bluuebunny/crossref_metadata_2025 huggingface dataset:
Party Behaviour in the Finnish Parliament
Authors: Isaksson Guy‐Erik
Published: October 2007

This article focuses on party behaviour in the Finnish Parliament. We consider the political parties as vote‐seekers, office‐seekers, or policy‐seekers in a multiparty system. We presume that the parliamentary position of a party affects its behaviour, and that the behaviour of a party differs from one arena to another in Parliament. The party activity is measured in terms of proposed motions, reservations to committee decisions, debates and statements at plenary sessions, and roll‐calls at plenary sessions. The empirical findings indicate that political parties in opposition act first and foremost as vote‐seekers. Only opposition parties make reservations to committee decisions and initiate roll‐calls at plenary sessions. On the other hand, the governing parties seem mainly to focus on policy‐seeking.
Russian Politics in Transition: Political Parties and Organizations in Russia and the Murmansk Region
Authors: Dellenbrant Jan Åke , Andreev Oleg
Published: October 2007

In this article the development of new political organizations in Russia is discussed. The authors acknowledge the fact that the new parties and organizations are still weak and not well organized. bur they nevertheless play a significant role in the preservation of democracy in Russia. Several stages in the party creation process can be discerned. Before the 1991 attempted coup d'état the Communist Party of the Soviet Union still played a dominant role, while a number of smaller political organizations emerged. After the dissolution of the CPSU. the centre groupings dominated the political scene. Gradually. the level of political polarization increased. as evidenced by the 1993 elections which spelled victory for the post‐communists and ultra‐nationalists. Using sartori's definitions, the authors analyse the party and organizations with the help of a left‐right continuum, which portrays some differences in Russian politics without covering all cleavages. The important regional differences in party formation are illustrated with empirical data from the Murmansk region. During the Gorbachev period a number of informal organizations emerged which gradually developed into parties critical of the CPSU. Initially, social democratic organizations were strong on the Kola Peninsula, but they declined in importance due to internal disagreement. In the 1993 elections, the largest parties in this region were the ultra‐nationalist Liberal Democratic Party and the market‐oriented Russia's Choice. In Russia as a whole, the post‐election period manifested itself in increasing political polarization and successive retreat from the marker‐reform policies. Clearly, the road to a well‐functioning system of parties in Russia is still a long one.
Voter Turnout in Norway: Time, Space, and Causality
Authors: Midtbø Tor
Published: October 2007

This article focuses on diachronic and synchronic variation in Norwegian electoral turnout from 1945 to 1991. The model contains aggregate data divided into two‐year intervals with regions as cross‐sections. The impact of both socio‐economic and political variables is tested. The two‐dimensional view on turnout variation makes it possible to distinguish between short‐term and long‐term effects, as well as between national versus local factors. In contrast to related studies, this analysis actually tests for causality relationships between different political variables. The empirical results indicate that an increase in either national unemployment or regional income contributes to an increase in turnout rates. Electoral participation is also positively related to Labour support, industrial employment and strike activity.
Antihypertensive Efficacy of the Oral Direct Renin Inhibitor Aliskiren as Add‐On Therapy in Patients Not Responding to Amlodipine Monotherapy
Authors: Drummond Waymon , Munger Mark A. , Rafique Mohammed , Maboudian Mojdeh , Khan Mahmudul , Keefe Deborah L.
Published: October 2007

This study investigated the addition of the direct renin inhibitor aliskiren to amlodipine in patients with mild to moderate hypertension that was inadequately controlled with amlodipine alone. Following once‐daily treatment with amlodipine 5 mg for 4 weeks, patients whose hypertension responded inadequately to therapy (mean sitting diastolic blood pressure [DBP] 90–109 mm Hg) (n=545) were randomized to 6 weeks of double‐blind treatment with amlodipine 5 mg plus aliskiren 150 mg, amlodipine 5 mg, or amlodipine 10 mg. At the study's end, mean systolic blood pressure and DBP reductions with the combination of aliskiren 150 mg and amlodipine 5 mg (11.0/8.5 mm Hg) were significantly greater (P<.0001) than with amlodipine 5 mg (5.0/4.8 mm Hg)—the comparator group—but similar to amlodipine 10 mg (9.6/8.0 mm Hg). All treatments were well tolerated. Edema occurred more frequently with amlodipine 10 mg (11.2%) than with combination therapy (2.1%) or amlodipine 5 mg (3.4%). In conclusion, aliskiren 150 mg plus amlodipine 5 mg shows similar but not better blood pressure‐lowering efficacy when compared with amlodipine 10 mg in patients not completely responsive to amlodipine 5 mg; less edema was noted with combination therapy.
The Secondary Oxalosis of Renal Failure
Authors: Thompson Catherine S. , Weinman Edward J.
Published: October 2007

