bluuebunny/crossref_metadata_2025 huggingface dataset:
Interactions of Mothers and Fathers with Conduct Problem Children: Comparison with a Nonclinic Group
Authors: Webster‐Stratton Carolyn , Fjone Andra
Published: May 2007

The purpose of this study was to compare the interactions of clinic‐referred mothers and fathers with their conduct problem children with those of nonclinic “normal” parents and their children without problems in terms of their expression of positive and negative affect. Forty parents and their 20 children participated. Results indicated that clinic mothers and fathers exhibited significantly increased negative verbal behaviors with their children than nonclinic parents. Valence scores also indicated clinic mothers had significantly more negative nonverbal affect behaviors than nonclinic mothers. Clinic children exhibited significantly less positive verbal and nonverbal affect behaviors with their mothers than nonclinic children. Valence scores indicated that clinic children exhibited more negative nonverbal behaviors with both mothers and fathers in comparison to nonclinic children.
Adolescent Parents and Toddlers: Strategies for Intervention
Authors: Van Cleve Susan N. , Sadler Lois S.
Published: May 2007

Adolescents share many developmental similarities with toddlers. When an adolescent becomes a mother, the parent‐toddler relationship is affected by the level of development of both individuals. It may be nurturing and satisfying, or it may be conflicted and frustrating for both. By comparing the developmental similarities the two share, the nurse is provided with a framework for assessing and working with these clients.

Adolescent parents share many developmental similarities with their toddlers. The adolescent mother, who is usually the primary caretaker, is at risk for conflict with her child as the two pass through similar developmental stages. Issues of independence, limit testing, cognitive changes, and mobility surface for both individuals and may increase the potential for parent‐child conflict.

Nurses are in an excellent position to assess these families for conflict and intervene appropriately. A continuing relationship with these families enables nurses to be a resource and assist adolescent assuming a successful parenting role.

Specific strategies such as providing adolescents with a chance to role‐play difficult parent‐child interactions, providing them with concrete suggestions and demonstrations for handling toddler behavior, and planning respite care are helpful. The goal of such individualized care is the healthy growth and development of both young parents and young children.
Opening the Gateway to Home Health Care
Authors: Rousseau Elaine J.
Published: May 2007

Abstract: Traditionally, home health agencies have been passive in seeking out referrals for patient care. Competition and a tighter economy, however, are altering the way they view themselves. Although physicians continue to be the gatekeepers to home health care, agencies must begin to promote themselves to physicians by using effective marketing techniques. Techniques that use a personal approach have been beneficial to the central Massachusetts agencies studied. It is necessary to expand beyond this method, however, and develop the philosophy of collaborative practice with physicians in the delivery of home care.
Clinical Competencies for Community Health Nursing
Authors: Kenyon Virginia , Smith Elaine , Hefty Luella Vig , Bell Mary Lee , McNeil Jo , Martaus Theresa
Published: May 2007

Cost‐containment strategies initiated in the early 1980s caused a major shift in site of care delivery for persons needing nursing care. Where once the majority of clients were cared for in the acute‐care setting until they were self‐sufficient, now most are discharged to the home environment still requiring acute‐care nursing interventions as well as community health nursing skills. This rapid shift in practice sites has placed severe strain on community health nursing agencies. Not only are more nurses required to fill the increased demand for services, but the demand comes at a time when we are experiencing a severe nursing shortage. This has forced many agencies to hire acute care nurses who have little or no community health nursing experience. These nurses come to community health nursing expecting to use the same set of skills and knowledge base used in their acute‐care practice; however, the skill levels and concepts required for community health nursing are quite different from the acute care setting. Educational preparation has not kept pace with this shift in practice. Consequently, many nurses are not adequately prepared to enter community health nursing. Preparation must include theoretical and experiential components that focus on assessment skills (of the community and individual), decision making, case management, health systems management, teaching, and leadership. Collaborative efforts between community health organizations and educational institutions would seem to be one solution that would ensure adequately prepared nurses for community health nursing. The establishment and maintenance of strong staff‐development programs within community health nursing agencies are also required.
Public Health Nursing: Cross‐Training in Core Services
Authors: Feagin Rosina , Alford Rena L.
Published: May 2007

Diminishing financial resources and increasing demands for health care precipitated one public health district to review its framework of delivery of care for effective and efficient use of personnel and facilities. Categorical funding patterns had promoted a framework that functioned along specialized programmatic lines in which were identified inequities in funding and staffing, and use of services by clients. In addition, to the often inefficient use of staff and fragmentation of patient care were the associated consequences of overcrowded clinics, long waiting lists for appointments, and chronic understaffing of some clinics. The concept of cross‐training in core services was initiated in one health center in October 1985. It was based on the belief that the best of generalized and specialized approaches to health care delivery in this district could be merged, and that all nursing staff should be proficient in certain basic functions. Results indicate improved efficiency in clinic management and flow, leading to reduced costs per patient encounter, increased demands for service that were met with existing staff, and reduced patient waiting time.
Nonreimbursed Home Health Care: Beyond the Bills
Authors: Phillips Elayne Kornblatt , Cloonan Patricia , Irvine Audrey , Fisher Mary E.
Published: May 2007

