bluuebunny/crossref_metadata_2025 huggingface dataset:
Avoiding Gender and Minority Barriers to NIH Funding
Authors: Harden J. Taylor , McFarland Gertrude
Published: April 2004

Purpose: To inform investigators of the National Institutes of Health (NIH) guidelines for the inclusion of women and minorities as subjects in clinical research and provide tips on avoiding barriers to federal funding.

Methods: Information about gender and minority barriers to funding was obtained by reviewing NIH policies, information submitted by applicants, and comments provided by NIH reviewers.

Organizing Framework: A brief history of the goals of U.S. federal legislation to increase opportunities for obtaining information to help enhance health and disease treatment for all Americans and to detect and account for ethnic and gender differences is described. Examples were derived from NIH Summary Statement comments of initial review groups.

Conclusions: Applications submitted to NIH are being barred from initial funding, even with excellent priority scores, if the plan for inclusion of women and minorities is judged to be scientifically unacceptable by the initial review group. This situation is correctable and avoidable.
Important Attributes of Quality Health Care: Consumer Perspectives
Authors: Oermann Marilyn H. , Templin Thomas
Published: April 2004

Purpose: Despite extensive research on defining and measuring health care quality, little attention has been given to consumers' perspectives of high‐quality health care. The purposes of this study were to (a) identify the importance to consumers of attributes of health care quality and nursing care quality, and (b) examine the relationship of consumer perspectives to health status and selected demographic variables.

Design: Exploratory. Consumers (N = 239) were recruited from waiting rooms of clinics and in neighborhoods of a large metropolitan area in the Midwestern United States that included both urban and suburban populations.

Methods: Participants completed the Quality Health Care Questionnaire (QHCQ) and the SF‐36 Health Survey. On the QHCQ, they rated the importance of 27 attributes of health care and nursing care quality. The SF‐36 is a 36‐item instrument for measuring health status in eight general areas.

Findings: The most important indicators of high‐quality nursing care to consumers were: being cared for by nurses who are up‐to‐date and well informed; being able to communicate with the nurse; spending enough time with the nurse and not feeling rushed during the visit; having a nurse teach about the illness, medications, treatments, and staying healthy; and being able to call a nurse with questions. The lowest‐rated item was having an opportunity to be cared for by nurse practitioners. Ratings differed by race, age, years of education, income, and health status.

Conclusions: The importance that consumers place on teaching by the nurse was emphasized, particularly among people with less education, low income levels, and chronic illnesses.
Native American Graduate Nursing Students' Learning Experiences
Authors: Dickerson Suzanne Steffan , Neary Mary Anne , Hyche‐Johnson Marilyn
Published: April 2004

Purpose: To identify learning experiences of Native American graduate nursing students in a university‐based nurse practitioner program.

Design: The phenomenological approach of Heideggerian hermeneutics.

Method: A purposive sample of 11 Native American graduate students in a nurse practitioner program were given the choice of participating in a focus group or completing an individual interview to elicit common meanings and shared experiences.

Findings: Four themes and two constitutive patterns: (a) Native American students' worldviews reflected unwritten knowledge that served as a background of common understanding, (b) academic environment as a rigid environment with only one way to learn and constant evaluation, (c) faculty‐student relationship barriers to establishing a supportive learning environment, and (d) strategies to survive, including a commitment to succeed, conforming to unwritten rules, helping each other, and ultimately changing themselves. Constitutive patterns were: (a) value conflicts when students' values conflicted with academic behavioral values, and (b) on the fringe, when students felt isolation from the main student body, and open to attack (evaluation). Students struggled to be successful in their commitment to complete the degree, but often questioned the applicability of the program in their cultural setting.

Conclusions: A more flexible supportive environment is needed to support students' goals to attain degrees, as well as to encourage dialogue on differing cultural values. Faculty who teach culturally diverse students may need to examine rigid behavioral standards that mandate an assertive practitioner persona and may be a barrier to attainment of goals.
An Instrument to Measure Professional Nursing Values
Authors: Weis Darlene , Schank Mary Jane
Published: April 2004

Purpose: To describe the Nursing Professional Values Scale (NPVS), its development, reliability and validity, and its derivation from the Code of Ethics of the American Nurses Association.

Design: The NPVS was tested on 599 subjects, including baccalaureate and masters' students and practicing nurses. The students were enrolled in one of 25 programs selected at random from all NLN accredited programs in the United States. Practicing nurses were randomly selected from a State Board of Nursing list.

Method: A 44‐item, norm‐referenced instrument with a Likert‐scale format was tested. The responses of participants to this instrument were subjected to principal axis factor analysis with varimax rotation.

Findings: Eight factors were identified, accounting for 58% of the total variance. The two major factors were Caregiving and Activism.