The secondary oxalosis syndrome associated with renal failure is an important, although incompletely understood, complication of renal insufficiency. The deposition of calcium oxalate crystals in vital organs can be associated with significant morbidity and mortality. The pathophysiology of this disorder relates to supersaturation of the blood with the insoluble calcium salt of oxalate. The factors which aggravate the hyperoxalemia in individuals with renal failure are only now becoming evident. Although no effective prevention or treatment exists in the chronic setting, further investigation into the role of dietary protein restriction, pyridoxine administration, and avoidance of ascorbic acid supplementation in patients without a documented deficiency of the vitamin is warranted.
Potassium Load of Blood Transfusions
Authors: Eisinger Robert P.
Published: October 2007

When a chronic hemodialysis patient requires a blood transfusion, it is generally given during dialysis. Occasionally, blood must be transfused between treatments raising a number of concerns, one of which is the potassium load imposed on the patient. How much potassium is given in a transfusion?
Potassium Homeostasis in Dialysis Patients
Authors: Spital Aaron , Stems Richard H.
Published: October 2007

Potassium homeostasis is remarkably well preserved in the majority of patients on dialysis, despite the loss of the normal major route of potassium elimination. Nonetheless, the new major pathways for potassium removal (dialysis and gastrointestinal) are clearly less able to adapt to changes in potassium intake than is the healthy kidney. Therefore, disturbances in the plasma potassium concentration, most commonly hyperkalemia, remain a constant threat to the health of dialysis patients. A recent survey of outpatients on chronic hemodialysis found about a 10% incidence of severe predialysis hyperkalemia (serum potassium concentration greater than 6.0 mmol/L). Several causes of this potentially lethal problem must be considered when it occurs (Table 2). We hope that through a sound understanding of potassium homeostasis, the incidence of such serious disturbances in plasma potassium concentration can be reduced.
Management of the Patient with a Failed Renal Transplant
Authors: Hines William H. , Grossman Robert A.
Published: October 2007

The management of the failed renal transplant depends upon the clinical circumstances. In most instances of failure secondary to acute rejection or structural lesions, transplant nephrectomy is necessary. When failure is due to chronic rejection, grafts often can be left in place and removed only for the indications of fever, pain, swelling, infection, or refractory hypertension. Once dialysis has been reinstituted, immunosuppression should be tapered in accordance with standard principles; this often does not result in the need to remove the failed allograft so long as it is clinically quiet. The presence of a nonfunctioning graft does not preclude retransplantation. With the use of cyclosporine, the results of retransplantation are beginning to look similar to the statistics for first transplants.

The quality of life in patients who have failed transplantation has not been definitely proven to be worse than that of patients on dialysis or those who have a functioning graft. However, patients with a failed transplant will need emotional support in their readjustment to dialysis.
The Interleukin Hypothesis: A Reappraisal after 6 Years
Authors: Shaldon Stanley
Published: October 2007

The concept of biocompatibility as a clinically important parameter in dialysis therapy is being challenged. The failure to establish clear and causally related pathogenetic associations between clinically relevant dialysis problems and measurements of complement activation and leukopenia have hindered intellectual acceptance of the value of measuring so‐called indices of biocompatibility. In an effort to find a link between these parameters and clinical problems, the Interleukin hypothesis was first proposed 6 years ago.

As a result of the availability of recombinant forms of IL‐1 and tumor‐necrosis factor and the subsequent development of more specific radioimmunoassays, evidence suggests that the original hypothesis be extended to various cytokines manufactured by monocytes (the Monokine Hypothesis). This is made necessary by the failure to detect raised levels of IL‐β in plasma both in normal and ESRD patients following endotoxin challenge. However, tumor‐necrosis factor is raised under these conditions as is IL‐6. Furthermore, these substances seem to act synergistically in producing the inflammatory response. Thus, despite using more specific methodology, IL‐1 is not the plasma messenger originally thought. Tumor‐necrosis factor and IL‐6, however, may be the mediators of the inflammatory response to hemodialysis, either by endotoxin‐contaminated dialysate, acetate dialysate, or membrane activation of C5a.

An association between monocyte cytokine production and β2‐microglobulin generation and, possibly the deposition of this protein in amyloid form in tissues may also exist. It is recommended that measures to reduce the pyrogen content of dialysate be introduced and that acetate dialysis be replaced by bicarbonate. The question of abandoning the use of membranes that cause C5a generation should also be considered.
Management of the Systemic Lupus Erythematosus Patient with End‐Stage Renal Disease
Authors: Rodby Roger A.
Published: October 2007

An appreciation of the natural history of SLE following the development of ESRD is important in the management of these patients. In addition, the care of these patients requires special consideration in the diagnosis and treatment of disease exacerbations.