The unprecedented growth in the home care industry over the past decade has produced a highly competitive environment for care delivery. To survive, most agencies are implementing strategies to maximize reimbursable care. This focus, while likely to improve an agency's financial situation, is fraught with potential problems. Reimbursed care represents only a small portion of the care that is required and delivered. Still, aside from anecdotes, little reporting has been done to document such additional service, much less to consider the consequences of reducing or deleting it. We selected a sample of 350 public health home care episodes throughout Virginia, and reviewed billing records to determine the number of billed home visits attached to them. We then reviewed home health records for the matching episodes and recorded all visits and other care‐related activities (e.g., telephone calls, conferences, laboratory trips). Total home visits increased, with an average of 1.5 unbilled home visits per episode. In addition, 10 additional care‐related activities take place per patient, none of which is billed. These findings represent one of the first attempts to quantify the amounts and types of nonbilled care delivered by nurses. This care consumes significant nursing resources and, as a result, may be destined to be reduced or totally eliminated.
Prevalence and Correlates of Depressive Symptoms in Mothers of Young Children
Authors: Hall Lynne A.
Published: May 2007

Mothers of young children are at risk for depressive symptoms due to their gender and status as parents. The primary purposes of this study were (1) to assess the prevalence of depressive symptoms in a sample of mothers with young children, (2) to identify sociodemographic correlates of depressive symptoms among the women, and (3) to determine if chronic stress is associated with depressive symptoms independent of other risk factors. In‐home interviews were conducted with 196 mothers of 5‐ and 6‐year‐old children using the Center for Epidemiologic Studies–Depression (CES‐D) Scale and the Everyday Stressors Index (ESI). High depressive symptoms (CES‐D ≥ 16) were reported by 49% of the mothers. They were highest among those who had never married, had less than a high school education, were under 25 years of age, were black, and had a low income. The ESI was a strong predictor of high depressive symptoms, controlling for sociodemographic characteristics. In comparison to mothers reporting a low level of everyday stressors (score = 5), those scoring 15 were 3 times more likely to have high depressive symptoms; those scoring 35 were more than 30 times as likely to have high CES‐D scores. The results suggest the importance of chronic daily stressors as correlates of depressive symptoms in mothers of young children and also point to th need for multivariate models when examining predictors c those symptoms.
Hispanics: At Risk for Adolescent Pregnancy?
Authors: Pletsch Pamela K.
Published: May 2007

Data from the Hispanic Health and Nutrition Examination Survey, 1982‐1984, were analyzed to describe pregnancy, miscarriage, and age‐specific birth rates as well as oral contraceptive use among Mexican‐American, Puerto Rican, and Cuban‐American females age 12 to 19 years. The Cuban‐American sample (n= 85) had the lowest pregnancy (99) and fertility (37) rates, with 6.5% ever having used oral contraceptives. In the Mexican‐American (n= 638) and Puerto Rican women (n= 300) the pregnancy and fertility rates were 205 and 223, and 141 and 110, respectively. Of these two groups, 14.5% and 12.6% had ever used oral contraceptives. These results suggest that Mexican‐Americans and Puerto Ricans are at risk for adolescent pregnancy, with the latter having more of the sociodemographic characteristics associated with the long‐term disadvantages of early childbearing. These facts have implications for nursing practice and research.
Elderly Clients' Perceptions of Public Health Nursing Care
Authors: Laffrey Shirley Cloutier , Renwanz‐Boyle Andrea , Slagle Rhoda , Guthmiller Alene , Carter Barbara
Published: May 2007

Although the health benefits of illness prevention and health promotion are accepted, little is known about the reasons for which elderly clients attend public health programs or the benefits they perceive from public health nursing care. This study reports the major reasons for which men and women age 60 and over sought care in a public health nursing program and the major benefits they perceived. The sample included 137 new and 360 returning clients. Responses to open‐ended questions were content analyzed into categories of like statements, which in turn were placed into overall groups. The results suggest that most clients realized significant benefits from receiving public health care and were able to articulate these benefits. Eliciting clients' perceptions can assist public health nurses to implement and market programs in a way that is acceptable and accessible to the recipients.
Cultural Diversity: A Resource in Planning and Implementing Nursing Care
Authors: Henkle Joan O. , Kennedy Susan M.
Published: May 2007