Conclusions: Initial results showed a high level of reliability and validity for the NPVS. The NPVS is a useful instrument for measuring professional nursing values and enhancing professional socialization.
Documentation of Health Risks and Health Promotion Counseling by Emergency Department Nurse Practitioners and Physicians
Authors: Sheahan Sharon L.
Published: April 2004

Purpose: The purpose of this study was to examine medical record documentation of health risk factors and health promotion discharge counseling by nurse practitioners and physicians practicing in an emergency department in the U.S. midwest.

Methods: In this two‐group comparative study researchers examined random‐stratified medical records 305 nonacute ambulatory patients for selected health risk factors, including smoking, alcohol use, elevated blood pressure, obesity, and dental caries.

Results: Fifty‐nine percent of this sample of relatively young adults (mean age = 33) had one or more health‐risk factors. According to medical record documentation, only 22% of these adults, with nonacute problems, received health promotion counseling. Multivariate analyses indicated that nurse practitioners were slightly more likely to provide smoking cessation counseling than were physicians.

Conclusions: Many opportunities for identification of health risks and follow‐up counseling, as recommended in Healthy People 2000 and by the U.S. Preventive Services Task Force, were not documented. To meet the new goals of Healthy People 2010, health care providers in all settings should identify health risk factors and document health promotion counseling during every patient encounter.
American Nursing Scholars Abroad, 1985–1995
Authors: Lash Ayhan Aytekin , Lusk Brigid , Nelson Madelyn A.
Published: April 2004

Purpose: To explore the international activities of American nursing scholars from 1985 to 1995, as indicated by their international teaching, scholarship, and consultation.

Methods: All faculty (N = 2,254) teaching in nursing doctoral programs in the United States were surveyed using an investigator‐designed questionnaire. The professional characteristics of American nursing scholars who worked abroad and the dates, nature, and types of international activities they undertook were ascertained. From a total of 928 usable returns, 247 described international activity.

Findings: Data indicated a three‐fold increase in international activity from 1985 to 1995 in the three major areas investigated. Universities in Western Europe and Asia were the most frequent recipients of nursing scholarly activity. The scholars or representatives of the host institutions made approximately half the initial contacts. The international hosts or U.S. universities were the predominant providers of funding. Nurses most likely to participate in international scholarly activity were senior faculty who were full professors in doctoralgranting institutions, published in international journals, presented educational topics, and were recognized by peers through membership in honorary organizations.

Conclusions: A substantial increase in international nursing scholarship occurred during the decade studied, particularly related to teaching.
The Shifting Perspectives Model of Chronic Illness
Authors: Paterson Barbara L.
Published: April 2004

Purpose: To present the Shifting Perspectives Model of Chronic Illness, which was derived from a metasynthesis of 292 qualitative research studies.

Design: The model was derived from a metasynthesis of qualitative research about the reported experiences of adults with a chronic illness. The 292 primary research studies included a variety of interpretive research methods and were conducted by researchers from numerous countries and disciplines.

Methods: Metastudy, a metasynthesis method developed by the author in collaboration with six other researchers consisted of three analytic components (meta‐data‐analysis, metamethod, and metatheory), followed by a synthesis component in which new knowledge about the phenomenon was generated from the findings.

Findings: Many of the assumptions that underlie previous models, such as a single, linear trajectory of living with a chronic disease, were challenged. The Shifting Perspectives Model indicated that living with chronic illness was an ongoing and continually shifting process in which an illness‐in‐the‐foreground or wellness‐in‐the‐foreground perspective has specific functions in the person's world.

Conclusions: The Shifting Perspectives Model helps users provide an explanation of chronically ill persons' variations in their attention to symptoms over time, sometimes in ways that seem ill‐advised or even harmful to their health. The model also indicates direction to health professionals about supporting people with chronic illness.
Purpose in Life and Depressive Symptoms in Persons Living with HIV Disease
Authors: Lyon Debra E. , Younger Janet B.
Published: April 2004

Purpose: To examine relationships among purpose in life, HIV disease severity, demographic variables, and depressive symptoms in people living with HIV disease (PLWHIV). The hypothesis tested was that purpose in life is a stronger predictor of depressive symptoms than is HIV disease severity.

Design: Descriptive, correlational study using a convenience sample of 123 PLWHIV recruited from an urban infectious disease clinic in a university teaching hospital in the Southeast United States.

Methods: A self‐administered questionnaire, including a sociodemographic tool, the Center for Epidemiologic Studies Depression Scale (CES‐D), and the Purpose in Life Scale (PIL), was used to collect data. Concurrent severity of HIV disease measures included HIV RNA viral load, CD4+ T‐lymphocyte count, and the Revised HIV Medical Symptom Scale. Analytical methods included descriptive and inferential statistics and hierarchical regression analysis.