It is ironic that, despite the destruction of a major organ system as a result of a disease process, the clinical course of that disease may improve. Such appears to be the case with SLE. The prognosis for renal transplantation is even more encouraging. Patients can therefore enter an ESRD program with optimism.
Contribution of Uremia to Pulmonary Edema in ESRD
Authors: Morgan Anthony G.
Published: October 2007

Pulmonary edema is a common occurrence in dialysis patients, presumably due to volume overload. It has been suggested that increased pulmonary capillary permeability due to “uremi” may contributeio the development of pulmonary edema in ESRD. Is this true and, ifso, does it have any therapeutic implications?
Value of Strict Control of Blood Pressure and Glucose in Diabetics with ESRD
Authors: Kabis Suzanne M. , Lyman Neil , Friedman Eli
Published: October 2007

On November 15, 1988 Eli A. Friedman spoke at a meeting of the Nephrology Society of New Jersey on the topic, Interventional Strategies in Diabetic Nephropathy. The following exchange of letters took place following that talk They are reprinted here because they were felt to be of interest to our readers.
Diabetic Retinopathy: A Review
Authors: Berman David H. , Garcia Charles A.
Published: October 2007

This review has provided a chronologic background to our current understanding of diabetic retinopathy: epidemiologically, pathophysiologically, and in terms of treatment modalities. Our options for sight‐saving and/or restoration have been greatly expanded over a short period of time, and continue to be explored. Current large‐scale multi‐center studies promise to yield invaluable information in this regard. The scientific community, working in concert will ultimately conquer the ravages of diabetes. For the moment, however, the battle is far from over.
Measuring Kt/V Urea and PCR in CCPD
Authors: Sherman Richard A.
Published: October 2007

Can you provide a protocol for measuring dialysis and renal clearances for continuous cyclic peritoneal dialysis (CCPD)?
Depression in End‐Stage Renal Disease Patients
Authors: Fishbein Leslie J.
Published: October 2007

A substantial proportion of ESRD patients suffer significant morbidity and mortality from major depression and severe adjustment disorders. Remission of major depression is often achieved with medications alone, though a lower relapse rate is associated with treatment combining psychotherapy and antidepressant medication. Adjustment disorders are often responsive to psychotherapy, with or without adjunctive medication therapy. Because treatment of these conditions is very often effective, I would urge the nephrologist to build comfortable consultation and referral relationships with local psychiatrists such that even the patients who decline psychiatric referral can benefit from treatment with judicious use of antidepressant medication.
Availability of Quinine for Muscle Cramps in Dialysis Patients
Authors: Foote Edward F.
Published: October 2007

One of my patients was told by his pharmacist that quinine will no longer be available for the treatment of leg cramps. Is this true?
Use of Ondansetron, a New Antiemetic, in Uremia
Authors: Andrews Peter A.
Published: October 2007

Nausea and vomiting are common problems before dialysis commences and sometimes persist after dialysis is initiated. Metoclopromide and prochloroperazine often help but not uniformly. Is there any experience with the new antiemetic agents used with chemotherapy (ondansetron) in this setting?
Metabolic Alkalosis in CAPD Patients
Authors: Tattersall James
Published: October 2007

Over the past year, our PD unit has found metabolic alkalosis to have become a more common problem than metabolic acidosis. I assume it's related to the new low calcium dialysate now in use widely. Is this a common experience? Is there a danger from this (soft tissue calcifications, kidney stones, hypoxemia)?
The Kidney Transplant Wait‐List: Allocation of Patients to a Limited Supply of Organs
Authors: Norman Douglas J.
Published: October 2007

The improvement of survival rates and the increasing demand for renal transplantation has resulted in tremendous growth of the deceased donor kidney waiting list. Unfortunately, over the same period, the number of deceased donor kidneys available for transplantation has only increased modestly. In this review, the rules by which deceased donor kidneys are allocated and distributed are reviewed. In addition, we discuss the ethical issues involved in the formulation of these policies and the implications for individual patients.
American Society of Diagnostic and Interventional Nephrology Section Editor: Stephen Ash: Arteriovenous Fistula Surgery: An American Perspective from Italy
Authors: Sreenarasimhaiah Vijayaprakash , Ravani Pietro
Published: October 2007

Hemodialysis depends on durable, long‐term vascular access for the patient. In the United States, arteriovenous fistula (AVF) creation rates are lower than they are in Europe. Excess morbidity and mortality has been attributed to reliance on catheters and prosthetic grafts. In Italy, there is a high rate of fistula creation, and they are predominantly created by nephrologists. As American interventional nephrologists become more involved in the procedural aspects of renal care, consideration should be given to replicating the Italian model of dialysis access creation. Specific aspects of the surgical technique, comparison to available literature, and potential reasons for higher fistula creation rates are explored from the vantage point of an American nephrologist visiting Italy. The pertinence to American dialysis access programs is discussed, as is the opportunity for interventional nephrologists in the United States to further expand and improve upon the successes of the Italian experience.
Abortion Attitude of Nurses: A Cognitive Dissonance Perspective
Authors: ESTOK PATRICIA JENAWAY
Published: October 2007