America's cultural diversity challenges the ability of nurses to respond with sensitivity to client needs. Enhancement of the client's health practices is contingent on the nurse's ability to use the individual's culturally based beliefs and values as an integral component in the design of nursing interventions. Nurse and client engage in a truly collaborative planning and implementation of care only after there is mutual understanding of the special meaning of beliefs and values from which health behaviors are derived. Educational preparation with experience in applying cultural knowledge is essential to the development of sensitive nursing practice. Integrating such information and experiences into baccalaureate nursing curricula through a sociocultural project will enhance student awareness of client values and beliefs and their potential nursing implications. Strategies exist for helping students recognize, accept, and use these features in planning and implementing nursing care.
Patterns of Fecal Coliform Contamination in Day‐Care Centers
Authors: Holaday Bonnie , Pantell Robert , Lewis Catherine , Gilliss Catherine L.
Published: May 2007

During a six‐month period, on four separate occasions, six licensed day‐care centers had cultures taken from environmental surfaces as well as the hands of children and teachers. Fecal coliforms were recovered from 64 (9.5%) of the 675 surfaces sampled. Recovery rate was not influenced by a center's socioeconomic status, time of year, or presence of children who were not toilet trained. Recovery rates did differ significantly in different areas, with the kitchen showing a relatively high recovery rate (19%), and toys and toilets showing remarkably low rates (2% and 4%). Centers with formal hand‐washing procedures had lower recovery rates than those without such practices. We also demonstrated a high recovery rate from hands of staff (16%); 6% of children had positive cultures. Contamination of hands and classroom objects is a potential source for the transmission of enteric diseases for children in day‐care centers. A program directed at reducing contamination would be important in preventing the spread of diarrheal illness.
Homeless Families: Rebuilding Connections
Authors: Francis Marion B.
Published: May 2007

Young families are the fastest‐growing group of homeless people in the United States. Many women have suffered violations of physical and sexual abuse, reduced income through divorce, and discrimination in seeking housing. Families have been disconnected from their homes, an adequate income, health care services, schools, and their families. Selected literature is reviewed to promote understanding and advocacy nursing for this high‐risk population.
Home Health Care: Reliability and Validity Testing of a Patient‐Classification Instrument
Authors: Albrecht Mary Nies
Published: May 2007

The purposes of this methodologic, descriptive, correlation study were to assess the reliability and validity of the Easley‐Storfjell (ES) patient‐classification instrument for home care, and determine to what extent it was useful in a large, hospital‐based home health care setting. A model for home health care developed by the investigator was used. In‐terrater reliability and concurrent validity were established by four nurse‐raters using a random sample. Nonparametric bi‐variate correlational analysis demonstrated that the ES instrument was both reliable and valid at a significant level. In addition, there was agreement between the overall ES category rating and rater frequency of home visits. Intrarater reliability for each of the four nurse‐raters on a random sample was at a significant level. The results of this study have important implications for home health care agencies providing care to chronically ill patients.
Identifying Infants at Risk: North Carolina's High‐Priority Infant Program
Authors: Cilenti Dorothy , Farel Anita M.
Published: May 2007

Recent federal legislation (e.g., PL 99‐457, Part H, and amendments to the MCH block grant and Medicaid legislation) has focused attention on infants at risk for health and developmental problems. The ability to plan services for these infants would be strengthened by data that could be used for program accountability and evaluation. Using nurses based in local health departments, North Carolina's High‐Priority Infant program currently identifies and follows infants with biologic (e.g., very low birth weight), environmental (e.g., psychosocial problems), and established (e.g., Down syndrome) risk conditions. Data from this program were collected to analyze specific features of its implementation, a necessary precursor to evaluating outcome.
Maladaptive Mother‐Child Relationships: A Pilot Study
Authors: Sachs Barbara , Hall Lynne A.
Published: May 2007

The primary purposes of this pilot study were to identify maternal psychosocial correlates of unrealistic expectations of children and of child abuse potential, and to investigate the relationships of these factors with child behavior. A cross‐sectional, two‐group design was used. One group consisted of 20 low‐income mothers whose preschool children were referred to a family care center for suspected abuse or neglect. A comparison group was made up of 20 low‐income mothers whose children attended a university‐based pediatric clinic and who were not referred for abuse or neglect. Data were collected during structured in‐home interviews with the mothers. Measures of parental bonding, maternal depressive symptoms, unrealistic expectations of children, child abuse potential, and child behavior were obtained. Preschool teachers of the children also rated the children's behavior. Mothers with high depressive symptoms reported more unrealistic expectations of children and had greater child abuse potential scores than those with fewer symptoms. The more child behavior problems mothers reported, the greater their unrealistic expectations of the children and the higher their score for child abuse potential. Maternal depressive symptoms were not directly related to child behavior. Teacher reports of child behavior were moderately correlated with maternal reports, but no study variable was associated with teacher reports.
Screening for Psychosocial Distress: Implications for Prevention and Health Promotion
Authors: Gage Lois W. , Kline Leidy Nancy
Published: May 2007