Findings: Depressive symptoms were greater and purpose in life was lower than in normative samples. Purpose in life was a stronger predictor of depressive symptoms than was HIV disease severity.

Conclusions: Purpose in life was more important than were laboratory markers of disease progression for predicting depressive co‐morbidity. Results from this study indicate the need for routine assessment of depressive symptoms in PLWHIV. Purpose in life should be explored as a potential buffer for depressive symptoms.
Ability of Blind People to Detect Obstacles in Unfamiliar Environments
Authors: Kells Karolyn
Published: April 2004

Purpose: To describe obstacle detection, sometimes called face vision, and blind peoples' lived experiences.

Design: This Husserlian phenomenologic inquiry included a convenience sample of eight blind participants who possessed the ability to detect obstacles in unfamiliar environments.

Methods: Face‐to‐face conversations were audiotaped in a setting of the participant's choice.

Findings: Three themes were identified: “a sense that something is there,”“sensing,” and “space.” These three entwined themes were recognized in the unity‐of‐meaning or uniting theme: sensing presence as open or closed space.

Conclusions: The findings of this study indicate many questions for nurses. Given the synergistic recognition of obstacles that the participants described, secondary analysis of the data is indicated, for example regarding pattern recognition and human environmental field integrality.
Youth Access to Tobacco in Two Communities
Authors: Teall Alice M. , Graham Margaret Clark
Published: April 2004

Purpose: To describe the availability of tobacco to youth in two urban communities, as a basis for designing a community‐based intervention program.

Design: Two Midwestern U.S. urban communities were the setting for unannounced tobacco compliance checks. The population of retailers for this study included all convenience stores, grocery stores, pharmacies, and discount stores licensed by the state to sell tobacco products in the two communities. Establishments where entry is restricted to adults were not included. The total population of retailers was used as the sample, and two purchases were attempted at each retail outlet.

Methods: Cigarette purchases by female teens and the location of cigarettes in stores were documented. Compliance‐check procedures were planned with needed protections for retailers and youth.

Findings: Adolescent tobacco purchase rates were near the federal recommendations for the two urban communities. Retailer use of self‐service displays was higher than expected. Availability of the designated brand for self‐service was significantly associated with the purchase rate of tobacco by underage youth.

Conclusions: Self‐service displays provide increased availability of tobacco to teens. Teen smoking and youth access to tobacco could be limited by legislation and policies to restrict retailer use of self‐service displays.
Adjustment to Chronic Illness Among HIV‐Infected Women
Authors: Bova Carol
Published: April 2004

Purpose: To identify factors that influence adjustment to chronic illness among HIV‐infected women, using the cognitive appraisal model of stress and coping.

Design: Cross‐sectional descriptive survey of 101 HIV‐infected women living in the Northeastern United States, from December 1996 to December 1997.

Methods: During face‐to‐face interviews, the Meaning of Illness Questionnaire, Duke UNC Functional Social Support Questionnaire, HIV Symptom Experience Inventory and Medical Outcomes Study (MOS) Short Form Survey were used to measure appraisal of illness, social support, HIV symptom severity and adjustment to chronic illness. Hierarchical linear regression, path analysis, and procedures to test for mediation were performed.

Findings: The model variables explained 70% of the variance in adjustment to chronic illness. Symptom experience accounted for the greatest percentage of variance in adjustment (28%). Two of the three predicted relationships were supported as hypothesized: adjustment to chronic illness was directly influenced by appraisal of illness and by HIV‐symptom experience. Social support was not found to have a direct effect on adjustment. Instead, appraisal of illness mediated the effect of social support on adjustment and symptom experience. HIV illness stage was not a significant predictor of adjustment.

Conclusions: The cognitive appraisal model of stress and coping was useful for building knowledge on adjustment to chronic illness among HIV infected women. Interventions aimed at reframing negative appraisals have the potential to affect adjustment.
Emotional Disorders in Young Offenders
Authors: Shelton Deborah
Published: April 2004

Problem: To estimate rates of emotional disorder in the Maryland Juvenile Justice system as a guide for planning and policy efforts.

Methods: In this cross‐sectional study, psychopathology and level of functioning in a random sample of 312 committed and detained youth (60 females, 252 males) were assessed. Youth diagnostically classified met criteria for mental disorder using the Diagnostic Interview Schedule for Children (DISC) combined with a cut‐off score (60 or below) on the Child Global Assessment Scale (CGAS), as established by the National Institute of Mental Health (NIMH).

