bluuebunny/crossref_metadata_2025 huggingface dataset:
The Pinwheel Model of Bereavement
Authors: Solari‐Twadell Phyllis Ann , Bunkers Sandra Schmidt , Wang Chin‐Eng , Snyder Dona
Published: October 2007

The Pinwheel Model of Bereavement is a process‐orientated model of grief which recognizes loss as a unique lived experience. The model and relevant nursing response are described using Margaret Newman's nursing theory of health as expanding consciousness. The model is based on research by Carter (1989) and clinical experience. The contextual theme for the model is “personal history.” Six core themes are: being stopped, hurting, missing, holding, seeking, and valuing. Three meta themes are change, expectations, and inexpressibility. Capacities for “being with” the bereaved are identified for the practice of nursing
Leave and Employment in Families of Preterm Low Birthweight Infants
Authors: Gennaro Susan
Published: October 2007

Objective: To determine how employment, income and out‐of‐pocket expenses changed in 224 families of low birthweight infants during the first 6 months after the infant was discharged home.

Design: Prospective, descriptive.

Population, Sample, Setting, Years: Families of preterm, low birthweight infants. A convenience sample of families of 224 preterm (<37 weeks gestation) low birthweight (<2500 grams) infants was obtained from one hospital in the Northeastern U.S.A. Mothers were interviewed over the telephone at each of the data points. Years of data collections were 1990–1994.

Methods: Mothers kept logs of expenses and were interviewed about changes in employment and income at infant discharge from the hospital and 1, 3, and 6 months later.

Findings: All but two of the employed mothers had to leave employment early because of pregnancy complications. After delivery, fewer mothers returned to work or returned later and worked less than mothers in national studies. Families spent 2% to 4% of their income in non‐reimbursed out‐of‐pocket expenses; transportation was a major expense.

Conclusions: Having a low birthweight infant results in unexpected changes in employment and in increased and unexpected out‐of‐pocket expenses.

Clinical Implications: Study findings support the need for longer leave for mothers who have small infants.
Older People and Attachment to Things, Places, Pets, and Ideas
Authors: Cookman Craig A.
Published: October 2007

A model of older adult to environment interactions is proposed that moves beyond the perspective of environment as safety hazard to environment as supportive resource the framework encourages health professionals to look for ways to incorporate positive environmental influences into individualized plans of care with older adults. Research is reviewed on the attachments formed by older adults to things, places, companion animals, ideas, and beliefs— which alongside people‐to‐people attachments comprise the “attachment structure.” Research on attachments of older people to environmental objects identifies important sources of security, belonging, and self‐identity. Further research is needed to define the nature of environmental connections in later life, their developmental characteristics, and their potential to influence the health of older people.
Caregiver Training for People with Alzheimer's Based on a Stress Threshold Model
Authors: Gerdner Linda A. , Hall Geri Richards , Buckwalter Kathleen C.
Published: October 2007

A caregiver training protocol for Alzheimer's disease and related disorders (ADRD) is presented for dementia management based on the progressively lowered stress threshold model. The training protocol is described using criteria for a nursing intervention including: (a) characteristics of the nursing diagnosis, (b) research base for the intervention, (c) desired patient outcomes, (d) acceptability to the patient, (e) capability of the nurse, and (f) feasibility for doing the intervention. A national study is described which is currently underway to further evaluate the effects of the training protocol.
Information Seeking Among People with Manic‐Depressive Illness
Authors: Pollack Linda E.
Published: October 2007

Objective: To develop a descriptive theory of the information‐seeking states of hospitalized people with manic‐depressive illness, as the first step in generating a substantive theory of the self‐management informational needs and activities of this population.

Design: Exploratory, using grounded theory methodology.

Population, Sample, Setting: Predominantly indigent and ethnically‐diverse population in one 250‐bed, university‐managed, county‐ and state‐funded acute psychiatric facility in the Southwestern U.S.A. A convenient sample of 20 women and 13 men hospitalized for manic‐depressive illness were interviewed from December 1992 through December 1993.

Methods: Interviews with participants and review of medical records. Interview transcriptions were analyzed using conceptual coding and the constant comparative method.

Findings: The core variable of information‐seeking states was acceptance of having manic‐depressive illness. Three groups are: information seekers, information receivers, and information rejectors. Seven informational states are: novice, recent acceptor, veteran, passive acceptor, acknowledged denier, acknowledged rejector, and complete rejector. An individual's information‐seeking state is not necessarily constant, and may shift to another state depending upon various factors.

Conclusions: This typology of information‐seeking states is the firstpartofa substantive grounded theory of the self‐management informational needs and activities of people trying to cope.

Clinical Implications: Results of this study suggest that patient education should address a person's current information‐seeking state. The proposed typology can be used to develop a self‐assessment tool for completion by a patient before participating in educational or therapy programs.
Life‐Span Perspective of Personality in Dementia
Authors: Kolanowski Ann M. , Whall Ann L.
Published: October 2007

Purpose: To propose an alternative view of personality change in dementia by presenting existing evidence for the continuity of personality.