The importance of identifying the mental as well as physical health needs of individuals served in primary care settings has been documented in the United States, Great Britain, and developing countries. This study compared the prevalence of psychosocial distress across four demographically diverse ambulatory care clinics, and described the relationship among selected demographic characteristics (age, gender, marital status, race, education, and income) and psychosocial distress in order to develop a profile of high‐risk clinics and patients. The sample was drawn from consecutive clinic attendees in two geographic regions of the United States. Psychosocial distress was measured with the Goldberg 28‐item general health questionnaire (GHQ). As a group, 64% of the subjects had GHQ scores of less than 5, indicating they were not at risk; 26.5% were moderately distressed and 9.5% were highly distressed. The distressed tended to be chronically physically ill patients who attended two clinics. Multivariate nominal scale analysis (MNA) indicated that the sociodemographic variables accounted for 11% of the variance in GHQ scores. Younger (<60 yrs), white, low‐socioeconomic subjects had a higher probability of falling into the high‐risk category. Contrary to previous research findings, gender was not associated with distress.
Smoking Policies in Health Science Schools
Authors: Rogers Bonnie
Published: May 2007

Abstract Although cigarette smoking has decreased significantly in the last 25 years in the United States, it continues to be a major contributor to morbidity and premature mortality. All 704 U.S.‐accredited health science schools were surveyed to determine the existence and scope of smoking policies, smoking cessation programs, and related activities in these schools. The aim was to encourage health care‐related organizations, institutions, and professionals to accept leadership roles in smoking prevention and cessation. Of 517 (73%) respondents, 339 reported some form of smoking policy; however, restriction was primarily prohibited in classrooms and elevators. Vending of cigarettes was reported in up to 17% of schools, and smoking‐related illness complaints were reported by 31%. Smoking programs and information were minimally offered. Health science schools must be more aggressive in their approaches to dealing with smoking prevention and cessation, and assume a more proactive leadership role toward achieving a smoke‐free environment.
Working with Multiproblem Families: An Intervention Model for Community Health Nurses
Authors: Lynch Irene , Beth Tiedje Linda
Published: May 2007

AbstractWe propose a model for working with multiproblem families that is based on provider‐client conceptual frameworks. The model includes primary areas of conflict in client‐provider relationships (values, control, and information), and suggestions for effective intervention strategies. It delineates ways to empower families and to assist nurses in achieving greater professional satisfaction.
AIDS Research in the Community: A Case Study in Collaboration Between Researchers and Clinicians
Authors: Salsberry Pamela J. , Nickel Jennie T. , O'Connell Muriel
Published: May 2007

Abstract This paper presents a practical guide for researchers‐academicians and clinicians who are considering the development of a collaborative community‐based project. It reports on a federally funded project developed by nurse‐researchers at a large midwestern university and the nurse clinician directing home care services at the city health department. The focus of this study is to determine the service needs and to evaluate the effectiveness of a case management protocol for persons who are positive for the human immunodeficiency virus and in need of home care.
Applying Critical Theories to Nursing in Communities
Authors: Stevens Patricia E. , Hall Joanne M.
Published: May 2007

AbstractPublic health realities in the United States indicate that unsafe physical surroundings, oppressive social arrangements, economic impoverishment, and political disenfran chisement threaten the safety and well‐being of countless aggregates. To affect change in health‐damaging conditions, nurses are urged to join with vulnerable groups, working together to expose oppressive situations and take action. As a guide for such emancipatory practice, the use of critical the ories as the conceptual basis for community health nursing is advocated.
Laying the Groundwork for Family Self‐Help: Locating Families, Building Trust, and Building Strength
Authors: Zerwekh Joyce V.
Published: May 2007

AbstractThe practice stories of 30 expert home visiting public health nurses were recorded and interpreted qualitatively, using constant comparative analysis. Three family caregiving competencies, which provide the essential preliminary groundwork to enable family self‐help, were identified: locating the family, which involves tracking down highly unstable families; building trust, which involves developing rapport with clients who have seldom experienced trust; and building strength, which occurs with those who have neither apparent strengths nor belief in their own capacity. These descriptions have major implications for investigation, teaching, and integration into policy.
Outpatient Chemotherapy: Patients' and Family Members' Concerns and Coping Strategies
Authors: Dodd Marylin J. , Dibble Suzanne L. , Thomas Mary L.
Published: May 2007

Abstract Since the majority of cancer chemotherapy is given on an outpatient basis, it is important for nurses in the community to understand the concerns that patients and family members experience during the treatment and how they manage these concerns. The 64 adult patients were diagnosed with selected solid tumors or lymphoma and were initiating a course of chemotherapy. Sixty‐nine family members participated as well. Each participant kept a log in which to record concerns and strategies taken to manage them. Patients reported fewer concerns than their families, but both had similar concerns and rated them as high in intensity. Patients performed more strategies than family members, but both rated the effectiveness of their strategies as moderately high and cited themselves as the sources of the strategies.
Making the Fit: Orienting New Employees to Community Health Nursing Agencies
Authors: Snow Lilyan , Hefty Luella Vig , Kenyon Virginia , Bell Mary Lee , Martaus Therese
Published: May 2007