Attitude formation and/or change has implication for nursing. The attitude of the nurse is said to influence the care received and how it is preceived by the client. The purpose of this study was to examine the relationship between abortion attitudes of nurses and cognitive dissonance theory. Findings reveal that nursing students studied became more positive toward abortion after clinical experience with abortion and, as a group, 64% favored unrestricted abortion. Since the majority of the subjects studied were positive toward abortion, they should be able to function effectively with clients seeking abortion health care services.
Patterns of Leadership
Authors: Diamond Helen
Published: October 2007

The following article was originally printed in Educational Horizons, official publication of Pi Lambda Theta. and introduced its “Patterns of Leadership” issue. Dr. Diamond was guest editor. The article is reprinted by permission.
Group Preparation of Pediatric Surgical Patients
Authors: McGrath Margaret M.
Published: October 2007

The purpose of this study was to validate the effect of group preparation, designed to increase pediatric surgical children's (and their parents) adaptation to hospitalization. Forty‐four children, aged 3–12, admitted for tonsillectomies were randomly assigned to either group condition or control. These were compared to forty children receiving individual Stress Point Preparation from a study done in the same institution three months earlier. Both the group and the individual intervention were based on a combination of systematic preparation, rehearsal, and supportive care conducted prior to each stressful procedure. Group preparation also included: (a) peer exposure, support and identification, (b) group process, and (c) group teaching.

The children's hospital adjustment was measured by blind ratings of behavioral upset and cooperation during the blood test, medication injection, induction, and post operative fluid intake and by recovery room medication and pulse rates and time to first voiding. Post hospital adjustment was assessed with the Vernon et. al., Post Hospital Behavior Inventory. Parent outcome measures included self ratings for anxiety and satisfaction with information and care. As hypothesized, children prepared in a group showed significantly less upset and more cooperation, and their parents were better informed and more satisfied than did children receiving individual preparation or those in the control.
Author Replies
Authors: Hodgman Eileen Callahan
Published: October 2007

Eileen Callahan Hodgman prepared the following response to Dana Cummings' letter to the editor after receiving a copy of the commentary.
Clinical Evaluation of Students of Nursing: A Step Toward Quality Nursing Practice
Authors: Lawrence Rena M. , Lawrence Sally A.
Published: October 2007

The methodology described in this manuscript was developed during the period that the Albright College Nursing Program was supported in part by Public Health Service Training Grant Number D10 NU 00609 from the Division of Nursing.
Symbolic Interactionism: A Conceptual Framework Useful For Nurses Working with Obese Persons
Authors: Schroeder Mary Ann Kadow
Published: October 2007

“The development of conceptual models links together facts and phenomena by means of an organized framework in order to assist the practitioner.rdquo; (Riehl and Roy, 1974, p. xi). One theoretical framework not widely used but potentially helpful to the practitioner is symbolic interactionism. This paper describes selected aspects of symbolic interactionism and applies some of its principles to nursing care of the obese adult client. Rose's (Riehl and Roy, 1974) assumptions about symbolic interactionism form the basis for analysis of clinical and research experiences with obese individuals.
A Model for Parent Education
Authors: Roberts Florence B.
Published: October 2007

Formal parent education programs often have been for the most part disappointing, poorly attended and relatively ineffective. From these results, one might conclude that parents either do not need or want to be educated. Based on reports from persons with experience in educating parents, however, neither of these conclusions seems warranted (Johnston, Kayne, & Mittleider, 1977; Rubin, 1975; Stranik & Hogberg, 1979; Williams, 1977; Zinner & Hertzman, 1978). What, then, is the problem? It is suggested here that the problem lies in the way parent education has been conceptualized and presented.
Role Considerations in Care of the Dying Patient
Authors: Williams Carol A.
Published: October 2007

Twentieth century Americans are ill‐prepared for death, either their own or that of another. Death has become a less visible part of daily life. Health professionals in general and nurses in particular often deny their legitimate role in relation to the dying patient, and instead regard death as a treatment failure. This paper contrasts the dying role and the sick role of the patient, and the therapeutic role and the supportive role of the nurse. It applies the concepts of role insufficiency and role supplementation to the care of the dying and suggests implications for research.
Cure: The Potential Outcome of Nursing Care
Authors: Loomis Maxine E. , Wood Delores jean
Published: October 2007

The recent Social Policy Statement of the American Nurses Association (1980) has advanced a definition of nursing as “the diagnosis and treatment of human responses to actual or potential health problems.” This definition has legitimized efforts of the last decade to develop a system of nursing diagnosis and should provide the impetus for subsequent development of nursing treatment interventions. Barnard (1982) has proposed a model for linking the phenomenon of concern to nursing with the human responses present in the maternal‐child nursing situation. Other specialty models are likely to follow.

In this article we present the possibility that in the diagnosis and treatment of human responses, nurses are capable of curing the actual or potential health problem. The most recent definition of nursing has opened up exploration of the interactions among human response systems and actual or potential health problems. Clinicians, researchers, and theoreticians are now in a position to reconceptualize nursing's impact on health and health problems.
ALS& Aging: A Case Study in Autonomy and control
Authors: Power Deborah J. , Craven Ruth F.
Published: October 2007

Quality of life is often seen as an ideal that is impossible to achieve in long‐term care. This paper suggests that the maintenance of automony and control is basic to attaining the highest potential quality of life.