Significance: As the population continues to age, dementing illnesses will account for a greater proportion of morbidity and mortality; the care of these people will have a significant effect on the health care system.

Organizing Framework: Life‐span perspective of personality continuity.

Scope, Method: Review of current literature on personality in dementia using Medline, 1980–1994; CINAHL, 1990–1994; and Psych Lit, 1980–1994.

Findings: Although there are systematic shifts in personality with dementia, individuals tend to maintain their unique pattern of premorbid personality traits.

Conclusions: The personalities of dementia patients seem to reflect adaptive patterns that served them in the past.

Implications: Use of a life‐span perspective can enhance individualized care for demented patients and advance theory development.
Advancing Nursing Practice with a Unit‐based Clinical Expert
Authors: Hanneman Sandra K.
Published: October 2007

Objective: To explore patterns in the practice of nursing and patient outcomes.

Design: Qualitative field research.

Population, Sample, Setting: Populations were critical care nurses and critically ill adult patients in the 10‐bed medical critical care unit of a 900‐bed teaching hospital. A convenience‐purposive sample of 27 nurses and 31 patients was studied in 1985.

Methods: Six months of participant observation, unstructured interviews, and the constant comparison method of grounded theory.

Findings: Markedly different patterns were found in expert and nonexpert practice. The substantive theory of conversion helped explain how the majority of nonexpert nurses advanced their practice. The metaphor of catalyzed conversion captures how a unit‐based expert nurse serves as a catalyst to advance the practice of nonexperts. Presence, defined as the way of being within a given clinical context, differentiated nurses.

Conclusions: (a) Expert and nonexpert practices are substantively different, (b) Expert and nonexpert practice results in different patient outcomes, (c) Conversion helps explain changes in nonexpert practice.

Clinical Implications: A unit‐based expert nurse can increase patient‐focused care.
Interviews With Seven Holders of Endowed Chairs In Nursing
Authors: Cogliano Janet
Published: October 2007

Objective: To describe the activities of selected nurses holding endowed‐chair positions and the development and funding of endowed chairs.

Design: Longitudinal, exploratory/descriptive.

Sample, Setting, Years: Data were collected 1992–1995 from seven university nurses in five states.

Methods: Questionnaire and interviews.

Findings: Nurses holding endowed‐chairs are highly committed to advancing nursing. There is an extremely high level of job satisfaction and also mobility into upper administrative positions. Activities commonly extend beyond the faculty role and involve working with local and national groups.

Conclusions: The numbers and funding of endowed chairs in nursing are increasing. Holders are contributing significantly to the profession's advancement and to human welfare.

Implications: Clinical practice and nursing's image are enhanced by the research and other scholarly activities of nurses holding endowed positions.
Caring and Comfort Metaphors Used by Patients in Critical Care
Authors: Jenny Jean , Logan Jo
Published: October 2007

Objective: To examine the meaning of metaphors used by critical care patients about their ventilator weaning experience.

Design: Grounded theory.

Population, Sample, Setting: In 1992–1993, from a population of mechanically ventilated patients, a convenience sample of 20 adult patients was recruited from one 14‐bed multispecialty ICU in a 740‐bed teaching hospital in eastern Canada.

Methods: Transcripts of interviews were reviewed from the 20 original study transcripts, of which 18 included one or more metaphors for a total of 70. All were coded and classified with sub‐themes analyzed for implicit meanings.

Findings: Four categories of metaphors were Physical Discomfort, Nurse Caring, Altered Self, and Patient Work. Data provide the elements for a mid‐range theory of caring.

Conclusions: Metaphors provide vivid images of significant patient concerns and are a way for people to express meaning and feeling.

Clinical Implications: People communicate about their inner world through language. Examining patients' metaphors is a valuable approach to understanding the experiential world of patients in critical care so that nursing actions can be directed toward personal needs which may not be expressed openly. Providing interventions aimed at these personal needs will help patients find suitable levels of physical and emotional comfort.
Health Beliefs and Social Influence in Home Safety Practices of Mothers with Preschool Children
Authors: Russell Kathleen M. , Champion Victoria L.
Published: October 2007

The purpose of this study was to determine relationships among health beliefs, social influence, and home injury proofing‐behavior in 140 low‐income mothers with preschool children. Data were collected through structured interviews and observations of safety hazards in subjects’homes. Regression analysis showed that the combination of health beliefs, social influence, demographic, and experiential variables accounted for 51% of the variance in hazard accessibility and 44% in hazard frequency. Self efficacy, previous injury experience, knowledge, age, and birth position of the children were significant predictors of home safety practices. Recommendations are offered for practice, research, and health policy.
Intervention Model for Substance‐Using Women
Authors: Tiedje Linda Beth , Starn Jane R.
Published: October 2007