Findings: Fifty‐three percent were classified with diagnosable mental disorders on the DISC, but were above the cut‐off scores on the CGAS. Forty‐six percent met criteria for diagnosis and low functioning. Twenty‐six percent of youth indicated need for immediate mental health services. Fourteen percent with serious mental disorders and substantial functional impairment were in need of a highly restrictive environment as determined by the severity of their offenses.

Conclusions: The number of youth in the Maryland Juvenile Justice System in need of mental health services indicates a need to examine treatment options that meet the requirements for security and treatment. The complexity of problems found in this sample indicates the need for collaborative efforts between mental health and juvenile justice personnel in planning for the immediate and future needs of these youth.
The Development and Psychometric Evaluation of the Ethical Issues Scale
Authors: Fry Sara T. , Duffy Mary E.
Published: April 2004

Purpose: To describe the Ethical Issues Scale (EIS), its conceptual development and psychometric evaluation, and its uses in determining how frequently nurses experience ethical issues in practice.

Design: The EIS was validated with a sample (N=2,090) of New England registered nurses (RNs) currently in practice. The sample was randomly split into two approximately equal samples. The calibration sample was used to derive the underlying components; the validation sample was used to confirm the component structure.

Methods: Psychometric analysis of the 35‐item EIS included: (a) item analysis, (b) confirmatory principal components analysis (PCA), and (c) internal consistency reliability using Cronbach's alpha.

Results: Three components (end‐of‐life‐treatment issues, patient care issues, and human rights issues) were demonstrated, confirming the original conceptually‐derived structure. The calibration sample accounted for 42.4% of initially extracted common variance; the validation sample accounted for 41.5% of initially extracted common variance.

Conclusions: The three EIS subscales had satisfactory internal consistency reliability and factorial validity for use as independent scales in future studies.
Acknowledging Unexplained Fatigue of Tired Women
Authors: Dzurec Laura Cox , Hoover Phyllis M. , Fields Jonathan
Published: April 2004

Purpose: To investigate indicators of fatigue, including depression, sense of powerlessness, and body aches, and to examine differences between symptomatic and asymptomatic women.

Design: Descriptive, comparative analysis.

Methods: Investigators evaluated fatigue, depression, sense of powerlessness, and body aches for two groups of women in a small, rural community. Participants in one group (n=20) reported subjective experiences of fatigue and the other group (n=20) did not. No participant had a recognizable disease or physiologic alteration that would account for her fatigue. Symptoms in groups were compared using t tests with Bonferroni adjustment.

Results: Although the asymptomatic group members were younger, the groups did not differ in ethnicity, mean weight, number of medications taken, or normality of laboratory values. Women who reported feeling fatigued also had significantly higher scores on the depression and fatigue subscales of the fatigue instrument and significantly lower scores on the power instrument. For participants reporting fatigue, fatigue correlated with depression and depression negatively correlated with sense of power. Data did not indicate how fatigue and depression, or depression and sense of power, are interrelated.

Conclusions: Findings provide support for the importance of acknowledging fatigued women's often readily dismissed complaints not only of fatigue, but of depression and sense of powerlessness, and for conducting further research regarding these complaints in women with no objective indicators of fatigue.
A Patient‐Derived Perspective of Health‐Related Quality of Life With Peripheral Arterial Disease
Authors: Treat‐Jacobson Diane , Halverson Sheri L. , Ratchford Andria , Regensteiner Judith G. , Lindquist Ruth , Hirsch Alan T.
Published: April 2004

Purpose: To evaluate the effects of peripheral artery disease (PAD) on health‐related quality of life (HRQoL) from the patient's perspective to establish a foundation for systematic PAD‐specific HRQoL assessment in this population.

Design: Grounded theory methodology.

Methods: Open‐ended, tape‐recorded interviews were conducted with 38 patients (24 men, 14 women) 44 to 83 years old (mean 65) from two US medical centers to report patient experience of PAD and its perceived effects on HRQoL. Tapes were transcribed and analyzed to identify themes and conceptual domains pertinent to the experience of PAD in this population.

Results: Seven major themes were identified: (a) delay in diagnosis and frustration with management of disease; (b) pain; (c) limitation in physical functioning; (d) limitation in social and role functioning; (e) compromise of self; (f) uncertainty and fear; and (g) adaptation to the effects of the disease and demonstration of resiliency.

Conclusions: These findings indicate important psychosocial and emotional consequences of PAD that existing HRQoL questionnaires do not indicate. More complete data might lead to greater understanding of the effects of PAD, serving as the foundation for a more sensitive instrument to assess HRQoL as a basis for more effective interventions.
Patients' Attitudes Toward Advance Directives
Authors: Douglas Rebecca , Brown Hazel N.
Published: April 2004

Purpose: To explore hospitalized patients' attitudes toward advance directives, their reasons for completing or not completing advance directive forms, and demographic differences between patients who did and did not complete advance directive forms.

