bluuebunny/crossref_metadata_2025 huggingface dataset:
Expanding the Activities of In-House Manual Writers
Authors: Mirel Barbara
Published: March 2007

In-house software manuals must satisfy many internal audiences that are adapting to computerization. Manuals must meet the operational needs of users, represent the technical requirements of in-house programmers, and achieve the goals of upper managers for stability and productivity. To achieve these multiple objectives, in-house writers, with support from their managers, need two special strategies for project management: conducting a contextual audience analysis and acting as liaisons in their workplaces. Contextual audience analyses examine the organizational dynamics that influence how users learn about and respond to a new system. These analyses investigate the relationship between users' task responsibilities and job satisfaction; the consequences of current interchanges among users, programmers, and managers; and successful adoptions of other manuals in the organization. In-house writers must also become liaisons who diagnose sources of resistance to computerization, negotiate among competing priorities, and document the fruits of their labor in their manuals. General liaison strategies include socializing oneself into that role and choosing tactics appropriate for the structure of one's workplace. Specifically, writer-liaisons may participate in multiple staff meetings, involve users in program modification and documentation development, and champion innovative uses of the system. All together, these project management strategies make an in-house manual a vital part of the entire computerization process.
The Corporate Spokesperson in External Organizational Communication
Authors: Troester Rod
Published: March 2007

This article examines the role of the corporate spokesperson in three contexts of external organizational communication. The organization is characterized as a community member with certain communication needs and obligations to the community. The literature on the corporate spokesperson is examined in the contexts of normal organizational-media relations, corporate crises, and issues-management efforts. General orientations and approaches as well as specific suggestions and recommendations are outlined for each area in an effort to summarize what is known and to suggest future research areas.
Strategic Ambiguity in the Birth of a Loosely Coupled Organization
Authors: Contractor Noshir S. , Ehrlich Matthew C.
Published: March 2007

The processes surrounding the birth of organizations have been explained on the basis of structural contingency, resource dependency, population ecology, and institutional theories. In general, these theories view the role of communication and interpretation as largely unproblematic. We argue that strategically ambiguous messages play a key role in the birth of loosely coupled organizations. The successful birth is contingent on these messages being interpreted differently by key constituencies in the organization's environment. A case study is presented in support of this argument.
Effects of Boundary Spanning Communication on the Sociopolitical Delegitimation of an Organization
Authors: Finet Dayna
Published: March 2007

Based on recent developments in the institutional literature on organization/environment relations, this study explores the relationship between the boundary spanning communication of individual organization members and organizational legitimacy. The research examined this topic in the context of a specific case of organizational conflict between two individual members of the same organization: the head of one of New York State's largest agencies and a dissenting member of that organization's professional staff. Public disagreement between these organization members resulted in substantial opposition to the agency head—a reflection of organizational delegitimation—from an external political coalition. Responding to the primary research question posed in the study, analysis of interview and survey data revealed that perceptions regarding the nature of the boundary spanning communication of the agency head and the staff scientist contributed importantly to the sociopolitical delegitimation of the organization.
Disciplining Organizational Communication Studies
Authors: Mumby Dennis K. , Stohl Cynthia
Published: March 2007

The authors argue that, although ostensibly organizational communication as a field of study appears fragmented, one can make the case for its status as a discipline. This status is rooted in four central problematics that implicitly frame a sense of community and identity among organizational communication scholars. These are: (a) the problematic of voice, (b) the problematic of rationality, (c) the problematic of organization, and (d) the problematic of the organization-society relationship. Together, these problematics articulate a conception of organizational communication that defines it as both object of study and discipline in a way that is radically different from other fields that study organizational phenomena.
Examining the Relationship between Organizational Dissent and Aggressive Communication
Authors: Kassing Jeffrey W. , Avtgis Theodore A.
Published: March 2007

The purpose of this study was to explore the degree to which individual differences, in general, and aggressive communication traits, in particular, influenced employees’dissent strategy selections. Employees completed self-report instruments describing their levels of verbal aggressiveness, argumentativeness, and how they chose to express dissent concerning organizational practices and policies. Results indicated that argumentativeness, verbal aggressiveness, and organizational position predicted articulated and latent dissent use. Results also indicated that individual differences did not predict the use of displaced dissent.
Negotiating Organizational Communication Cultures in American Subsidiaries Doing Business in Thailand
Authors: Stage Christina W.
Published: March 2007

The goal of this project was to study organizational communication cultures in U.S.-Thai parent-subsidiary organizations doing business in Thailand and to then ascertain to what degree employees at the subsidiary locations participated in the creation of their organizational communication cultures. To understand the extent to which Thai employees perceived and negotiated aspects of organizational life, the idea of negotiated cultures was developed. Negotiated cultures characterize local employee participation and negotiation as a struggle about the legitimacy of whose norms/style (those of the parent or the subsidiary) would be used in the subsidiary location.
The Nurse Theorists: 21st-Century Updates—Callista Roy
Authors: Fawcett Jacqueline
Published: March 2007