Treatment programs for pregnant women using alcohol, tobacco, and other drugs are generally ineffective because of a focus that is male‐oriented and because of an emphasis on primarily fetal outcomes. This paper examines women's addiction to alcohol and other drugs from a feminist perspective. Published literature over the past decade on the importance of relationships in the etiology of women's drug‐use behavior is reviewedand an intervention model based on home visits and framed in the context of women's relationships is proposed.
Building Community Participation in Health Care: A Model and Example from South Africa
Authors: Hildebrandt Eugenie
Published: October 2007

A conceptual model was developed for a community‐based intervention study in a Black township in South Africa. The model shows a useful way to structure the complex role public health nurses play as they meet community health needs using a community's priorities and building toward community involvement in health and self‐care. The model was applied over a 2‐yearperiod in an under‐developed community of 100,00 people where the unemployment rate was over 50%, fewer than 10% of the homes had electricity, and only one‐third had access to the sewage removal system. Over half of older adults interviewed were illiterate. The residents, in collaboration with the nurse researcher, gathered data, prioritized needs, and chose projects to produce solutions. The model guided activities for community empowerment through a deliberate transfer of information and expertise from the nurse to members of the community. Conceptual models or paradigms are useful to focus nursing strategies, to guide professional nursing practice, and to support interdisciplinary goals for cooperative efforts. The principles are also applicable in the United States and other developed countries as more effective ways to achieve health goals are sought.
Health Education in Jinja, Uganda
Authors: Kater Vered
Published: October 2007

A community‐based health care program in Uganda is described. Perceived learning needs of a group of adults with 3–4 years of elementary school education were assessed and prioritized. A decision was made to teach a few subjects in depth as opposed to many superficially after hearing the large amount and type of topics requested. Teaching sessions included practical applications based upon the availability of materials and local practices and beliefs. Basic needs, such as the need for food and water, were continuously addressed. Traditional ways of healing were only encouraged when these did not endanger health. Teaching a group of adults with limited knowledge of anatomy or physiology was a challenge that demanded simplification of complex problems and the use of interventions that were sometimes unusual.
Exploring the Use of Explanatory Models in Nursing Research and Practice
Authors: McSweeney Jean C. , Allan Janet D. , Mayo Kelly
Published: October 2007

Purpose: To address the lack of information in nursing for delivering culturally appropriate care and provide a framework for nurses to incorporate diverse beliefs and health needs into research and practice. People interpret and react to health and illness events within a cultural system. However, the nursing literature contains little about how to elicit cultural beliefs.

Organizing Framework: Use of Kleinman's (1980) concept of explanatory models (EMs) is explored first, by describing the concept as it was developed by Kleinman, and second, by illustrating how it was used in three research studies conducted between 1990 and 1994.

Method: Individual in‐depth interviews were conducted with community‐based convenience samples. Data were analyzed using content analysis. Explanatory models were explored with healthy people, with people following illness, and with people having a condition with potential health risks, to illustrate their usefulness in nursing research and practice.

Conclusions: The findings provide a beginning understanding of the complex linkages between beliefs and actions and demonstrate the versatility and usefulness of EMs for nursing research and practice. Assessing models offers one means for researchers and clinicians to explore health beliefs and the linkages between beliefs and behaviors.
Testing Orem's Theory with Mexican Americans
Authors: Villarruel Antonia M. , Denyes Mary J.
Published: October 2007

Purpose: To examine an ethnographic study using evaluation criteria for theory‐testing through verification of personal experience.

Organizing Framework: Ten theory‐verification criteria developed by Silva and Sorrel (1992) for inductive methods of inquiry.

Scope and Sources: A 1995 ethnographic study conducted with Mexican Americans and conceptualized within Orem's Self‐Care Deficit Theory of Nursing. Twenty Mexican American key informants were from 13 families. Primary data sources were focused observations and a series of ethnographic interviews. The study, purposes, methods, selected findings, confirmability and credibility of study findings, and relevance to Orem's theory are presented in the context of each criterion.

Findings: The purpose, design, analysis, and examination of results of the 1995 study sufficiently meet the 10 formative criteria. Because this study can be considered an example of theory verification research, findings are relevant to the development of Orem's theory.

Conclusions: Through the use of theory‐verification criteria, inductive methods of research can be used to test or verify theory. The testing of nursing theory with diverse populations is an important direction for continued theory development. Use of evaluation criteria can serve as a template for inclusion of diverse perspectives.
Future of the Nudrse Labor Market According to Health Execudtives in High Managed‐Care Areas of the United States
Authors: Buerhaus Pedter I. , Staiger Douglas O.
Published: October 2007

Purpose:To understand how the work environment of nurses is changing in states with high enrollment in health maintenance organizations (HMOs), the underlying forces driving change, and how these forces are expected to affect employment and states with high enrollment in HMOs are generally regarded as indicative of the future for all the United States.

Design: Survey in 1995 of a convenience sample of 62 health excutives in 11 states with high enrollment in HMOs. Excutives included officals in state goverments, state and metropolitan hospital associations, professional an nonprofessional nursing associations, state boards of nursing, community and public health, home health care, nursing homes, other non‐acute care associations, and leading HMOs.