Design and Method: The convenience sample comprised 30 hospitalized patients in North Carolina. Participants were interviewed using an adapted advance directive attitude survey (ADAS), and were asked five general questions about advance directives. Validity and reliability were established on the adapted tool.

Findings: The overwhelming majority of participants had received information on advance directives and they were moderately positive about them. The majority who had completed advance directives were Caucasian, female, over age 65, had less than a high school education, and perceived their health as poor. Most believed that an advance directive would ensure they received the treatment they desired at the end of life.

Conclusions: Patients' attitudes alone did not determine who will and will not complete advance directives. Most participants who completed advance directives had specific reasons for doing so. Nurses have responsibility for discussing advance directives with patients, families, and physicians to ensure adequate education about the completion of advance directives.
Health Promotion and Participatory Action Research with South Asian Women
Authors: Choudhry U.K. , Jandu S. , Mahal J. , Singh R. , Sohi‐Pabla H. , Mutta B.
Published: April 2004

Purpose: To examine South Asian immigrant women's health promotion issues and to facilitate the creation of emancipatory knowledge and self‐understanding regarding health‐promoting practices; to promote health education and mobilization for culturally relevant action.

Method: The study was based on critical social theory; the research model was participatory action research (PAR). Two groups of South Asian women (women from India and of Indian origin) who had immigrated to Canada participated in the project. The qualitative data were generated through focus groups. Reflexive and dialectical critique were used as methods of analyzing qualitative data. The data were interpreted through reiterative process, and dominant themes were identified.

Findings: Three themes that were extracted from the data were: (a) the importance of maintaining culture and tradition, (b) placing family needs before self, and (c) surviving by being strong. An issue for action was the risk of intergenerational conflicts leading to alienation of family members. Over a period of 3 years, the following action plans were carried out: (a) workshops for parents and children, (b) sharing of project findings with the community, and (c) a presentation at an annual public health conference.

Conclusions and Implications: The project activities empowered participants to create and share knowledge, which was then applied toward action for change. Health and health promotion were viewed as functions of the women's relationships to the world around them.
Sexual Health Practices of Homeless Youth
Authors: Rew Lynn , Fouladi Rachel T. , Yockey Ronald D.
Published: April 2004

Purpose: To describe the sexual health practices of homeless adolescents, examine relationships among variables in a conceptual model of sexual health practices, and determine direct and indirect effects of population characteristics, cognitive‐perceptual factors, and behavioral factors on sexual health practices among homeless adolescents.

Design and Methods: Descriptive exploratory design. A survey was administered to a convenience sample of 414 homeless young men (244) and young women (170) aged 16–20 years, the majority of whom were Anglo American.

Findings: Thirty‐five percent reported homosexual or bisexual orientation, and sexual orientation was reported as a reason for leaving home. Over half reported a history of sexual abuse and nearly one in four had been treated for gonorrhea. Safe‐sex behaviors were related to age, time away from home, assertive communication, social support, future time perspective, connectedness, perceived health status, intentions to use condoms, and condom self‐efficacy. A parsimonious model with good fit indicated that the only direct paths to safe‐sex behaviors were future time perspective, intentions to use condoms, and self‐efficacy to use condoms, and the direct paths to sexual self‐care behaviors were from assertive communication, social support, and self‐efficacy to use condoms.

Conclusions: As in other studies of homeless youth, respondents reported a high incidence of sexual abuse and homosexual and bisexual orientation. Their safe‐sex behaviors were surprisingly similar to those of university students, were modestly related to cognitive‐perceptual variables in the sexual health model, and might be amenable to brief culturally relevant interventions.
Rational Suicide in the Terminally Ill
Authors: Fontana Joyce S.
Published: April 2004

Purpose: To examine the current debate over the right to die specific to the rational suicide of terminally ill patients.

Methods: Literature was reviewed for information concerning historical end‐of‐life practices and the past acceptance of suicide. Another review showed philosophical opinions and perspectives that spanned from ancient Greece and the Roman Empire to modern philosophical discourse. A case study of a terminally ill woman who chose suicide is presented to apply the history and philosophy to nursing care today.

Conclusions: As more nursing care is delivered in patients' homes, nurses will face this situation with increasing frequency. A call is made for organizations to provide guidelines for nursing practice.
Finding the Findings in Qualitative Studies
Authors: Sandelowski Margarete , Barroso Julie
Published: April 2004

Purpose: To describe the challenges of finding the findings in qualitative studies.

Method: Review of literature on representation in qualitative research and analysis of 99 reports of qualitative studies of women with HIV infection.