This edited transcript of an interview with Callista Roy presents Roy’s recent thoughts about the current state of the discipline of nursing; the contributions of the Roy adaptation model; and Roy’s other work on the advancement of the discipline of nursing, nursing research, and nursing education.
The Dilemma of Nursing Science: Current Quandaries and Lack of Direction
Authors: Packard Sheila A , Polifroni E. Carol
Published: March 2007

The theme of this paper is the need to address the central question in nursing science. It is hypothesized that in the absence of a central, unifying question, the view of nursing as an applied science, the current research methodological debate, and the social policy statement definition of nursing have hindered nursing's ability to advance the science of nursing. The authors suggest that the terminology of applied science has been wrongfully interpreted as immediate application to nursing practice, that the research methodological debate has occurred because the focus of research efforts is on the means and not the end, and that the policy statement implies a stimulus-response approach to human behavior.
The Structure of Nursing Diagnosis from Orem's Theory
Authors: Taylor Susan G.
Published: March 2007

Nursing diagnosis is generally accepted as a legitimate part of the nursing process; however, there is no consensus on the form, structure, or meaning of diagnosis within the discipline. Some nursing theories and models provide the basis for deriving a structural model for nursing diagnoses. A general structural model for a classification schema from the perspective of Orem's general theory, the self-care deficit theory of nursing has been developed and described. Sample diagnostic statements for various levels within the schema are presented. The language of nursing diagnosis which is appropriate to the theoretical perspective is also described and examples are provided. Diagnostic statement models are identified. This work is the beginning of a formal classification system for nursing diagnosis from one nursing theoretical perspective.
Movement and Time: Exertion and Perceived Duration
Authors: Schorr Julie Anderson , Schroeder Carole A.
Published: March 2007

This study examined differences in consciousness indexes (perceived duration of time) at different levels of physical exertion within the framework of Newman's model of health and with emphasis on Prigogine's theory of dissipative structures. The sample consisted of 100 volunteers participating in regular aerobic exercise. Instruments included 817E Monarch Stationary Bicycles, 1800 Dynamap Automatic Blood Pressure/Pulse Monitors, the production method of time estimation, and the Perceived Exertion Scale. Repeated measures ANOVA revealed significant differences in consciousness indexes during exertion (p<.00001). Paired t-tests yielded significant differences between the resting consciousness index and consciousness indexes at preferred, increased, and decreased exertion levels (p=.000). Results indicate that the consciousness index decreased with physical exertion regardless of actual exertion level. In addition, changes in perceived exertion and in physiological parameters suggest a pattern of expanding consciousness that is consistent with the theoretical framework.
Nursing Theory as a Base for a Computerized Nursing Information System
Authors: Bliss-Holtz Jane , Taylor Susan G. , McLaughlin Katherine
Published: March 2007

This article illustrates how nursing theory can be used in a computerized nursing information system (CNIS). Before development of such a system can begin, data relationships must be specified so that: (a) the relationships are specific enough to support a computerized relational base and (b) the resultant information can support nursing science. Both goals were achieved through three interrelated processes: (a) validation of a practice model based on Orem's self-care deficit nursing theory, (b) classification of clinical data into theory-related categories, and (c) establishment of data relationships to yield meaningful information.
Living Paradox in Parse's Theory
Authors: Mitchell Gail J.
Published: March 2007

Paradox has been of interest to humankind since ancient times. More than a decade ago Rosemarie Rizzo Parse specified paradoxical patterns of human relating in her nursing theory man-living-health. Since that time there has been increasing recognition by nurse researchers that paradox is an inherent aspect of human experience and an important dimension of health. The purpose of this article is to describe the phenomenon of living paradox as an inherent aspect of human experience and health. The author explores the historical development of paradox, along with its various forms and uses. Living paradox is defined as a rhythmical shifting of views, the awareness of which arises through experiencing the contradiction of opposites in the day-to-day relating of value priorities while journeying to the not-yet. The author demonstrates that living paradox as specified in Parse's theory of human becoming (formerly man-living-health) is a significant contribution to nursing and human science.
Quality of Life: Sciencing and Living the Art of Human Becoming
Authors: Parse Rosemarie Rizzo
Published: March 2007

Quality of life, from the person's perspective, is the goal of the human becoming theory. Thus far, research on quality of life has been implemented from a totality paradigm perspective, excluding consideration of the human as a unitary being. The most valuable conclusion to be drawn from all the research is that quality of life cannot be quantified. This article specifies a different meaning of quality of life and points out ways of sciencing and living the art of nursing when quality of life is the goal.
Using Roy's Adaptation Model in Practice: Nurses' Perspectives
Authors: Weiss Marianne E. , Hastings Wendy J. , Holly Debra C. , Craig Debra I.
Published: March 2007