Methods: Through structured telephone interviews, executives were asked about changes in nurse employment, earnings, collective bargaining, fringe benefits, nurses' roles, substitution of licensed practical nurses (LPNs) and aids for RNs, patients severity, quality of patient care, and expectations for nurse employment during the remainder of the decade.

Findings: Executives perceive a mostly and fast‐changing nurse labor market but they are concerned about the aging RN work force, possible development of an RN shortage, and linking quality of patient care to the provision of nursing services. They doubt the ability of nurse educators to respond quickly to th need to prepare nurses for rapidly changing employer requirements.

Conclusions: Public and private forces are causing rapid, profound changes in health care delivery and throughout the nurse labor market. These changes are most evident in the shift in these changes, no evidence of an “employment disaster” exists it the views of health
Doctoral Education in Nursing for Practitioner Knowledge and for Academic Knowledge: The University of Adelaide, Australia
Authors: Pearson Alan , Borbasi Sally , Gott Marjorie
Published: October 2007

Australian nursing has undergone rapid academization in the past 10 years and this radical change has tended to meld the somewhat different academic traditions of North America and Britain. The introduction of doctoral education in nursing in 1987 has led to a massive increase in scholarly activity and to the preparation of talented leaders. We concur with the view expressed by Henry (1997), “I am convinced that the problems we face in the nursing services would be much more creatively solved if the majority of our doctoral programs prepared young, energetic nurses, early in their career, for clinical practice, not for research and teaching” (p. 162).
Using National Data Sets on CD‐ROM to Teach Nursing Research
Authors: Ailinger Rita L. , Lasus Howard , Choi Elizabeth
Published: October 2007

Purpose: To explore the use of national data sets on CD‐ROM for teaching graduate nursing research.

Significance: Secondary data analysis of national health data sets is economical and provides a useful experience for students learning research.

Scope: The advantages and disadvantages of using national health data sets on CD‐ROM are described. Students in three majors in nursing worked in groups to address research questions that could be answered using variables in the National Health Interview Survey. Several computer laboratory sessions were held to teach students how to extract the data and apply SPSS to analyze data.

Findings: The pilot program was a success, but not without problems. Ten steps to ensure better attainment of objectives were formulated.

Conclusions: National data sets on CD‐ROM are an inexpensive, rich data source that allow flexibility for students and faculty. Secondary data analysis using national health data sets is an underused approach in nursing. Graduate students can have a significant research experience while curbing the costs‐to organizations and themselves‐associated with primary data collection.
Managing Health Problems among Homeless Women with Children in a Transitional Shelter
Authors: Halton Diane C.
Published: October 2007

Purpose: To describe health problems among homeless women with children living in a transitional shelter, analyze how they managed various ailments and when and how they sought care.

Design: Qualitative using grounded theory and dimensional analysis.

Sample: During 1992 and 1993, data were gathered from a convenience sample of 13 Latina, 11 White, and 6 African American women (n=30) who lived in a transitional shelter in California, USA.

Methods: In‐depth, semi‐structured interviews

Findings: Despite many supportive services in transitional shelter, respondents had difficulty managing health problems. Typically, a woman reported she managed a health problem by overcoming it alone.

Conclusions: The pattern of overcoming it alone existed years before transitional shelter life, and, in many instances, persisted during shelter years.

Clinical Implications: Clinical nursing interventions that address shame, fear, lack of information, and eligibility for services could improve health outcomes among women and children living in transitional shelters.
Analysis of the Concept of Mutuality
Authors: Henson Robbie Helmich
Published: October 2007

Purpose: Mutuality is explored as an interaction style for providers and clients that encourages

Significance: Accountability by both providers and clients is necessary to manage health care Organizing Framework: Walker and Avant's method of concept analysis.

Scope: Literature from 7 930 to 1996. Mutuality is compared to autonomy, reciprocity, consumerism, negotiation, participation, collaboration, and paternalism.

Conclusions: Mutuality is shown to balance power and respect, and to promote productive provider‐client communication. This interaction style for partnership relationships fosters positive and lasting health care outcomes.

Implications: Nurses are challenged to develop the skill of elicitinggive and take, and creative, m utua I exchanges.
Sister Elizabeth Kenny, an Australian Nurse, and Treatment of Poliomyelitis Victims
Authors: Oppewal Sonda Riedesel
Published: October 2007

Purpose: To analyze the strategies that Elizabeth Kenny, an Australian nurse, used when trying to obtain medical endorsement for an innovation that was not based on knowledge of pathology, but was empirically demonstrated.

Significance: When faced with the need to “Do the best you can with the symptoms presenting themselves,” Kenny used keen observation to develop a new treatment for poliomyelitis in the early 1900s. Her innovation was to use hot packs to relieve muscle spasms in people with early symptoms of poliomyelitis when orthodox medical treatment included use of splints or casts to immobilize affected limbs.

Method: Historical case analysis.