Abstract Community health nurse managers require tested orientation methods to fit new employees into the rapidly changing conditions of professional practice, increase nursing productivity, and reduce turnover. The clinical competencies for community health nursing provide a workable framework for applying orientation principles to the special demands of community health nursing.
A Public Health Quality Assurance System
Authors: Zlotnick Cheryl
Published: May 2007

Abstract Quality assurance (QA) systems are commonplace among hospitals. They are even found in home health and health maintenance organizations, but they are less common among public health agencies. This article enumerates the discrepancies between the design of traditional QA and that necessary to meet the needs of a department of health's public health nursing service. It characterizes the subsequent changes that must be inserted into the QA system for it to comply with the mission and services of a public health setting. The system and instruments presented are used in the Baltimore County Department of Health, Public Health Nursing Services.
The Relationship of Ideology to Developing Community Health Nursing Theory
Authors: Hamilton Patricia A. , Keyser Patsy K.
Published: May 2007

Abstract Ideology plays a major role in developing theory, guiding education, and directing practice in nursing. This study investigated the opinions of community health nurse educators regarding specific elements of community health nursing ideology and its relationship to the educators' opinions about the appropriateness of existing theory for professional use. The majority of participants agreed that a specific set of beliefs can be called a community health nursing ideology. Covariant factor analysis indicated that it is not a undimensional, internally consistent single set of beliefs or values, but rather is a set of two types of values, one focusing on the individual and the other on society. Individually oriented beliefs were positively related to satisfaction with existing theory. Socially oriented beliefs were negatively related to satisfaction with existing theory, but the relationship was not statistically significant. Anyone engaged in developing community health nursing theory would do well to consider which ideologic model is undergirding the process.
How Elderly Women Cope: Concerns and Strategies
Authors: Heidrich Susan M. , Ryff Carol D.
Published: May 2007

Abstract Forty‐two elderly women were asked to describe the problems they faced with aging, and how they coped with both real‐life and hypothetical problems in seven areas. Content analysis indicated that their spontaneously reported ongoing strategies were consistent with current theoretical formulations, the strategies differed by area of concern and for real‐life versus hypothetical problems, and direct action strategies were related to lower levels of psychologic distress. These results have implications for nursing research and practice.
Blood Pressure Comparison in a Selected Native American and White Population
Authors: Helgeson Diane M. , Berg Carol L. , Juhl Nyla
Published: May 2007

Abstract This study compared the frequency of blood pressure elevation in a selected Native American and white population. Three hundred individuals participated: 87 Native Americans, 210 whites, and 3 others. Data were gathered using a questionnaire that addressed residence, sex. age, race, occupation, height, smoking, alcohol use. tea/coffee consumption, medications, and past or present illness. Weight and blood pressure were measured by the researchers at the time of data collection. The sample mean for systolic blood pressure (SBP) was 124 mm Hg (SD 14.78) and diastolic blood pressure (DBP) was 77 mm Hg (SD 10.13). One‐way analysis of variance showed age groups and sex to affect blood pressure significantly (P= 0.0001). Stepwise multiple regression indicated weight significantly predicted blood pressure (SBP multiple R = 0.39, P= 0.001; DBP multiple R = 0.43, P= 0.00001). The interaction of age, sex, tobacco, alcohol, and caffeine influenced SBP and DBP. Obviously, these findings have limited generalizeability due to the sampling frame used in this study.
Effects of Public Health Nursing Participation in Selected Academic Courses on Self‐Reported Functions and Competencies: A Collaborative Pilot Study
Authors: Lundy Karen Saucier , Bender Kaye W. , Powell Charlotte
Published: May 2007

Abstract A profile of the education levels of practicing public health nurses (PHNs) in Mississippi in 1988 indicated that 71% of those nurses were prepared in associate degree or diploma programs. Since these programs typically do not provide formal academic courses in community health nursing, nurses currently enter the workplace with insufficient preparation for this increasingly complex role. A collaborative pilot study between the agency and a state‐supported school of nursing evaluated the impact of participating in selected components of an academic community health nursing program on the self‐reported competencies and functions of beginning PHNs. Twelve PHNs who were employed during six months in the geographic area contiguous to the school were selected to attend 10 classroom sessions on basic topics applicable to the generic PHN role in a southern state. A control group of 12 PHNs hired during the same period of time was also selected. Both groups completed an instrument on functions and competencies before and after the course. A significant difference was seen in certain functions and competencies between attenders and nonattenders.
Giving Up: Shelter Experiences of Battered Women
Authors: Newman Karen D.
Published: May 2007

