceive daily stressors as challenges. Hardiness has been linked with less stress and fewer health problems among various occupational groups. This study found that among 237 hospital nurses, work-related stress and emotional exhaustion were associated with greater health problems in the form of anxiety, depression, and somatic complaints. Hardier nurses reported less work-related stress, less emotional exhaustion, and less anxiety, depression, and somatization. This article discusses considerations for strengthening future studies concerned with the relationships between personality hardiness, work-related stress, and health in nurses.

Emotional exhaustion and distress among nurses: how important are AIDS-care specific factors?

This study describes distress symptomatology and levels of job-related exhaustion in a sample of 153 hospital nurses currently caring for AIDS patients. While the level of emotional exhaustion in the sample was not alarmingly high, these nurses did report symptoms of distress. Levels of emotional exhaustion were related to a variety of personal demographic, AIDS-specific, and job-related factors. These factors included: age, income, years of practice on the unit, recent change in shift, type of unit, discomfort caring for AIDS patients, willingness to continue caring for AIDS patients, number of AIDS patients cared for, job tension, job influence, and enthusiasm about returning to work. Regression analysis indicated, however, that six general job-related factors accounted for about 46% of the variation in emotional exhaustion. These results suggest that general job-related factors such as 8-hour shifts, changing shifts, level of job tension, and other factors characterizing all hospital care are particularly worthy of future study.

Burn-out in hospital nurses: a comparison of acquired immunodeficiency syndrome, oncology, general medical, and intensive care unit nurse samples.

Previous research has shown that job-related stress and burn-out are associated with high levels of demand placed on the worker, especially in situations where influence is low. This study examined burn-out among nurses working on acquired immunodeficiency syndrome (AIDS) special care units (SCUs), oncology SCUs, medical intensive care units (ICUs) and general medical units to measure the extent to which delivery method (SCU, ICU, and general unit), patient diagnosis, or other key personal and work-related characteristics were associated with the level of distress in these nurses. A sample of 237 nurses from 18 units in seven hospitals were surveyed using the Maslach Burnout Inventory. This study showed no significant differences in burn-out scores across nurse samples representing variations in patient diagnosis and delivery method. Specifically, nurses on AIDS SCUs, oncology SCUs, medical ICUs, and general medical nursing units reported similar levels of distress on the burn-out subscales. There was one exception: medical ICU nurses scored significantly lower on the Personal Accomplishment subscale (P < .001). Regression analyses for the Emotional Exhaustion and Personal Accomplishment subscales indicated that greater job influence had a significant protective effect on emotional exhaustion and enhanced personal accomplishment (P < .05). As expected, job tension was a key predictor of exhaustion (P < .001), and being white was associated with greater feelings of accomplishment (P < .002). Working in a medical ICU continued to show a negative impact on accomplishment when race and other important covariates were controlled for (P < .05), and working on an AIDS SCU was predictive of exhaustion in a multivariate context (P < .05).

The relationship of stressful life events, health status and stress-resistance resources in persons with AIDS.

Depression and hopelessness are major problems in persons with AIDS (PWAs). This study provides a paradigm for viewing these mental health states as outcomes that are dependent on stressors, physical health states, and stress-resistance resources. The sample consisted of 30 male, English-speaking PWAs with stage IV AIDS. A significant positive relationship was found between negative life events and the measure of depression, and number of complications and depression. Satisfaction with social support, intrapersonal hope, and global hope were all significantly, negatively associated with hopelessness. The findings support the importance of stress-resistance resources in promoting mental health in PWAs.

Methodological concerns in evaluating psychiatric nursing care modalities and a proposed standard group protocol format for nurse-led groups.

The importance of detailing therapeutic effort and its outcome cannot be underestimated. The need to document outcomes has been re-emphasized in recent psychiatric mental health literature; however, the methodology for addressing threats to validity is well established. This article identifies the problems and issues related to a systematic evaluation of a therapeutic group intervention in an inpatient setting, specifically threats to validity, and describes the processes used in planning and implementing a standard group protocol format. The findings of this project depicting problems in the clarity and precision of documenting nursing practice are believed to be typical and generalizable. However, problems related to clarity and precision have not been addressed in the nursing literature. For a number of reasons, nursing staff members have not been sensitized to the importance of describing their practices in sufficient detail to allow others to replicate these practices. And yet, adequate evaluations of nursing efforts, particularly programmatic initiatives, require systematic testing with repeated trials. Although no description can describe in absolute terms what occurred, clear and precise descriptions of an intervention provide the foundation for valid conclusions about the effort. A detailed standard group protocol format provides a basis for establishing internal validity in subsequent quasi-experimental research designs as well as program evaluation studies.

Quality and cost of AIDS nursing care as a function of inpatient delivery systems.

Decisions to hospitalize persons with AIDS (PWAs) and the subsequent nursing process and outcomes associated with this hospitalization are of major concern to nurse administrators. Although decisions to hospitalize may be out of their control, events occurring during hospitalization that affect the quality of nursing care received are clearly the nurse administrator's responsibility. This report addresses a major issue concerning the care of PWAs: the decision to establish a dedicated AIDS unit. The effect upon both quality care and nursing care costs is discussed.

Nursing-led group modalities in a psychiatric inpatient setting: a program evaluation.

This examination of group practice activities conducted by nurses in an inpatient setting combined retrospective examination of practices and concurrent analysis of what is actually done on the units. The most striking finding of this evaluation of institutional nursing-led or co-led group activities was the significant decline in the number of groups. Second, and a related finding, was the need to standardize the format for documenting group activities and outlining the scope and function of these groups. And finally, the need for concise evaluation criteria and measures to document the achievement of stated patient outcomes was very apparent.

Patient satisfaction on AIDS and oncology special care units and integrated units: a pilot study.

The authors assessed patients' satisfaction with their nursing care in seven hospitals. Five of the hospitals utilized the special care unit (SCU) method of delivering care to AIDS or oncology patients; three had SCUs for AIDS patients. All seven of the hospitals had integrated units (IUs) where general medical, oncology, and/or AIDS patients were received in various proportions. Satisfaction with nursing care was measured with the Risser Patient Satisfaction Instrument. Patient satisfaction with nursing care was shown to be a function of delivery method; AIDS and oncology patients on SCUs expressed greater satisfaction with their care than medical, oncology, or AIDS patients on IUs (p less than .001). Patient satisfaction with nursing care was greater among whites than nonwhites. Also, some major sociodemographic and case mix variables, such as age, employment status, and diagnosis, were not associated with patient satisfaction directly; in other instances, the associations initially seen did not hold when delivery method (SCU vs. IU) and race were controlled for in a linear regression analysis.