Findings and Conclusions: Sister Kenny made bold assertions, obtained scientific validation, learned from experience, used publicity, and opposed resistance. Although some strategies were unsuccessful (and Kenny faced many obstacles) medical practice changed in a relatively short time. Immobilization of limbs was largely discontinued in the acute stage of the disease. Kenny persisted in caring for children who otherwise might have sustained deformities.
Rules Outside The Rules for Administration of Medication: A Study in New South Wales, Australia
Authors: Baker Helen M.
Published: October 2007

Purpose: To improve understanding of how nurses define or redefine medication error.

Design: Qualitative descriptive.

Methods: This 18‐week ethnomethodological study in one hospital used participant observation, documentary analysis, and validation criteria. Ethnomethodology is useful for making clearer the every‐day, taken‐for‐granted understandings and practices of people as they make sense of their world. It hinges on the use of tacitly held knowledge in practical situations.

Findings: Nurses adopted practices and embodied logic to accomplish tasks. They created criteria to decide when incidents were “real errors” and used institutional rules to create order.

Conclusions: The findings provide a body of tacitly held knowledge about medication error that is shared among clinical nurses and redefines medication error using six criteria. The study calls into question the way institutions seek to identify, document, and reduce medication errors by nurses and the validity of nursing research based on reported error rates.
Russian Nursing Education Reform Project: New Nurses for a New Russia
Authors: Rosebrough Anita
Published: October 2007

Purpose: To describe a 2‐year nursing exchange project, 1992–1994, designed to access Russian nursing education and to make recommendations for change.

Results: Nursing education in Russia is at a level similar to vocational schools in the United States and is closely linked to medicine. Russian nurrse educators were assisted in developing a philosophy of nursing, developing definitions for nursing, and incorporating process into practice.

Conclusions: The Russian government and Russian nurse educators are committed to improving the equality of health care and nursing. This exchange toward a process‐based baccalaureate model.
Linking Research and Practice Through Discussion
Authors: Moch Susan Diemert , Robie Diane E. , Bauer Kathleen C. , Pederson Annette , Bowe Sharon , Shadick Kathleen
Published: October 2007

Purpose: To describe the process and outcomes of a researcher‐intiated discussion group with nurses in clinical practice.

Design: Descriptive case study. The study, which began in 1991, included one group of four acute care nurses. Between 1992–1996, three other groups of nurses participated.

Methods: Nurses in practice read and discussed articles from a program of research on brast cancer during a series of group sessions. The semi‐structured sessions were tape‐recorded.

Results: Participants suggested how to make article content more understable to clinicians; they affirmed findings relevant to practice; and identified ways to integrate research in practice.

Conclusions: Discussion served as a means for the researcher and nurses to connect the research‐practice gap through learning the practice perspective and the process and value of research. Discussion groups are recommended to enhance science‐based clinical practice.
Youngsters Caring for Adults with Cancer
Authors: Gates Marie F. , Lackey Nancy R
Published: October 2007

Purpose: To describe the caregiving provided by children and adolescents for adults with cancer. Because nurses are assuming an increasingly prominent role in working with caregivers, it is necessary to understand young caregivers.

Design: The population of interest was youngsters aged 10 to 19 caring for adults at home with cancer. Eleven children and adolescents in seven families were recruited, 1993–1994, through purposive sampling from hospices and cancer clinics.

Methods: Phenomenologic interviews, ethnographic interviews and selected participant observation experiences, and identification of needs through an unstructured survey were used.

Findings: “Hard, but gratifying” emerged as the dominant phenomenologic description of caregiving. Emergent ethnographic themes indicated caregiving by children and adolescents was an expectation of family life. School and church were described as avenues for social support for youngsters in care‐giving situations.

Conclusions: Youngsters aged 10 to 19 are caring for adults with cancer at home. Further descriptive study of youngsters caring for adults with cancer is needed.
Emancipatory Potential of Storytelling in a Group
Authors: Banks‐Wallace JoAnne
Published: October 2007

Purpose:To examine the health‐promoting functions of storytelling in a group of women. Design: Secondary analysis, descriptive. A convenience sample of 28 women of African descent living in the Seattle‐Tacoma region of the United States was used.

Methods:Narrative analysis of 115 stories. Data were audio‐taped in four focus groups convened during a 6‐week period in 1992.

Findings: Six major functions of storytelling were identified:(a) contextual grounding, (b) bonding with others, (c) validating and affirming experiences, (d) venting and catharsis, (e) resisting oppression, and (f) educating others.

Conclusions:Storytelling is useful for learning more about historical and contextual factors affecting the well‐being of women of African descent and for improving their lives. Group storytelling can create an environment that supports evaluation of experience and promotes problem‐solving.
Nursing Education and International Health in the United States, Latin America, and the Caribbean
Authors: Wright Maria da Gloria Miotto , Godue Charles , Manfredi Maricel , Korniewicz Denise M.
Published: October 2007

Purpose: To identify international health activities in United States, Latin American, and Caribbean schools of nursing. In the international community, nurses face challenges similar to those in related professions, but without the benefit of a long tradition. There is little research about how nursing education and associated activities prepare nurses to deal with international health, and little information about the extent of international health activities in U.S. schools of nursing.