Abstract Within the last decade intrafamilial violence has been identified as a major health and social problem. Women in particular are at high risk for battering and often seek refuge in shelters. Empirical evidence is required regarding the experiences of battered women who use these shelters. Therefore, we collected qualitative data from interviews with seven battered women and by observation in ten group counseling sessions at a shelter in the Southeast. Using grounded theory methodology, the core concept that emerged was “giving up.” Supporting concepts were helplessness and fear of the unknown. The participants found it easier to give up and return to the abusive relationship than to seek alternatives.
Responsibilities and Reactions of Family Caregivers of Patients Dependent on Total Parenteral Nutrition at Home
Authors: Smith Carol E. , Moushey Lois , Ross Jill Allard , Gieffer Cheryl
Published: May 2007

Abstract This prospective study assessed the caregiving responsibilities and reactions of family members who provide home care to a relative who is dependent on total parenteral nutrition (TPN). A short, semistructured interview based on the Roy adaptation model was used to gather data about the caregiving experiences of 20 relatives of adult TPN‐dependent patients. Data were content analyzed, and frequently occurring themes identified. Results indicated that altered family responsibilities as well as negative and positive psychologic reactions to caregiving do occur. The interviews suggested that caregivers master TPN technology but make little use of assistance from extended family or professionals. Although depression and fatigue were reported as common, these family members felt capable and successful in their caregiving roles. Further longitudinal research with larger samples should allow for comparison of caregivers on demographic differnces, stress, and other variables pertinent to managing complex home care.
Case Commentary—Bass v. Barksdale: Implications for Public Health and Home Care Nurses
Authors: Killion Susan Westrick
Published: May 2007

Abstract A recent malpractice case involved public health nurses. Given the legal issues based on this case, recommendations can be made to help ensure legal accountability, improve practice, and minimize liability risk. Areas of concern include doctor's orders and communication relating to telephone orders, the nurse's accountability to the client, documentation and patient teaching, the physician's duty to supervise the nurse, and corporate negligence. The court's analysis of the facts in finding areas of liability can guide nurses in avoiding malpractice litigation.
Sense of Coherence in Minority Women at Risk for HIV Infection
Authors: Nyamathi Adeline M.
Published: May 2007

Abstract It is theorized that persons with strong sense of coherence are likely to define an event as less stressful and be able to manage a problem more successfully than those with weak sense of coherence. The study investigated the relationship among coherence and personal and environmental concerns, appraisal of threat, emotional distress, and high‐risk behaviors in minority women at risk for human immunodeficiency (HIV) infection. As predicted, a significant negative relationship was seen between level of coherence and concerns. Moreover, women strong in coherence reported less negative appraisals of threat, less emotional distress, and fewer high‐risk behaviors than those with weak coherence. Results of tests of a path model investigating the impact of coherence and appraisal on distress and risk revealed coherence to be significantly and negatively associated with appraisal, distress, and risk, both directly and indirectly through its association with appraisal. The path model accounted for 45% of the variance in distress, 10% of the variance in appraisal, and 4% of risk behavior. Continuing investigation of factors such as coherence that can lessen the seriousness of environmental stressors is imperative as it relates to women at risk for HIV infection.
Realities of Developing Community Health Orientation Programs
Authors: Martaus Therese M. , Bell Mary Lee , Kenyon Virginia , Snow Lilyan , Hefty Luella Vig
Published: May 2007

Abstract The realities of developing an orientation program include recognizing the critical influence of organizational culture and management priorities on the final form of plans and projects. The step from theory to practice is illustrated in the experience of three of the authors as they began to implement competency‐based orientation programs. The common experiences of these three very different agencies were that programs are affected by organizational readiness, evolution to meet organizational needs, and the administrative context.
A Community‐Based Smoking‐ Cessation Program: Self‐Care Behaviors and Success
Authors: Utz Sharon Williams , Shuster George F. , Merwin Elizabeth , Williams Barbara
Published: May 2007

Abstract Given the serious health consequences of smoking, nurses need to be well‐informed on how to help various client populations with smoking cessation. Much recent research is focused upon effectiveness of various programs to enhance self‐efficacy and self‐management skills necessary to succeed in permanent smoking cessation. This study used a model based on Orem's Self‐Care Deficit Theory to examine specific variables of importance in smoking cessation using descriptors relevant to understanding self‐care actions. The model is used to examine the outcomes of a community‐based smoking‐cessation program. Results indicate that 15% of the final sample quit smoking and 42% reduced smoking while participating in the program. Additional findings are helpful in describing actions taken by subjects who were and were not successful in quitting. Remedies suggested by the American Lung Association booklet “Freedom from Smoking for You and Your Family” were reported by subjects to be helpful in dealing with the most common problems experienced during smoking cessation. Results are applied to public health nursing, emphasizing that smoking cessation is “a process” in which individuals learn strategies that work for them.
The Effectiveness of Community Health Nursing Interventions: A Literature Review
Authors: Deal Lisa W.
Published: May 2007