Findings: Factors complicating finding the findings in qualitative studies include varied reporting styles, misrepresentation of data and analytic procedures as findings, misuse of quotes and theory, and lack of clarity concerning pattern and theme. Theses and dissertations present special challenges because they often contain several of these problems.

Conclusions: Given the varied beliefs about findings among qualitative researchers, the challenge is to find ways to present findings that will make them discernible to the diverse audiences for whom they are intended, including researchers and practitioners.
Economic Evidence for Evidence‐Based Practice
Authors: Stone Patricia W. , Curran Christine R. , Bakken Suzanne
Published: April 2004

Purpose: To explicate (a) the types of economic analyses available to nurses, (b) the measurement of costs in different types of economic evaluations, (c) recommendations for standardization, and (d) the assessment of economic evaluations for evidence‐based practice.

Methods: Five types of economic analyses are reviewed. Recommendations for standardization of cost‐effectiveness analyses are included as well as a worksheet for use in critiquing economic evaluations for validity and applicability to clinical settings.

Findings: Limited knowledge and a lack of consistent approaches to economic analyses are evident in the nursing and health care literature. However, nurses have not contributed to the conduct of rigorous economic evaluations or research to the extent found in other health care disciplines.

Conclusions: Basing nursing practice on the best available evidence is now the expected standard of care. Applying economic evidence to practice requires understanding the methods used to conduct economic evaluations and to analyze the rigor of such evaluations.
Building a Model of Self‐Care for Health Promotion In Aging
Authors: Leenerts Mary Hobbs , Teel Cynthia S. , Pendleton Mary K.
Published: April 2004

Purpose: To synthesize knowledge about self‐care in older community‐dwelling people, identify essential dimensions of self‐care related to health promotion and well‐being in aging, and organize the findings into a literature‐based, integrated model with applicability in practice, research, and education.

Organizing Construct: Self‐care and health promotion. Related concepts included self‐concept, self‐care ability, and self‐care activity.

Methods: These terms were used to search Medline, CINAHL, and PsycINFO data bases. Theoretical and research articles from the last decade that related to self‐care and health promotion in community‐dwelling elders and that provided recommendations for education and practice were selected for inclusion in the analysis.

Findings: Self‐care for health promotion in independent elders is multidimensional. Synthesis of literature findings resulted in development of the model of Self‐care for Health Promotion in Aging, with five dimensions: internal and external environment, self‐care ability, education, self‐care activity, and outcomes. Examples of education plans that are developed in partnership with clients to promote better health and maximize quality of life are presented.

Conclusions: Findings from current theoretical and empirical literature were synthesized to develop a model of self‐care for health promotion in aging. Suggestions are made regarding application of the model in clinical practice and further theory building and hypothesis testing.
Lessons Learned from Testing the Quality Cost Model of Advanced Practice Nursing (APN) Transitional Care
Authors: Brooten Dorothy , Naylor Mary D. , York Ruth , Brown Linda P. , Munro Barbara Hazard , Hollingsworth Andrea O. , Cohen Susan M. , Finkler Steven , Deatrick Janet , Youngblut JoAnne M.
Published: April 2004

Purpose: To describe the development, testing, modification, and results of the Quality Cost Model of Advanced Practice Nurses (APNs) Transitional Care on patient outcomes and health care costs in the United States over 22 years, and to delineate what has been learned for nursing education, practice, and further research.

Organizing Construct: The Quality Cost Model of APN Transitional Care.

Methods: Review of published results of seven randomized clinical trials with very low birth‐weight (VLBW) infants; women with unplanned cesarean births, high risk pregnancies, and hysterectomy surgery; elders with cardiac medical and surgical diagnoses and common diagnostic related groups (DRGs); and women with high risk pregnancies in which half of physician prenatal care was substituted with APN care. Ongoing work with the model is linking the process of APN care with the outcomes and costs of care.

Findings: APN intervention has consistently resulted in improved patient outcomes and reduced health care costs across groups. Groups with APN providers were rehospitalized for less time at less cost, reflecting early detection and intervention. Optimal number and timing of postdischarge home visits and telephone contacts by the APNs and patterns of rehospitalizations and acute care visits varied by group.

Conclusions: To keep people well over time, APNs must have depth of knowledge and excellent clinical and interpersonal skills that are the hallmark of specialist practice, an in‐depth understanding of systems and how to work within them, and sufficient patient contact to effect positive outcomes at low cost.
Revisioning Nursing Scholarship
Authors: Riley Joan M. , Beal Judy , Levi Pamela , McCausland Maureen P.
Published: April 2004

Purpose:To propose a universal model of nursing scholarship that (a) indicates the importance of professional practice disciplines, (b) incorporates the synthesis of intellectual pursuit with social change, and (c) is holistic in its design.