Using a qualitative research methodology, the utility of the Roy adaptation model as a framework for nursing practice within a hospital setting was investigated. The level of integration of the model into practice varied among nurses. The model was generally found to be useful in focusing, organizing, and directing nurses' thoughts and actions regarding patient care, resulting in a perception of improved quality of nursing process and patient outcomes. Prior education on the Roy model and participation in professional advancement activities facilitated model integration, while lack of education and resistance to change inhibited implementation of model-based practice.
A Comparison of Two Nursing Models: Allen's Developmental Health Model and Newman's Theory of Health as Expanding Consciousness
Authors: Ford-Gilboe Marilyn V.
Published: March 2007

Allen's developmental health model and Newman's theory of health as expanding consciousness are compared here with respect to their goals, theoretical influences, general orientations, and conceptualizations of the metaparadigm concepts of person, health, environment and nursing. While development of each of these models began around the same time (early 1970s) and each emphasizes health as the central concept, clear differences and relatively few similarities are evident. Each proposes that health is a process which evolves over time, yet conceptualization of these processes lies at the heart of the distinctiveness of the models. For Allen, health is a phenomenon of the family which can be developed through the learning of healthy behavior (coping and development skills). In Newman's view, health is not developed through behavior change but reflects increasing awareness of one's unitary pattern of interaction with the universe. Both models contribute to nursing science in a unique way by offering alternative perspectives of health and nursing and, for Allen, considering the family as the unit of concern.
The Meaning of Alcohol to Traditional Muscogee Creek Indians
Authors: Wing Donna Marie , Thompson Timmy
Published: March 2007

The purpose of this study was to learn the meaning of alcohol to the traditional Muscogee Creek Indians of eastern Oklahoma. Using Leininger's theory of culture care diversity and universality as the theoretical base, the authors conducted interviews of 24 traditional people to elicit both emic and etic meanings of alcohol. The conceptualization of alcohol as a dichotomy of power to do both good and evil emerged as the central theme. Other meanings of alcohol were explicated in relation to five social structure dimensions. The findings suggest culturally competent nursing implications for preserving, accommodating, and repatterning the meaning of alcohol.
Reality: A Seamless Symphony of Becoming
Authors: Parse Rosemarie Rizzo
Published: March 2007

Health care providers worldwide are visioning anew their commitment to service with an emphasis on person-focused care. Receivers and providers are frustrated with the ineffectiveness of the machine model health care delivery systems and are considering different possibilities. In this article the human becoming perspective as a guide to multidisciplinary health care delivery is discussed in light of discipline-specific goals.
Empirical Verification of a Theoretical Model Derived From the Roy Adaptation Model: Findings From Five Studies
Authors: Levesque Louise , Ricard Nicole , Ducharme Francine , Duquette Andre , Bonin Jean-Pierre
Published: March 2007

This article presents a theoretical model derived from the Roy adaptation model and the findings of an empirical verification of this model from five studies. Four groups of subjects were included in the studies: informal caregivers of demented relatives at home, informal caregivers of psychiatrically ill relatives at home, professional caregivers of elderly institutionalized patients, and aged spouses in the community. In at least three studies, a number of theoretical propositions derived from the Roy adaptation model were supported using LISREL VIII, thus adding credence to some tenets of Roy's model. Particularly, the focal stimulus of perceived stress, the contextual stimulus of conflicts in the exchange of social support, and one component of the coping mechanisms (the passive/avoidance coping strategies) were positively linked directly or indirectly with psychological distress, which is an indicator of adaptation in the self-concept mode. Given their importance, these elements should be considered in the development of a middle-range theory of psychological adaptation derived from the Roy adaptation model.
Religion, Public Schools, and Hyper-Pluralism: Is there a New Religious War?
Authors: Herrington Carolyn D.
Published: March 2007

For the past decade, members of the public educational community have called attention to threats to public schooling and to a pluralist democracy from religious conservatives. This article reviews recent empirical and theoretical research on religious conservatives, suggesting that they form a group that is very large and not necessarily Christian and which may be considerably less monolithic, less extreme, less politically active, and less conservative than previously thought. The article explores how the educational reform movement's focus on curriculum standards, academic rigor; and a larger role for the state may be failing to connect with religious communities that place greater value on instruction in morality, strong interpersonal relations, and an ethos of individual responsibility.
The East Asian Version of Whole-Class Teaching
Authors: Stevenson Harold W. , Lee Shinying
Published: March 2007