Design: Descriptive.

Method: Using a questionnaire with 16 items, a survey was conducted in 1995 on a random sample of representatives from 100 university schools of nursing in the United States plus 15 schools with known international activities (10 from the United States and 5 from Latin America and the Caribbean).

Findings: International health as a program topic was found in one‐third of U.S. schools of nursing. However, nursing curriculums do not integrate international health with other subjects. Also, partnerships with foreign institutions are incipient and international health activities are usually individual initiatives with little institutional support.

Conclusions: For nurses to become major contributors to international health, nursing curriculum content must shift from “international nursing” to “international health.” Programs of nursing education should include study of social, economic, and political factors that affect health care systems. Schools should develop partnership agreements.

Educación en Enfermeía y Salud Internaciónal en los Estados Unidos, América Latina y el Caribe
Quality Health Outcomes Model
Authors: Mitchell Pamela H. , Ferketich Sandra , Jennings Bonnie M. ,   American Academy of Nursing Expert Panel on Quality Health Care
Published: October 2007

Purpose: Donabedian's 1966 framework of structure, process, and outcome has guided three decades of study in the United States of the elements needed to evaluate and compare medical care quality. Donabedian's perspective was essentially linear, assuming that structures affect processes, which in turn affect outcomes. Patient characteristics are sometimes considered as mediating outcomes and clinical interventions are considered to be processes. A model is presented in the following article that relates multiple factors affecting quality of care to desired outcomes. It extends previous models by positing dynamic relationships with indicators that not only act upon, but reciprocally affect the various components.

Scope and Sources: The proposed model was derived from a synthesis of the authors' experience in quality of care practice and research, as well as selected previous theories.

Conclusions: The quality health outcomes model is sufficiently broad (a) to guide development of databases for quality improvement and outcomes management, (b) to suggest key variables in clinical intervention research, and (c) to provide a framework for outcomes research and outcomes management that compares not only treatment options, but organizational or system level interventions. The model also has several policy implications.
Nurses, Indirect Trauma, and Prevention
Authors: Clark Marcia L. , Gioro Sandra
Published: October 2007

Purpose: To begin examining the nature of vicarious or indirect trauma and to discuss risk factors and prevention strategies. Despite the fact that many nurses are traumatized indirectly, few recognize the insidious development of such trauma. The dynamics of indirect trauma are relevant to nursing as are risk factors and prevention strategies.

Scope: Brief review of the literature (1974–1997) on vicarious trauma, compassion fatigue, secondary traumatic stress disorder, and traumatic countertransference using short vignettes for illustration.

Conclusion: Nurses who are informed about vicarious trauma and who actively maintain a balanced personal and professional life are in the best position to bring themselves and their clients through the many hazards of trauma work. The implications of vicarious or indirect trauma for nurses and clients are serious and complex requiring thoughtful analysis and research to clarify its effects.
Making Do with Fewer Nurses in the United States, 1945–1965
Authors: Grando Victoria T.
Published: October 2007

Purpose: To analyze the perceptions that nurses and hospital administrators had about the nursing shortage between 1945 and 1965 and the actions they took. Reasons nurses' wages remained low during this period of shortages and high demand were also examined to expand knowledge of nursing labor during a critical time in nursing history.

Method: Historical analysis of primary and secondary sources generated between 1945 and 1965 including: (a) American Nurses' Association's (ANA) central files in Washington, DC; (b) ANA archives at the Mugar Memorial Library, Boston University; (c) official proceedings oftheANA's and American Hospital Association's (AHA) conventions; (d) nursing and hos pital journals; (e) ANA and US. Government statistical documents and reports on the status of nursing labor; and (g) monographs on nursing, hospitals, the history of women's labor and the history of women in the 19405, 1950s, and 1960s.

Findings: Hospital administrators and nurses disagreed on the causes of the nursing shortage and its remedies in the 20 years after World War II. Hospital managers believed the shortage occurred because many nurses left the work force to remain at home with their families. Nurses, however, identified low wages and deplorable working conditions as the cause.

Conclusions: Hospital managers were successful at easing the shortage and controlling nursing costs by employing ancillary workers to replace RNs. Nurses took several different actions to deal with poor working conditions: initiating the ANA Economic Security Program, joining unions, and leaving hospital nursing.
World Wide Web Search Took
Authors: Sparks Susan M. , Rizzolo Mary Anne
Published: October 2007

This article describes and compares five popular general search tools and two popular general metasearch tools. The tools and their related files in February 1998 are the source of information and illustrations. A MEDLINE(R) search no longer guarantees retrieval of the most current, relevant, appropriate, and useful information. To meet demands for current information, the World Wide Web (WWW) must be searched. However, the enormous size of the WWW makes finding relevant information a difficult task. Fortunately, there are many automated search tools that can assist in locating relevant information quickly. Choosing the most appropriate tool depends on the type of information being sought.
Shifting Images of Chronic Illness
Authors: Thorne Sally , Paterson Barbara
Published: October 2007

Purpose:To describe results of a meta‐study of client roles in two decades of qualitative research on elements of chronic illness experiences. While a vast body of qualitative health research has uncovered insider perspectives on a range of chronic diseases and their related illness experiences, Systematic analysis has not been attempted, and research has not yet contributed to coherent theoretical developments.