Abstract As the devastating impact of many public health problems becomes more evident nationwide, a need exists for effective programs aimed at community‐oriented health promotion. Escalating health care costs, however, severely limit available health care resources, threatening the demise of many public health efforts. During this time of imminent reform in our national health care system, it is imperative for community health nurses to elicit support by demonstrating the efficacy of their interventions (Oda & Boyd, 1987). This article describes services provided by community health nurses and documents the effectiveness of these interventions based on available literature. The programs reviewed represent community health nursing strategies developed in response to the needs of high‐risk families, geographic communities, and vulnerable population groups. Both descriptive analyses and outcome‐evaluation studies are used to support the effectiveness of home‐based and community‐centered community health nursing interventions. Recommendations eliciting support for community health nursing practice from legislators, policy makers, practice agencies, professional organizations, educators, and research institutions are included.
Differences in Social Support and Loneliness in Adolescents According to Developmental Stage and Gender
Authors: Mahon Noreen E. , Yarcheski Adela , Yarcheski Thomas J.
Published: May 2007

Abstract The purpose of this study was to examine differences in both perceived social support and loneliness according to the three stages of adolescent development (early, middle, and late), as determined by chronological age and gender. The sample consisted of 113 early adolescents, 106 middle adolescents, and 106 late adolescents. Data were collected in classroom settings. All participants responded to the PRQ85—Part II, A Social Support Measure; the Revised UCLA Loneliness Scale; and a demographic data sheet. Results of the study, which used the two‐way analysis of variance, indicated that there were no statistically significant differences in perceived social support or loneliness across the three stages of adolescence. Findings also indicated that girls reported statistically significantly higher levels of perceived social support than boys; however, there were no statistically significant gender differences in loneliness.
Too Many Medications, Too Little Money: How Do Patients Cope?
Authors: Chubon Sandra J. , Schulz Richard M. , Lingle Earle W. , Coster‐Schulz Marcia A.
Published: May 2007

Abstract Many individuals with chronic illnesses have multiple medications prescribed that often are not covered by third party payers. In South Carolina, Medicaid pays for only three prescriptions per month per recipient. A qualitative pilot study was conducted to learn how Medicaid recipients with more than three prescriptions decide which ones to have filled under Medicaid and what they do about the remaining medications. Nineteen Medicaid recipients who had more than three prescriptions were interviewed in their homes. Research participants paid for medications out‐of‐pocket, borrowed money, were extended credit by the pharmacy, got samples from the physician, did not get prescriptions filled or refilled, took medicines less frequently or in lower doses to stretch their supply, and very infrequently took someone else's medication. These individuals decided which medications to take based on: their perceptions of the importance of the medication or the seriousness of the condition for which it was prescribed, current symptoms, and the drug's cost. Some participants had to choose monthly whether to buy medications or food.
Student Experiential Learning: A Collaborative Community Practice Project
Authors: Bayne Tina , Barker Joyce B. , Higgs Zana , Jenkin Shirley A. , Murphy Denice , Synoground Gail
Published: May 2007

Abstract Theoretical and experiential learning in community assessment are essential components of the preparation of first‐level community health nurses. This article describes a collaborative community practice project in which faculty incorporated senior baccalaureate community health nursing students as participants. Students assessed availability and utilization patterns of health care services in Spokane. Washington. Data derived from the survey were used by community planners in addressing issues of access to health care by low‐income persons. Learning outcomes of this experiential process are described within the context of Burnard's Experiential Learning Model and community health nursing course objectives. Recommendations for design of similar experiential learning opportunities are made.
Health Promotion in Child and Family Health Care: The Role of Finnish Public Health Nurses
Authors: Lauri Sirkka
Published: May 2007

AbstractStarting from a theoretical model for the work of public health nurses, we explored the knowledge, skills, and decision making of Finnish public health nurses in the context of their efforts to maintain and promote child and family welfare. The results indicate that the nurses' knowledge basis and skills cover the concepts included in the theoretical model. The nurses tackle existing situations in the lives of children and their family, attempt to solve the current problems, and together with parents, make collaborative decisions. No attempts are made to produce long‐term health care plans. The model seemed to work fairly well in promoting children's welfare, but less so in the case of families. Finnish public health nurses follow the official guidelines governing the work of child welfare clinics, but they set fewer individual goals for children and families.
The Role of the Community Health Nurse in Environmental Health
Authors: Neufer Lynelle
Published: May 2007