Quality of care has become a particular concern in nursing. In the long‐term care setting, the quality of care has come to the attention of the public, resulting in a loud outcry against the nursing home industry as a whole. Even those facilities that already provide high‐quality nursing care must strive for even higher standards if they are to move health care delivery towards the ever elusive ideal–the greatest possible quality of life.

Individualization of patient care has become a watchword in nursing. Yet it may be undermined by the health care system and by nursing staffing patterns in general and nursing philosophy and allocation of time in particular. Upon entering a long‐term care facility the geriatric patient loses much autonomy. Activities of daily living become regulated by the system and are determined by the time available for staff members to assist the patient. As the elderly become more physically disabled they become increasingly dependent on the staff, losing more and more control over their life‐style– when they rise, what they wear, even how they dress.

Quality of life must be considered from a person's point of view and in relation to the capabilities of that person (Cassel, 1980). The maintenance of autonomy and control can be crucial in maintaining self‐esteem and achieving quality of life. Loss of control over the outcome of one's own behavior leads to helplessness. Helplessness is based on the perceptions and beliefs of the individual, whether they be founded on fact or fallacy (Seligman, 1975). The helpless individual too frequently lacks quality of life.

This paper presents a plan for individualized care, which focuses on the issue of patient autonomy versus “adequate” nursing care. It was developed collaboratively between a patient and the authors–nurses who assume the role of consultant and patient advocate.
Psychotherapeutic Treatment of Idiopathic Cardiomyopathy: A Case Study
Authors: Martin Elizabeth Jane
Published: October 2007

The referral of an extremely anxious young. Black mother suffering from idiopathic cardiomyopathy to a local psychotherapy clinic by her internist for evaluation and treatment caused consternation among the professional staff (psychologists and psychiatric social workers). Although all felt competent to assess and manage the patient's anxiety, none felt comfortable with the serious physical manifestations of the cardiopathy. When a nursing faculty member who was supervising graduate nursing students in the agency volunteered to take the case, the assignment was readily made. This paper is a description of the course of treatment of that client. Following a brief review of the literature on psychosomatic illness and idiopathic cardiomyopathy, the client is described and the course of treatment detailed. Then the theories that served as the basis for the clinical interventions are identified, and the shift from the psychodynamic to the Bowen Family Systems approach is discussed.
In Opposition to Nursing Diagnosis: A Minority Opinion
Authors: Shamansky Sherry L. , Yanni Celeste R.
Published: October 2007

Does nursing diagnosis further nursing practice? This article examines the premises underlying nurses diagnoses and their impact on clinicians and the health care delivery system. The authors argue that nursing diagnoses in their current form limit nursing practice, create obstacles to clear communication, and constrain inference and intuition.

Once upon a hot summer day, a community health nursing student returned from a home visit to do her charting. Unbeknown to her instructor, this student was an aficionado of nursing diagnosis. She completed her note and gave it to the instructor to read:

S: “My feet hurt.”‘7 waked three miles today.(in 97o weather.)

O: Ankles edematous bilaterally; dorsum of feet warm to touch; 1 cm. vesicle on plantar aspect, right foot.

A. Alternation in comfort as a result of restless legs.

P. Bathe feet in tepid water; dry well; do not rupture vesicle; elevate legs.
Discovery of Nursing Gestalt in Critical Care Nursing: The Importance of the Gray Gorilla Syndrome
Authors: R. N. Sue Holland Pyles , Stern Phyllis Noerager
Published: October 2007

How do critical care nurses determine if a patient is developing cardiogenic shock? What assessment and decision‐making processes do they use, and how do they learn them? To find out, in‐depth interviews were conducted with 28 critical care nurses during a study that investigated the practice of critical care nurses in the early detection and prevention of cardiogenic shock in patients with acute myocardial infarction (AMI). Through the analysis and comparison of these interviews, we developed a theory of> Nursing Gestalt to explain the cognitive process used by experienced critical care nurses in making assessments and judgments. Moreover, we discovered that critical care neophytes learn to make assessments, diagnoses, and sound judgments about care from a more experienced nurse who supports and teaches the neophyte the Nursing Gestalt during a mentoring relationship. We call this mentoring relationship The Cray Gorilla Syndrome, for reasons we will explain later.

This paper presents selected findings from the study. The origin and properties of Nursing Gestalt are discussed, as well as factors that enhance its development and use–namely, The Gray Gorilla Syndrome.
Locus of Control: Implications for Clinical Nursing Practice
Authors: Shillinger Freda L.
Published: October 2007

Compliance, adherence, and a therapeutic alliance are terms that, when used in a health care context, refer to the process whereby a patient assumes the various tasks that comprise a therapeutic regimen. When a patient is said to be compliant there is the suggestion that he has been coerced; when he is said to be adherent it appears that he is conforming to some norm or standard set for him; when he forms an alliance it seems he has negotiated what it is he will do to care for himself. Coercion, conformity, and negotiation make up a continuum that varies in the degree to which a patient is active in the decisions being made about himself, or inversely, the degree to which others determine the patient's behavior (Barofsky 1978). All too often a person's experience with the health care system is coercive, thereby restricting the individual's need to freely direct and control his life affairs freely, which in turn leads potentially to noncompliance behaviors.