One of the hallmarks of teaching in Japanese and Chinese classrooms is the whole-class method of teaching. The development of this approach, wherein the teacher leads all students in the class through the lesson, stands in marked contrast to efforts in Western countries, where there are increasing tendencies to reduce class size and individualize instruction by dividing students into small groups. In this article we attempt to describe the form of whole-class teaching found in Japanese and Chinese classrooms and to point out the benefits of this type of classroom organization and teaching when lessons are conducted by well-prepared, skilled teachers. Information was obtained from the authors' visits to East Asian classrooms and from data obtained in a large observational study involving narrative descriptions of the behavior of students and teachers.
Education and Work in Japan: Implications for Policy
Authors: Stern Sam
Published: March 2007

Educators and policymakers in the United States and other Western countries have been reluctant to seriously consider Japanese approaches to work-related education. Consideration and analysis, as opposed to adoption, of Japanese approaches to work-related education can contribute to a better understanding of the basis for workforce development and formulation of policy. Drawing on extensive interviews with Japanese workers and managers in a variety of Japanese companies, this article describes the basis for the relationships between education and work in Japan and policy implications for the role of employers in workforce development.
Urban School Development: Literacy as a Lever for Change
Authors: Bryk Anthony S. , Rollow Sharon G. , Pinnell Gay Su
Published: March 2007

The Center for School Improvement (CSI) collaborates with a number of Chicago elementary schools on an Urban School Development Initiative. The schools, which are racially isolated and serve low-income communities, agree to work with CSI toward supporting fundamental restructuring using literacy as a lever for change. This article draws together evolving understandings based on several years of work in these schools. The authors first discuss their approach to comprehensive school development, then detail the literacy initiative that is the major academic component of their work, The article concludes with reflections on the role of the research university in promoting urban school reform.
School-Based Management in the Netherlands: The Educational Consequences of Lump-Sum Funding
Authors: Karsten Sjoerd , Meijer Joost
Published: March 2007

Important changes are taking place in the ways schools are funded in a large number of countries. In by far the majority of cases, these changes involve more freedom at the school level to decide how money should be spent. The Netherlands has had lump-sum funding in vocational secondary education since 1992. This has recently also been in operation in general secondary education and will soon be introduced in primary education. Not very much is known about how this method of funding works and its consequences. This article reports on the first study into the relationship between financial position and primary process under this new funding system.
Poison Centers: An Overview of the Past, Present, and Future
Authors: Gould Soloway Rose Ann
Published: March 2007

Poison centers are the source of expert treatment advice for all types of poison exposures. For this reason, health care providers and consumers are encouraged to call poison centers immediately in case of a possible poison exposure. This allows for rapid evaluation of potential toxicity, determination of the need for treatment, follow-up to the conclusion of a patient's clinical course, and data collection which can be useful in identifying unsuspected poisons, directing future research, and identifying subjects for poison prevention efforts.
Exposure Assessment: Industrial Hygiene and Safety
Authors: Pierce J. Thomas
Published: March 2007

Poison information specialists use a wide variety of consultants in the process of fielding calls. One group with whom they may appear to have the least in common is the industrial safety and health specialists. By knowing more about their respective backgrounds, both these specialists can benefit, ultimately making better clinical decisions on any given patient exposure event that they may be responding to. In terms of training, there are some important differences to note with respect to the poison information specialist and industrial safety and health specialist.
Specific Forensic Applications for Pharmacists
Authors: Anderson Peter D. , O'Donnell James T.
Published: March 2007

Many concerns to society are relevant to forensic pharmacists. Specific applications of forensic pharmacy include death investigation, professional malpractice, drug-induced violence, competency to stand trial, acquaintance rape, child abuse, drug testing, fraud & white collar crime, worker's compensation, and medication errors. Effects of the drug on either the victim or the defendant can be an issue in civil or criminal cases. Pharmacokinetics calculations can be useful in legal cases relating to drunk driving and adverse drug events.
Applications of Pharmacoeconomics in the Evaluation of Hospital Pharmacy Services
Authors: Taylor Andrea L. , Pierpaoli Paul G.
Published: March 2007

The evolution of the US health care system has driven institutions and professionals who practice in those institutions to deliver care in a more constrained and competitive environment. Quality care must be delivered with the least amount of resources possible. Because of the economic climate, institutions and professionals must now evaluate and develop their services. This article describes the application of pharmacoeconomics to hospital pharmacy services. Specific steps in conducting pharmacoeconomic analyses are discussed and illustrated by both hypothetical examples and recent examples in the literature. The marketing concepts of segmentation, targeting customers, and strategic planning will be discussed briefly to illustrate the application of pharmacoeconomics for streamlining services for maximum efficiency. Applying pharmacoeconomic principles to evaluate and develop services will provide information about the value and outcomes of those services. This information can be used to better target services to customers in need of those services, and to better use those services efficiently and effectively in an environment of scarce resources. Copyright © 1995 by W.B. Saunders Company
Pediatric Immunization: Current Recommendations and Controversies
Authors: Vosper Heather J.
Published: March 2007