Organizing Construct:Health care relationships as articulated in the context of insider research into chronic illness experience.

Sources:Elements of meta‐theory, meta‐method, and meta‐data‐analysis in the available qualitative research reports addressing chronic illness experience published 1980 through June 1996. Of over 400 published reports, 158 met the inclusion criteria and were subjected to systematic analysis on a number of themes, one of which is reported in this article.

Methods:Data selection, reduction, thematic analysis, and synthesis using constant comparative analysis.

Findings:Early conceptualizations of individuals with chronic illness shift from a focus on loss and burden toward images of health within illness, transformation, and normality. Parallel conceptualizations of health care relationships appropriate to chronic illness shift from client‐as‐patient to client‐as‐partner for the 15‐year period.

Conclusions:Meta‐study permits critical analysis of the location of current inquiry into the larger context of systematic patterns in knowledge development. Researchers are cautioned against uncritical acceptance of current trends in interpretation.
Middle‐Range Theory Of Chronic Sorrow
Authors: Eakes Georgene G. , Burke Mary L. , Hainsworth Margaret A.
Published: October 2007

Purpose:To introduce a middle‐range nursing theory of chronic sorrow that presents this sorrow as a normal response to ongoing disparity due to loss. Chronic sorrow is the periodic recurrence of permanent, pervasive sadness or other grief related feelings associated with a significant loss. The theory provides a framework for understanding and working with people following a single or ongoing loss.

Organizing framework:The model of chronic sorrow includes antecedents, trigger events, and internal and external management methods.

Scope:Theory is useful for analyzing individual responses of people experiencing ongoing disparity due to chronic illness, caregiving responsibilities, loss of the “perfect” child, or bereavement.

Sources:The theory was developed using concept analysis, critical review of research, and validation in 10 qualitative studies of various loss situations.

Conclusions:Chronic sorrow has been shown to explain the experience of people across the lifespan who encounter ongoing disparity because of significant loss. Nurses need to view chronic sorrow as a normal response to loss and, when it is triggered, provide support by fostering positive coping strategies and assuming roles that increase comfort.
Health Promotion Among Immigrant Women From India Living in Canada
Authors: Choudhry U.K.
Published: October 2007

Purpose: To describe the health promoting practices of immigrant women from India and how cultural knowledge, norms, and values influence their behavior.

Design: Descriptive using a small convenience sample.

Method: Using ethnographic methodology, 20 women between the ages of 40 and 70 years living in Canada, 1995–1996, were interviewed individually using open‐ended questions. Community get‐togethers were also observed.

Findings: The sample of women consistently reported that to remain healthy, a good diet, activity, and weight control were important. In addition, prayers, spiritual activities, and good relationships with families helped.

Conclusions: Health professionals should be aware of the special needs of immigrant women to help them promote healthy lifestyles in their cultural context.
Hospital Nurses' Perceptions of the Ethical Climate of Their Work Setting
Authors: Olson Linda L.
Published: October 2007

Purpose: To develop an instrument to measure how hospital nurses perceive the ethical climate of their work setting and to evaluate its psychometric properties. A way to measure ethical climate can help nurses understand the work setting influences on their practice and can be used to diagnose areas for organizational change as well as to evaluate effectiveness of organizational interventions.

Design: Descriptive. Instrument developed was the Hospital Ethical Climate Survey (HECS). Sampled were 360 RNs (48% response rate) employed in clinical practice at two acute‐care hospitals in one U.S. midwestern city. The nurses completed a questionnaire in 1993–1994 consisting of items developed to assess their perceptions of ethical climate, along with the 43‐item Integrity Audit, a social desirability scale, and a demographic inventory.

Methods: Construct validity was assessed by confirmatory factor analysis (CFA) using the LISREL®7 statisticaI program.

Results: The final CFA model consisted of 26 variables in five factors, which were organized according to the relationships of nurses with peers, patients, managers, hospital, and physicians. Internal consistency reliability, using Cronbach's alpha, for the final 26‐item instrument was 0.91 (range 0.68 to 0.92) for the subscales.

Conclusions: The Hospital Ethical Climate Survey has acceptable initial reliability and validity.
Factors Associated with Domestic Violence in Low‐Income Lebanese Families
Authors: Keenan Colleen K. , El‐Hadad Ayam , Balian Sossy A.
Published: October 2007

Purpose:To analyze the cultural context of domestic violence in low‐income Moslem and Christian‐Armenian families living in Lebanon. Analysis also included an identification of family stressors, conflict management strategies, and Moslem and Christian‐Armenian cultural differences. The study was part of a larger project designed to identify patterns of wife and child abuse in low‐income Middle Eastern families living in Lebanon and Egypt.