Organizing Construct:Scholarship, traditionally viewed as part of or generated in the university enterprise, must be an expectation in all settings in which a community of scholars from both discipline and practice can and do coexist.

Methods:Review and synthesis of the literature on scholarship, nursing scholarship, nursing as a practice discipline.

Findings:The history, culture, and intellectual property of nursing comprise an appropriate basis for adopting a universal holistic model of scholarship built upon a set of universal assumptions about nursing scholarship. As a discipline and a profession, nursing should include four connected domains in a universal holistic model of scholarship: knowing, teaching, practice, and service.

Conclusions:Confirmation of this universal holistic model of scholarship can contribute significantly to a larger nursing identity. Use of universal holistic model of nursing scholarship indicates responsibility of the nursing profession collectively and all nurses individually. Additional work is needed to understand how a universal holistic model of nursing scholarship evolves across cultures, domains, and work settings.
Vitamin A Supplementation and Health Outcomes for Children in Nepal
Authors: Grubesic Ruth B. , Selwyn B.J.
Published: April 2004

Purpose: To compare vitamin A supplementation status of children age 6–60 months to the prevalence of vitamin A deficiency disease, malnutrition, diarrhea, and acute respiratory infection.

Methods: The nutritional status of children was estimated using mid‐upper‐arm circumference measurements. A trained ophthalmology assistant assessed for clinical signs of vitamin A deficiency disease. A trained female community health worker interviewed mothers about child health status using a standardized questionnaire.

Results: Compared to children who did not receive supplements, children who received vitamin A supplements regularly had less malnutrition, diarrhea, and acute respiratory infection, regardless of the number of children per household, age, sex, or father's occupation.

Conclusions: Supplementation with vitamin A is necessary twice a year. Children who received a vitamin A capsule only one time were not as protected as were those children who received vitamin A as a regular twice yearly scheduled dose.
Concepts in Caregiver Research
Authors: Hunt Chantal K.
Published: April 2004

Purpose: To clarify and delineate conceptualizations of the effects of caregiving for nursing research and practice with family caregivers.

Organizing Construct: The biopsychosocial (psychosocial and physiological) sequelae, both negative and positive, associated with providing care for a relative or friend with a chronic illness.

Methods: Literature reviewed was obtained via searches of CINAHL, MEDLINE, and PsycInfo computerized databases through mid‐2002. Key words for the searches were caregiver, caregiving, family caregiving, caregiver burden, and caregiver appraisal. Reports of both earlier reviews of literature and original research were included.

Findings: Negative concepts included caregiver burden, hassles, strain, and stress. Positive concepts included caregiver esteem, uplifts of caregiving, caregiver satisfaction, finding or making meaning through caregiving, and gain in the caregiving experience. A neutral concept for describing the caregiving process is caregiver appraisal. Although earlier studies were focused on negative aspects of caregiving, more recent research has also included positive aspects.

Conclusions: More attention should be given to (a) gender and cultural differences in caregiving, (b) development of flexible interventions, and (c) the biophysical sequelae of caregiving.
Desire for Children Among Black Women With and Without HIV Infection
Authors: Wesley Yvonne
Published: April 2004

Purpose: To determine the relationship among self‐esteem, self‐efficacy, and desire for children, and to contrast these concepts between Black women with and without HIV infection.

Design: Correlational analysis.

Methods: A nonrandom sample of 98 Black women, 52 HIV positive and 46 HIV negative, recruited from an American inner‐city health center, completed four questionnaires: the Rosenberg Self‐Esteem Scale, the General Self‐Efficacy Subscale, a modified Index of Parenthood Motivation, and a background information sheet. Data were analyzed using descriptive statistics, zero‐order correlations, and multiple regression techniques.

Findings: Increased self‐esteem and self‐efficacy were positively correlated with desire for children in both HIV infected and uninfected Black women. No significant difference in the intensity of desire for children was found between uninfected Black women and HIV‐infected Black women. The combination of age, number of previous abortions, and strength of religious belief was a better predictor of desire for children than was self‐esteem and self‐efficacy.

Conclusions: Variables other than HIV status were significantly correlated with desire for children among these low‐income Black women with and without HIV infection.
Psychological Factors in Nepali Former Commercial Sex Workers with HIV
Authors: Eller Lucille Sanzero , Mahat Ganga
Published: April 2004

Purpose: To examine perceived stress, coping style, and symptoms of anxiety and depression in HIV‐positive Nepali women who were formerly commercial sex workers (CSWs).

Design: Descriptive, correlational study with a convenience sample of 98 Nepali women with HIV recruited from a nongovernmental organization (NGO) in Nepal.