The prevention of life-threatening childhood infections through vaccination is a remarkable achievement in the history of medicine. Although 98% of all American children are fully immunized at age 5 to 6 years because state laws require it for school entry, in 1991 less than half of children younger than 2 years of age were up to date for their diphtheria, tetanus, and pertussis (DTP); polio; measles, mumps, and rubella (MMR), and Haemophilus influenzae type b (HIB) immunizations. These children are at greatest risk for life-threatening infection. The last decade has seen many changes in the recommendations for routine childhood immunization. The resurgence of measles led to the addition of a second measles immunization. The introduction of the HIB vaccine has had a significant impact on the incidence of dreaded childhood meningitis. The effort to reduce adverse events associated with the pertussis component of the DTP vaccine resulted in the development of a new pertussis vaccine. The oral polio vaccine (OPV) is still being used with much debate on the merits of the inactivated polio vaccine (IPV). The hepatitis B vaccine was recently incorporated into the childhood immunization schedule in an attempt to eliminate this costly and devastating disease. The childhood disease chickenpox may become a disease of the past with the recent introduction of the varicella vaccine. With the multiplicity of new vaccines on the horizon, childhood immunization schedules will become more complex. To ameliorate an increase in the number of injections and physician visits, major efforts are currently being devoted to the development of combination vaccines, and the latest routine childhood immunization schedule has made every attempt to provide flexibility. The Children's Vaccine Initiative (CVI) defines a goal of developing a single supervaccine that "could be given once at or near birth, provide immunity for life, require no boosters, permit storage without refrigeration, obviate the use of needles and syringes and protect against as many as 20 diseases at once." To achieve this goal, enormous investments in research and development will be necessary. In the meantime, pharmacists can do much to encourage good immunization practices in their daily interaction with patients, and in so doing further the goals of pharmaceutical care. Copyright © 1996 by W.B. Saunders Company
Clozapine: Serious Adverse Side Effects, Drug Interactions, and Other Complications of Therapy
Authors: Guith Deanna M.
Published: March 2007

Clozapine (Clozaril®, Sandoz, East Hanover, NJ), an atypical antipsychotic agent with pharmacological properties considerably different from standard neuroleptics, has been found to be of great benefit especially to patients with treatment-resistant psychotic disorders. However, it is these unique pharmacological properties that have also been associated with mul tiple side effects ranging from the relatively benign (ie, sialorrhea during sleep, dizziness) to the potentially fatal (ie, agranulocytosis, seizures, and respiratory depression) which have limited its use. These untoward side effects are particularly problematic in the elderly population who often have concomitant medi cal illnesses requiring multiple medication regimens, including psychotropics that may interact with cloza pine (ie, benzodiazepines, cimetidine, fluoxetine). Because even the most benign of side effects has the potential of becoming fatal in certain circumstances if left unaddressed, it is imperative for patients, clinicians, pharmacists, and all health care professionals to be aware of adverse reactions and possible complica tions of clozapine therapy to prevent significant morbidity and mortality. Copyright © 1996 by W.B. Saunders Company
Cardiopulmonary Adverse Effects of Oral and Subcutaneous Terbutaline for Tocolysis
Authors: O'Donnell James , Iffy Leslie
Published: March 2007

Are there differences between the expected or reported adverse reactions associated with terbutaline when administered orally as opposed to the parenteral routes (such as subcutaneously or intravenously)? This is a report on a pulmonary edema and subsequent death of a laboring woman who was treated with a combination of tocolytic agents in an attempt to prolong the gestation. The agents included magnesium sulfate, and subcutaneous and oral terbutaline. The intention is to alert the reader to the cardiovascular risks associated with combining tocolytic agents, and to dispel a pervasive myth that serious adverse reactions do not occur with oral tocolysis (i.e., terbutaline).1 Until recently, the package insert sheets for both manufacturers of terbutaline restricted the attribution of serious cardiovascular risks to parenteral administration only. The clinical case will be presented, followed by a review of the published literature and the reports on file in the unpublished Food and Drug Administration MedWatch database. Finally, the comparative pharmacokinetics of the oral and parenteral terbutaline is presented to help the reader understand how these adverse events are to be expected with any route of administration of the tocolytic.
Cost Benefit Analysis of Monitoring Serum Vancomycin Concentrations in a Teaching Hospital
Authors: Oparaoji Edward C. , Siram Suryanarayana , Anosike Rofina , Pippalla Rao S. , Mezghebe Haile M.
Published: March 2007