Individuals perceptions of their control over the environment and its relationship to other areas of cognitive functioning and to behavior have aroused considerable interest. Health beliefs and behaviors, however, have received little attention as a specific area in which to investigate perceptions of control. Since many health actions depend on voluntary behaviors and many health programs are predicated on an assumption of controllability, patients'expectancies concerning control seem to be a worthwhile area for examination.

Locus of control, an individual difference construct from social learning theory, has shown some promise in predicting and explaining specific health‐related behaviors. Yet compliance problems, being highly complex, are not easily reducible to a single simple explanation. This paper will review research demonstrating the utility of locus of control in understanding health behaviors. A method for incorporating the construct into the nursing process will be described. Using this framework as a basis, the author will explore methods of increasing client participation in treatment programs while maintaining a therapeutic alliance.
Effectiveness of Policy Related Research: Nurse‐Midwifery as Case Study
Authors: Diers Donna , Burst Helen Varney
Published: October 2007

“Policy” is inevitably “politics”– the use of power. What is so striking and instructive about the nurse‐midwifery studies is that so much has been accomplished by their use when the studies themselves are so few; the nurse‐midwives who benefit from the changes in policy are few as well; however, the changes in health care access are great. Granted, other forces are at work here, including the wisdom of the professional organization of nurse‐midwives in concentrating its agendas, the marriage of consumer and provider interests in humane experience in childbirth, the rise of feminism, the wish of patients and providers (nurse‐midwives) alike to control their own existence, the disenchantment of childbearing families with traditional patronizing obstetrical care, and so on. Many of these variables are not rational contributions to policy formulation. What is rational is the argument from data, and that is where the studies come in.

Yet what becomes clear in this review is that no amount of research will ever be enough. The intricate relationship of policy to politics shows through very clearly in the studies reviewed, and as the politics change (from “safety” as agenda to “cost effectiveness” or competition) more data will continue to be needed. Indeed public policy making is an eternal process.

Important as effectiveness studies are and have been, alone they could not possibly make or break the policy considerations nursing faces. Without studies of effect, however, nursing is left to argue on moral principle, right to practice, or naked power. With them, nursing may argue, as Fagin (1982b) has, that its services are “substitutive, not additive”, (p. 1849)
Issues for Research on Alternative Patterns of Care for Low Birth weight Infants
Authors: Brooten Dorothy
Published: October 2007

It is unlikely that the rate of very low birthweight infants born annually will change in the near future. However, efforts to improve their outcomes and to control the cost of their care will continue. Professional opinion, special interests, politics, and values all will play some role in public policy decisions about the provision of care to this group, especially during periods of economic restraint. In this context it is even more important for nursing to examine alternative models of care that are efficacious, that justify their costs, and that promote the image and self‐determination of the profession in advancing its practice.
The Financial Distress of Higher Education: Impact on Nursing
Authors: Morton Paula C.
Published: October 2007

Until recently, serious financial problems were of limited concern to nursing education. With generous program and student aid from government sources, nursing education has not felt the same kind of severe financial distress that has afflicted the rest of higher education (Gonyea,1978). Unfortunately this state of affairs is changing. Funding of such programs is an expensive proposition for colleges and universities, and some institutions of higher education have begun to question the feasibility of continuing to fund their nursing programs (Allen & Gray,1975). Additionally, as supply and demand gaps in nursing manpower have narrowed, there is less incentive for the government to underwrite the costs of nursing education.

It is expected that tuition costs to nursing students will continue to escalate. Job opportunities for graduates will be less attractive and fewer in number than previously. Fewer women in the future are likely to select nursing as their career field. Small nursing education programs will be unable to sustain the very high costs of educating students and will likely cease to exist. Nursing education programs within colleges and universities will very likely compete less successfully with other institutional programs than they have in the past for the limited dollars.