Abstract Chemical contamination in the environment is affecting public health in increasing numbers of communities across the country. Although historically and theoretically well within the realm of nursing, methods for assessing and diagnosing threats to community environmental health are not being included in community health nurses' training. A community's environmental health is assessed by retrieving information from federal, state, and local sources. Developing the diagnosis involves four steps: identifying a community aggregate at highest risk of exposure, determining the potential or actual health response, citing related host and environmental factors, and correlating any existing epidemiologic data that may substantiate the nursing diagnosis. To illustrate these concepts, a systematic environmental health assessment was conducted for Douglas, Arizona. The results indicated elevated lead levels in residential soils and led to the community diagnosis, potential for injury: children in Douglas are at risk of developing adverse neurobehavioral health effects, and pregnant women in Douglas are at risk of developing adverse reproductive health effects related to several environmental and host factors, as evidenced by average blood lead levels in children exceeding the Centers for Disease Control recommended level of 10 μ/dl.
Reducing Prenatal Risk and Improving Birth Outcomes: The Public Health Nursing Role
Authors: Schmitz Kathleen , Reif LuAnn
Published: May 2007

Abstract We conducted a descriptive study to determine the relationship between prenatal risk and birth outcomes in the antepartal caseloads of rural public health nurses. A convenience sample of 41 low‐income pregnant women was assessed for prenatal risk by the nurses at the time of admission and again after 32 weeks' gestation. Birth outcome data were collected from maternal and infant hospital medical records. Analysis of the difference in mean scores from the first to the second assessment indicated a statistically significant change in the prenatal psychosocial risk score (P= 0.000) after public health nursing care. Physiologic and psychosocial risks at both assessment points were related to only one infant outcome measure: the 5‐minute Apgar score. Psychosocial risk in late pregnancy accounted for 22% of the variance in 5‐minute Apgar scores.
Promoting Prenatal Care: What Do Community Leaders Know and Believe About It? (Community Leader Beliefs About Promotion)
Authors: Zotti Marianne E. , Kozlowski Lisa A.
Published: May 2007

Abstract Community leaders directly affect prenatal services in their local communities. Twenty‐nine leaders in an urban community and 47 in a rural community in Wisconsin were interviewed to determine their knowledge and beliefs about and intent to promote prenatal care for low‐income women in their communities. The findings showed that leaders generally assigned high importance to prenatal care for low‐income women and intended to promote it during the next six months; and they demonstrated good general knowledge about prenatal care and perceived broad‐based community support for their decision to promote it. Disturbingly, many community leaders did not know what percentage of local pregnant women entered prenatal care late or how many medical care providers were available to their constituents on Medicaid, cost was cited as a disadvantage to promoting prenatal care for low‐income women, and several leaders in both communities believed that promoting prenatal care would result in low‐income women wanting to have more babies or increasing their dependence on free programs. Public health nurses can use the findings of this study in their work with community leaders to ensure prenatal services for low‐income populations.
Breastfeeding: Perceived Barriers and Benefits/Enhancers in a Rural and Urban Setting
Authors: Alexy Betty , Martin Angela Carter
Published: May 2007

Abstract This study investigated differences in perceived benefits/enhancers and barriers between women who planned to breastfeed, those who were uncertain, and those who did not plan to breastfeed. The volunteers were obtained from rural (60) and urban (82) public health department prenatal clinics. Fifty‐three percent of the women were married, the average age was 23 years, 25% had not graduated from high school, 38% were black, and 46% were planning to return to work. The breastfeeding inventory consisted of 13 items to measure benefits and enhancers, 15 to measure barriers, and an openended question. Cronbach's alphas for internal consistency for benefits and enhancers and barriers were 0.88 and 0.83 respectively. Analysis of variance found significant differences among the three groups on perceived benefits and barriers. Rural and urban differences existed in perceived benefits/ enhancers, but not in perceived barriers. In a multiple discriminant function analysis that included demographic characteristics, the most important predictor of breastfeeding decision was perceived benefits.
Environmental Tobacco Smoke Exposure Among Hispanic Women of Reproductive Age
Authors: Pletsch Pamela K.
Published: May 2007

Abstract Exposure to environmental tobacco smoke is a potential health risk for women of reproductive age and their children. Household and workplace exposures were estimated for 4256 Hispanic women age 12 to 49 who participated in the Hispanic health and nutrition examination survey. Age‐specific household exposure for nonsmokers was 31% to 62% for Mexican‐Americans, 22% to 59% for Puerto Ricans, and 40% to 53% for Cuban‐Americans. Exposure was significantly high for Puerto Rican and Mexican‐American adolescents, 59% and 62%, respectively. Workplace exposure for nonsmokers was 22% to 35% for Mexican‐Americans, 28% to 33% for Puerto Ricans, and 33% to 49% for Cuban‐Americans. Young Mexican‐American and Puerto Rican and all Cuban‐American women reported high exposure to environmental tobacco smoke in the home or workplace. Assessment of family living and smoking patterns, understanding cultural values and norms, and household smoking control and cessation strategies that are mutually derived are useful for nurses and Hispanic and Latino populations to meet the environmental tobacco smoke health objectives for the nation.