Objective: To evaluate the economic benefits of routine monitoring of serum vancomycin concentrations and recommend monitoring guidelines. Design: An IRB approved 5-months retrospective chart review. Setting: The study was conducted using patients' medical records in a Teaching hospital. Patients: All patients on intravenous vancomycin, who have stable serum creatinine at the time of initiating vancomycin. Main Outcome Measures: Benefit-to-cost ratio and Return-on-investment were calculated. Benefits were determined using costs avoided that would have occurred in managing SVC-related toxicity, while the cost was the hospital charge for determining SVC. Interventions: Using a computer-generated list of patients on vancomycin from August to December 1995, thirty-one patients' charts were randomly retrieved from the medical records department and reviewed. We extracted and recorded pertinent data on a data collection sheet. The data extracted included SVCs, frequency of SVC determination, dose and duration of vancomycin treatment, and vancomycin untoward effects. Other data recorded were age, weight, height, sex, status of renal function, and other concurrent nephrotoxic or ototoxic drugs. Result: The Benefit-to-cost ratio was 0.696, and the Return-on-investment was -30.4%. A mean of 2.83 ± 3.1 SVCs was obtained per patient during a mean therapy duration of 10.2 ± 6.8 days. The mean daily dose (27.8 ± 7.0 mg/kg), peak (21.7 ± 6.54 mcg/mL), and trough (7.4 ± 5.98 mcg/mL) were within recommended standards. Also, two (8.3%) patients experienced increased serum creatinine. Conclusion: Our results show that the routine monitoring of SVCs is not cost beneficial. We recommend only one trough SVC for patients with normal or stable renal functions for a course of treatment. Patients with unstable renal function may require more than one trough SVC determination and should be evaluated on a case-by-case basis. Peak and trough SVCs should be reserved for patients with other risk factors for ototoxicity.
Empirical Evidence for the Nature of Holistic Comfort
Authors: Kolcaba Katharine , Steiner Richard
Published: March 2007

The nursing outcome of holistic comfort encompasses physical, psychospiritual, social, and environmental aspects of human nature. The primary purpose of this study was to test four propositions about the nature of comfort: (a) Comfort has equal proportions of state and trait characteristics; (b) comfort is sensitive to changes over time; (c) when subjects are exposed to an effective intervention, they demonstrate differences in comfort that increase in a linear way compared to a control group; and (d) the whole (total comfort) is greater than the sum of its parts (relief plus ease plus transcendence). A secondary purpose of this study was to present preliminary concurrent validity between two types of comfort instruments, a traditional questionnaire with a Likert-type format and visual analog scales. Findings were positive for all theoretical propositions and moderate concurrent validity between the Radiation Therapy Comfort Questionnaire and the visual analog scale for total comfort was demonstrated.
The Lived Experience of Listening to Music While Recovering from Surgery
Authors: McCaffrey Ruth G. , Good Marion
Published: March 2007

Music has been shown to have positive physiological and psychological effects on patients in previous studies. In this study, the authors looked at the lived experience of listening to music and evaluated findings from a phenomenological perspective. Specifically, the authors described the following three themes that emerged from interview data with 8 participants who listened to music during postoperative recovery: (a) comfort from a discomforting condition, (b) familiarity in a strange environment, and (c) distraction from fear, pain, and anxiety. In addition, implications for the use of music by nurses are discussed.
Forgiveness
Authors: Brush Barbara L. , McGee Eileen M. , Cavanagh Bonnie , Woodward Mary
Published: March 2007

This article provides an operational definition of forgiveness as a first step in the systematic analysis of the concept. Using the method described by Walker and Avant (1995), the authors identify the attributes and characteristics of forgiveness and its theoretical and practical implications for nursing. Sample cases from clinical practice help illustrate the concept further. Further nursing research needs to test the theoretical relationships between forgiveness and nursing practice outcomes.
Ethical Principles Applied to Complementary Healing
Authors: Wardell Diane Wind , Engebretson Joan
Published: March 2007

With the public and professional shift to an interest in alternative/complementary therapies and holistic health, existing assumptions about the relationship between providers and clients are being challenged. This study explores the ethical approaches and underlying principles in the expectations of three organizations espousing holistic health and touch therapies. An analytic technique using a qualitative approach was applied to the documents of written ethical codes and standards from these organizations and was augmented by field exposure from previous work with each of the groups of healers. The emphasis on and approach to the principles of paternalism and autonomy from the groups provided contrasts with general biomedical approaches. All groups gave attention to the constructs of nonmaleficence, beneficence, and autonomy, with a strong emphasis on virtue ethics. The shift in the expression of the principles of paternalism and client agency allowed the healers to employ the therapeutic effects of placebo, suggestion, optimism, hope, and surrender with the avoidance of noicebo effects.
Living Arrangements and Participation in Leisure-Time Physical Activities in an Older Population
Authors: Satariano William A. , Haight Thaddeus J. , Tager Ira B.
Published: March 2007