As in all of higher education, nursing education will increasingly be held accountable for its costs, costs that will only increase in the coming decade. It will be asked to do more with far fewer resources, in terms of dollars, numbers of students, and numbers of programs. Should this trend continue, the profession may well be confronted in 20 to 30 years with another critical shortage of nurses across the nation.
Priorities for Nurse Training Act Legislation: A National Survey of Nursing Deans
Authors: Crosby Leanna J. , Facteau Lorna M. , Donley Sister Rosemary
Published: October 2007

1984 represents a pivotal year for nursing and nursing education in part as a result of future legislation of the Nurse Training Act (NTA). In the face of lost federal funds secondary to the recession, and/or the current administration's attitude toward funding for higher education as well as a decreasing number of college‐age students, nursing must be prepared to launch a united effort to recapture lost funds and/or prevent future losses. This must be a deliberate, pragmatic, and well‐organized effort. It must be goal‐oriented, not merely reactive. To assess how nursing deans and/or chairpersons are planning to confront the financial and demographic realities of the1980s and 1990s a national survey was conducted among 227 nursing education administrators. These administrators responded to a four‐page questionnaire providing quantitative and qualitative data. Areas covered in the questionnaire included previous use of NTA funds, priorities for future nurse training legislation and funding, enrollment trends of undergraduate and graduate nursing students and lastly, master plans and future goals designed to cope with reduced federal funding. Categories that were most important in the establishment, maintenance, or expansion of their programs were capitation, graduate and undergraduate student assistance, and special projects. The respondents indicated that future priorities for nurse training funding would include direct student assistance, piogram and institutional support, and individual needs of specific schools and/or regions. The respondents claimed that over the last five years 30% of schools had experienced a decline in enrollment of undergraduates, and 27% had experienced a decline in graduate enrollment. Lost federal funds contributed to 74 % of the undergraduate decline and 74% of the graduate decline. Future goals and master plans designed to cope with reduced federal funding have been characterized as developmental programatic approaches and/or a combined developmental/programatic approach. However, a startling 16% of the total respondents did not indicate future plans or goals. This survey further indicated that the priorities of those surveyed have changed from program concerns to student concerns and that their assessed needs are dramatically different from those of the Reagan administration. Of the deans and/ or chairpersons surveyed, 74% indicated that they were generating creative plans to cope with lost federal funds.
Selecting a Clinical Nursing Problem for Research
Authors: Fleming Juanita W.
Published: October 2007

Clinical nursing problems selected for inquiry are generally those encountered in nursing practice and those that deal with modalities of patient care such as support, comfort, prevention of trauma, promotion of recovery, health screening, appraisal and/or assessment, health education, and coordination of health care. The psychosocial dimensions of health care are an essential aspect of clinical nursing research. Factors considered in selecting a clinical nursing problem for research fall into three general categories: personal, social, and scientific. The personal factors include interest in the problem, competence to conduct the study, time, energy, and money to conduct the study as well as the essential instruments, space, personnel, and equipment to carry out the study. Social factors are concerned with the advancement of science and the ethical value of the study as well as its practicability and applicability. The scientific factors are those that relate to the logic, empirical, rep‐licable, reductive, and transmittable aspects of selection of the problem for study.
The Metaparadigm of Nursing: Present Status and Future Refinements
Authors: Fawcett Jacqueline
Published: October 2007

The central concepts and themes of the discipline of nursing are identified and formalized as nursing's metaparadigm. Examples illustrate the direction provided by the metaparadigm for theory development. Refinements of the metaparadigm through conceptual models and programs of nursing research are proposed.
Explaining Primary Care Visits
Authors: Molde Susan , Baker Dorothy
Published: October 2007

Patients visit health professionals for a variety of medical and nonmedical reasons, many of which are not obvious. This study examined the reasons motivating people to initiate visits to a clinic staffed by nurse practitioners. 128 patients responded to a special question concerning expectations of the visit. Approximately 30% of the sample had “hidden agendas” that could not have been predicted during their regular interview on arrival at the clinic. At that time virtually all sampled patients said that they had initiated a visit because of a physical symptom, but their later responses to the special question consistently revealed their needs for nursing care. Implications for nurse practitioner practice and research are presented.
The Nature of Knowledge and Theory in Nursing
Authors: Visintainer Madelon A.
Published: October 2007

The formulation of nursing as a discipline is under way. Work on theory development, concept clarification and the development of a knowledge base is spurred by the creation of new doctoral programs and the emphasis on nursing research. As nursing establishes itself as an inventor of theory, the contrasts and similarities between its existence as both a practice profession and academic discipline come into sharp focus. As nursing strives to understand itself both as a user‐applier and discoverer‐inventor of knowledge and theory, it provides a model for other practice professions and academic disciplines to explore such questions as, What is the nature of theory in practice? What is the role of application in the formulation of theory? This paper examines the characteristics of theoretical constructs as they apply to the practice of nursing, the use of theory in that practice and the limitations of theory in application.
A Comprehensive School Health Initiative
Authors: Meeker Robert J. , DeAngelis Catherine , Berman Barbara , Freeman Howard E. , Oda Dorothy
Published: October 2007

In 1978 the Robert Wood Johnson Foundation appropriated almost $5 million to support primary care demonstration projects in 69 schools located in four states—Colorado, New York, North Dakota and Utah. It was by far the largest national effort ever undertaken to implement and assess the feasibility and utility of providing comprehensive health services in school settings, with nurse‐practitioners as head of the team. This paper summarizes the findings of the evaluation of this national effort.
Family Study and Nursing Research
Authors: Murphy Susan
Published: October 2007