Design:Qualitative content analysis of descriptive narratives by 60 low‐income women who self‐reported spouse abuse in two urban Lebanese clinics during a 2‐month period in 1992.

Methods:Narratives describing exemplary incidents were obtained during a semi‐structured interview and recorded in the participant's native language then translated to English for coding and content analysis.

Findings:Contextual factors for violence included unmet gender role expectations, conflict with husband's relatives, and alcohol abuse. Family stressors were: emotional, financial, and work. Women used three types of conflict management: negotiation, taking initiative, and passive resignation.

Conclusion:From a cultural perspective, the analysis revealed both strengths and vulnerabilities of Lebanese women who experienced domestic violence. The study raised several questions, including whether it is appropriate to apply Western‐generated domestic violence theories to a Middle Eastern population. Culturally‐specific nursing interventions should be directed toward bolstering strong family and social resources to cope with family stressors and to modify patterns of maladaptive communication.
Addressing Urinary Incontinence with Educational Continence‐Care Competencies
Authors: Jirovec Mary Marmoll , Wyman Jean F. , Wells Thelma Joan
Published: October 2007

This article is a report of a task force formed from a discussion group hosted by the American Nurses Association on theAHCPR Guidelines on Urinary Incontinence. The need to standardize content related to bladder incontinence to be used in curriculums was identified as an initial step in implementing the guidelines. A task force was formed to develop educational competencies to be used by schools in identifying content that should be addressed at various levels of preparation. Although special training is needed when continence care is a significant part of a nurse's practice, it is expected that by using the educational competencies, schools will produce graduates at the basic level able to provide beginning continence care and graduate nurses able to address advanced incontinence problems.
Case Study of Institution‐Building by Nurse Bertha Wright and Colleagues
Authors: Nichols D. Jeanette , Hammer Marjorie S.
Published: October 2007

Purpose:To illuminate the history of nurses' participation in institution‐building in the early 1900s, using the Baby Hospital in Oakland, California (now called Children's Hospital Oakland) as a case.

Design:Historical research using a framework of women's history theory focused on the women who founded Oakland's Baby Hospital, 1910–1930.

Method:Data collection included studying original sources, archival material, and interviews. Data evaluation included external criticism for authenticity and genuineness, and internal criticism for accuracy and bias.

Findings:In 1912, nurse Bertha Wright and social worker Mabel Weed, with a circle of community women, including Jessica Peixotto and Jean Howard McDuffie, established the Baby Hospital. Their activism included home visits, education, research, publications, political lobbying, and state policy and program development. At the center of this activity, was the lifelong commitment of Wright and Weed, who created new definitions of family. With social changes in the late 1920s, the male Board of Directors seized control of the hospital, and relegated women to auxiliary roles.

Conclusions:Health and social issues of the United States at the turn of the century are still problematic as a new century approaches and pertain to maternal‐child health, foster care, and immigration. Feminists, including nurses, have played a central role in creating solutions. Knowledge of some of their incredible effort has been lost, particularly nursing's history in the western United States.
Estimation of a safety limit for ultraviolet radiation‐B (UVR‐B)‐induced cataract in an in vivo pigmented guinea pig model
Authors: MODY V , KAKAR M , DONG X , ZHANG Y , HUANG S , GALICHANIN K , LÖFGREN S , SÖDERBERG PG
Published: October 2007

Purpose: To establish a threshold measure, maximum tolerable dose (MTD), for avoidance of UVR‐B‐induced cataract in the pigmented guinea pig.

Methods: Thirty female guinea pigs, five to nine weeks of age, were divided into 5 groups of 6 guinea pigs each. Pupils were dilated bilaterally before exposures. The guinea pigs were unilaterally exposed to UVR‐B under anesthesia in vivo, receiving between 0 and‐84.9 kJ/m2 over a duration of 60 minutes. Each guinea pig was sacrificed 24 hours after exposure. Lenses were extracted and photographed in vitro. Intensity of forward light scattering was measured for each lens. The data were analyzed with regression using a second order polynomial model, considering the first order term to be 0. The applied MTD concept is based on the UVR‐B dose response curve obtained for the pigmented guinea pig.

Results: All of the guinea pigs exposed to UVR‐B developed cataracts in the anterior subcapsular region. MTD for avoidance of UVR‐B‐induced cataract was estimated to be 69.0 kJ/m2 in the pigmented guinea pig.

Conclusions: The MTD for avoidance of UVR‐B‐induced cataract in the pigmented guinea pig is significantly higher than the threshold obtained by Pitts et al. in the pigmented rabbit. MTD is an appropriate method for estimation of toxicity for UVR‐B‐induced cataract in the guinea pig. The pigmented guinea pig is less sensitive to UVR‐B exposure than the pigmented rabbit, pigmented rat, and pigmented mouse.