Objectives: This is a cross-sectional investigation of living arrangements, social contacts, and level of leisure-time physical activity (LTPA) among residents of Sonoma, California, aged 55 and older. Methods: The odds of different levels of LTPA were assessed by living arrangements and social contacts following adjustment for measures of health, functioning, physical performance, selected health behaviors, and socioeconomic status for men and women separately ( n = 2,073). Level of LTPA also was examined among married couples only (subset of sample, n = 511 spouse pairs). Results: The relationship between living arrangements, social contacts, and LTPA varied by gender and level of LTPA. Among married couples, the LTPA of the partner was the most significant predictor of the LTPA of the participant, with the exception of those who engaged in less than brisk activity. Discussion: Living arrangements and social contacts are important determinants of LTPA and should serve as the basis for future interventions.
Perceptions of Health and Use of Ambulatory Care
Authors: Pourat Nadereh , Lubben James , Yu Hongjian , Wallace Steven
Published: March 2007

This study identifies whether culturally based differences in perceptions of health resulted in differences in ambulatory care use among the elderly. Methods:The authors conducted stratified Poisson regressions on data from a 1992 survey of older Koreans and Whites in Los Angeles County. The models included measures of demographics, health, functioning, income, insurance, social support, and culture (perceptions of health or other beliefs). Results:Descriptive findings showed older Koreans had more ambulatory physician visits, poorer functioning, and poorer perceptions of their health than Whites. Multivariate findings showed that positive perceptions of health independently reduced office visits for bothKoreans and Whites, but the effect was significantly smaller for Koreans. Other cultural differences also affected use. Discussion:The findings highlight differences between older Koreans and Whites’ responses to physical and socioeconomic conditions and the importance of cultural sensitivity in the health care delivery system.
Differences in Functional Status of Hispanic versus Non-Hispanic White Elders
Authors: Carrasquillo Olveen , Lantigua Rafael A. , Shea Steven
Published: March 2007

Objectives:Fewnational studies have focused specifically on the functional status of Hispanic elders. We examined the prevalence of functional limitations and disabilities among Hispanic and Black elders compared to non-Hispanic Whites. Methods:We analyzed seven measures of functional limitations, disabilities, and dependencies. Logistic regressionwas used to examine racial and ethnic group differences adjusting for age, gender, and education. Results:Compared to non-Hispanic Whites, Hispanics tended to report greater instrumental activities of daily living (IADL) dependencies and cognitive disabilities. Blacks were more likely to have activities of daily living (ADL) and IADL dependencies and require use of assistive devices compared to non-Hispanic Whites. Further adjustment for respondent status reduced differences between groups, but these models may overadjust for functional status differences. Discussion:Given the projected growth of minority elders, policymakers and planners will need to consider race and ethnic differentials in functional status in determining future medical and social service needs.
Job Characteristics and Leisure Physical Activity
Authors: Wu Bei , Porell Frank
Published: March 2007

Objectives:This study employs a sample population of older workers to estimate an empirical model of leisure exercise activity. Alternative theories relatingwork and leisure attitudes relevant for understanding the exercise behavior of older workers are tested empirically. Methods:Responses of 6,433 full-time older workers (51 to 61 years old) from the 1992 Health and Retirement Study (HRS) are grouped into two white-collar and blue-collar worker categories and are analyzed to test whether self-reported levels of regular physical activity are associated with the physical demands and stress associated with one’s job. Results:Although the white-collar workers, whose jobs involve more physical efforts, are more likely to do light physical activity, the blue-collar workers, whose jobs are more physically demanding, tend to engage in more vigorous exercise. Discussion:The empirical results are most supportive of the generalization theory, and they also illustrate the complexity of relationships between work and leisure physical activity.
Factors Associated with Time to First Hip Fracture
Authors: Young Yuchi , Myers Ann H. , Provenzano George
Published: March 2007

Objective: To examine the relationship between risk factors associated with first hip fracture ever and its time to first fracture. Methods:Data were from the Longitudinal Study on Aging. Of the 7,527 participants, 334 sustained a first hip fracture between 1984 and 1991. Results:Results from the Cox proportional hazards model indicate the time to first fracture was inversely related to the number of risk factors involved. The risk factors significantly associated with first fracture were increasing age, female, Caucasian race, history of falls, insufficient exercise, infrequent church attendance (a likely proxy for outside the home activities), hospitalization in the year before the study, and lowbody mass index. Conclusion:As the number of risk factors increases, the estimated time to fracture becomes shorter; thus, the window of opportunity for prevention is smaller. To reduce the incidence of first hip fracture and to prolong the time to first fracture, interventions should focus on modifiable risk factors identified: increasing exercise, increasing outside-the-home activities, and improving or maintaining body mass index.
Race, Gender, and Health Care Service Utilization and Costs among Medicare Elderly with Psychiatric Diagnoses
Authors: Husaini Baqar A. , Sherkat Darren E. , Levine Robert , Bragg Richard , Holzer Charles , Anderson Kathyrn , Cain Van , Moten Carmen
Published: March 2007