The development of this paper was supported in part by a National Research Service Fellowship Award, US PHS No. NU‐05805‐01. The author would like to thank the following for their valuable feedback during the development of this manuscript: Marilyn Savedra, R.N., D.N.S.; Katharyn May, R.N., D.N.S.; Bonnie Holaday, R.N., D.N.S.; and Catherine Gillis, R.N., DNS.
The Day I Felt Most Like a Nurse
Authors: Schwartz Linda Spoonster
Published: October 2007

[The nurse] is temporarily the consciousness of the unconscious, the love of life of the suicidal, the leg of the amputee, the eyes of the newly blind, a means of locomotion for the infant, knowledge and confidence for the young mother, the [voice]for those too weak or withdrawn to speak.—Henderson, 1964.*
A Basis for Prospective Payment for Home Care
Authors: Pasquale Debra K.
Published: October 2007

In this pilot study, a production function model was used as a framework to explore the relationships between Medicare clients' living arrangements, functional status, plan of care and consumption of home care resources. The findings showed that the independent variables significantly explained resource consumption and that differences appear to exist for age and gender cohorts. These results provide a beginning direction for defining a basis for setting prospective reimbursement rates.
The Nursing Struggle in Australia
Authors: Short Stephanie D. , Sharman Evelyn
Published: October 2007

The contemporary occupational struggle by nursing in Australia presents to the sociologist a pair of apparently contradictory tendencies: professionalisation along the lines drawn by the medical profession (Pittman, 1985), or assertive trade unionism along with other sections of the working class (Salvage, 1985). This paper assesses the applicability of each of these strategies for nursing in Australia and suggests that neither model is adequate in dealing with the importance of gender in the nursing struggle or with conflicting interests between different classes of women within nursing. An alternative feminist analysis is then forwarded—one that locates the current nursing struggle within the context of contemporary class and gender relations.
The Confidence of Community Health Nurses in Caring for Ethnically Diverse Populations
Authors: Bernal Henrietta , Froman Robin
Published: October 2007

Community health nurses (N = 190) responded to a Likert‐type cultural self‐efficacy scale to determine their degree of confidence in caring for three distinct populations (blacks, Puerto Ricans and Southeast Asians). The highest confidence scores were reported for caring for the black population, the lowest ratings were reported for Southeast Asians, while Puerto Ricans fell between the other two groups. Low scores were observed on items that included knowledge of health beliefs and practices as well as beliefs about respect, authority and modesty. Higher scores were observed in using an interpreter correctly. In no instance did ratings reach even moderate levels of confidence. Results suggest that nurses do not feel confident about caring for any of the three major ethnic groups in our communities. Furthermore, this perceived weakness cuts across the three groups and across nurses' educational and demographic variables.
Enteral Tube Feeding: Indications, Practices and Outcomes
Authors: Flynn Kathleen T. , Norton Linda Celentano , Fisher Rosemarie L.
Published: October 2007

A descriptive study was conducted at a large medical center to explore the state of the art in enteral nutrition. Demographic data as well as data on reason for feeding, evidence of a nutritional assessment, daily practices and problems related to feeding were collected on 53 acutely ill adults. The subjects ranged in age from 17 to 90 years (x = 67.8) and were on medical (47.2%) or surgical (52.8%) services, the majority (62.3%) having been in an intensive care unit when feeding was initiated. More than hay the sample (56.6%) were malnourished at the outset of feeding; yet the mean daily calories fed were only 1,035.55 K cal/day. Common problems among the subjects were diarrhea (60.3%) and aspiration (26.4%). Outcome albumin tests in 24 subjects averaged only 2.29 gms. A new look at an old practice indicates that there are gaps between what is known and what is practiced.
Satisfaction, Commitment and Professionalism of Newly Employed Nurses
Authors: McCloskey Joanne Comi , McCain Bruce E.
Published: October 2007

Over their first year of work all nurses employed in a large hospital reported decreased job satisfaction, decreased organizational commitment, and decreased professionalism. This happened with both new graduates and experienced nurses alike; only Master's prepared nurses did not report this decline. The results suggest that employers need to assess the initial expectations of new nurses and either meet more of those expectations or help new nurses form more realistic expectations about their jobs.
Cognitive Maturity of Nursing Students
Authors: Frisch Noreen A.
Published: October 2007

The important issue of the cognitive level of the professional nurse is often ignored when nurses debate appropriate credentials and job descriptions for entry into professional practice. This article summarizes what is known about the development of the cognitive reasoning skills in young adults, presents data gathered from student nurse populations indicating that students' level of cognitive development is relatively low, and discusses the implications for the profession.
Literature Searches by Computer
Authors: Sinclair Vaughn G.
Published: October 2007

This article informs nurse researchers of the advantages of learning to perform their own computerized literature searches. Hardware and software requirements for long‐distance data retrieval are discussed. A variety of financially feasible means of accessing health‐related databases are presented along with technologic trends related to online retrieval systems.