Objective: To investigate race and gender differences in health care service utilization and costs among the Medicare elderly with psychiatric diagnoses. Methods: The authors employ a 5% sample of Medicare beneficiaries from Tennessee ( N = 33,680), and among those with a psychiatric diagnosis ( n = 5,339), they examine health care service utilization and costs by race and gender. Results: African Americans had significantly higher rates of diagnosis for dementia, organic psychosis, and schizophrenia, whereas Whites had significantly higher rates for mood and anxiety disorders. White and African American men have higher rates of utilization of emergency and inpatient services and lower rates of outpatient utilization compared to White women and African American women. African American men have significantly higher health care costs. Discussion: The findings suggest that race and gender interact to influence service utilization and preventive care, thereby driving up costs of care, for elderly persons with psychiatric diagnoses.
Epidemiologic Aspects of Alzheimer's Disease
Authors: Brody Jacob A. , Cohen Donna
Published: March 2007

To date, the classical approach of epidemiology has been neither exhaustive nor particularly helpful in developing insights into the nature of Alzheimer's disease. The inability both to diagnose the disease and predict its clinical course hampers our ability to conduct adequate research on cause, prevention, clinical trials, and other treatment modalities as well as to select those key patients for whom greater efforts toward securing autopsies must be made. We are engaged in establishing an Alzheimer's Disease Patient Registry, to determine the data needed to embark on major etiologic and epidemiologic studies. Our studies of Alzheimer's disease in families and in forms of social and financial milieu are designed to develop humanitarian and potentially cost-effective approaches.
Social Support, Stress, and Psychological Distress among Older Black and White Adults
Authors: Ulbrich Patricia M. , Warheit George J.
Published: March 2007

This analysis examines the relationship among sources of stress, sources of support, and psychological distress among black and white elderly living in the community. The data are drawn from an epidemiological survey conducted in 1984 and show that black and white elders are equally likely to have family and friends available. and to ask relatives for help when they have problems. Older black people, however, are more likely than their white counterparts to ask friends more frequently for help. Using regression models and adjusting for age, sex, education and marital status, the results provide qualified support for a buffering hypothesis. Asking family and friends for help does modify the relationship between financial concerns and psychological distress among older adults. Friends are an important resource for coping with financial concerns among older blacks, and relatives are an important resource for coping with financial concerns among older, low-income whites. Finally, there is no evidence for a buffering hypothesis of calling on family or friends for help among older. high-income whites. These findings illustrate the need to examine the buffering effects of specific sources of support in relation to specific sources of stress, and the need to examine how race and socioeconomic status shape these relationships.
Outcomes of a Geriatric Rehabilitation Program in a Long-Term Care Facility
Authors: McCusker Jane , Mundt Diane J. , Stoddard Anne M. , Cole Ellan , Whitbourne Susan K. , Simmons Joan E.
Published: March 2007

This study investigated outcomes of geriatric rehabilitation and predictors of success among 81 consecutive admissions to a 40-bed rehabilitation unit in a long-term care facility. Predictors measured at admission included sociodemographic variables, functional status (both current and prior to illness), social contact, and self-motivation. In all, 62 patients (77%) successfully completed the rehabilitation program; 76% of the successes were discharged home. Failure to discharge successfully rehabilitated subjects was mainly due to placement problems and patient and family preference. Both of the success groups showed significant improvement in functional status (Barthel Index), while failures had poorer initial functional status, and showed no improvement on average. At six-month follow-up, functional status (measured by the Sickness Impact Profile) was similar in the two success groups. No predictors other than functional status were associated with rehabilitation success. Among the successes, better functional status at six months was predicted by aspects of self-motivation.
Expenditures for Unintentional Injuries among the Elderly
Authors: Bernstein Amy B. , Schur Claudia L.
Published: March 2007

This article presents national estimates of the probability of having an unintentional injury, the types of medical care associated with unintentional injuries, and the costs of unintentional injuries that occurred in calender year 1977 for persons aged 65 and older. Data come from the 1977 National Medical Care Expenditure Survey (NMCES) and the 1977 National Nursing Home Survey (NNHS). Among persons aged 65 and older, we found differences in the probability of having an unintentional injury by age, sex, and living arrangement, which suggests that unintentional injuries are not "accidental," or random, events. Our estimates indicate that total medical care expenditures for unintentional injuries for the elderly population in 1977 may have been over $2 billion. Using simple adjustments, we also estimated that the amount expended on injury-related medical care in 1984 might have been as high as $5 billion. Given the large amount of monetary, and presumably nonmonetary, costs associated with unintentional injuries, programs designed to reduce such injuries may well pay off in a cost-benefit or cost-effectiveness framework.