Methods: Investigator‐administered questionnaires included a sociodemographic questionnaire, the Perceived Stress Scale (PSS), the Ways of Coping Questionnaire (WOC), the Center for Epidemiologic Studies Depression Scale (CES‐D), and the Symptoms Checklist‐90 (SCL‐90)

Anxiety Subscale. Analytical methods included descriptive statistics and hierarchical regression analysis.

Findings: The level of perceived stress was similar to that observed in a healthy female population of similar age. The primary coping style was problem‐focused, with the strategy of seeking social support used most. Depression measured with the entire CES‐D was 3% but is was 18% on the somatic subscale. Twenty‐two percent of the variance in depression was predicted by the combination of perceived stress and the coping strategy of escape avoidance. Twenty‐four percent of the variance in anxiety was predicted by the combination of perceived stress and three coping strategies: problem solving, accepting responsibility, and distancing.

Conclusions: This sample had a low prevalence of psychological symptoms. Somatic symptoms, which may be more relevant than affective symptoms in non‐Western populations, were the best indicator of depression. Future studies are needed to examine culturally relevant appraisals, coping style, and psychological symptoms. Knowledge of psychological factors can be used to develop interventions for this population that has no access to treatment for HIV disease.
Profession and Society
Authors: Uzun Özge
Published: April 2004

Purpose: To determine the frequency and sources of verbal abuse against nurses working in clinical settings in different hospitals in the last 12 months, to identify nurses' perceptions about verbal abuse, and to determine types of emotions experienced by nurses who had encountered verbal abuse.

Design and sample: This descriptive study was conducted in May 2001 in Turkey. Data were collected from 467 nurses working in various clinical settings in three hospitals.

Methods: The instrument was a 23‐item questionnaire on verbal abuse. Data were evaluated using frequency and descriptive statistics.

Findings: The findings revealed that the majority of nurses had experienced verbal abuse in the last 12 months (86.7%, n= 405). Most nurses (92%) reported that verbal abuse negatively affected their morale. The most common sources of verbal abuse were patients' relatives and patients themselves.

Conclusions: Workplace verbal abuse events cannot always be anticipated. Contingency plans to handle potential situations should be developed.
Beyond MEDLINE for Literature Searches
Authors: Conn Vicki S. , Isaramalai Sang‐arun , Rath Sabyasachi , Jantarakupt Peeranuch , Wadhawan Rohini , Dash Yashodhara
Published: April 2004

Purpose: To describe strategies for a comprehensive literature search.

Organizing Construct: MEDLINE searches result in limited numbers of studies that are often biased toward statistically significant findings. Diversified search strategies are needed.

Methods: Empirical evidence about the recall and precision of diverse search strategies is presented. Challenges and strengths of each search strategy are identified.

Findings: Search strategies vary in recall and precision. Often sensitivity and specificity are inversely related. Valuable search strategies include examination of multiple diverse computerized databases, ancestry searches, citation index searches, examination of research registries, journal hand searching, contact with the “invisible college,” examination of abstracts, Internet searches, and contact with sources of synthesized information.

Conclusions: Extending searches beyond MEDLINE enables researchers to conduct more systematic comprehensive searches.
Media Portrayal of Nurses' Perspectives and Concerns in the SARS Crisis in Toronto
Authors: Hall Linda McGillis , Angus Jan , Peter Elizabeth , O'Brien‐Pallas Linda , Wynn Francine , Donner Gail
Published: April 2004

Purpose: To describe nursing work life issues as portrayed in the media during the SARS crisis in Toronto.

Methods: Content analysis of local and national news media documents in Canada. Media articles were sorted and classified by topic, and themes were identified.

Findings: Themes were: (a) changing schemas of nursing practice: the new normal; (b) barriers to relational nursing work; (c) work life concerns: retention and recruitment; (d) nursing virtue: nurses as heroes and professionals; (e) paradoxical responses to nurses from the community; and (f) leadership in nursing during the SARS crisis.

Conclusions: This analysis enhanced understanding of how nurses are portrayed in the media, but it indicated the significance of quality of work life and issues about work‐home life. Some descriptions of the care and caring of nurses have made nursing seem like an important and influential profession to potential applicants who might previously have dismissed nursing as a career.
Understanding and Responding to Patients' Requests for Assistance in Dying
Authors: Schwarz Judith Kennedy
Published: April 2004

Purpose: To explore how nurses experience and respond to patients' requests for assistance in dying (AID).

Design and Methods: A phenomenological study of 10 self‐selected nurses.

Findings: Four major themes: Being Open to Hear and Hearing; Interpreting and Responding to the Meaning; Responding to Persistent Requests for AID, and Reflections. When faced with persistent requests for AID, participants provided a continuum of interventions: refusal, providing palliative care that might secondarily hasten dying, respecting and not interfering with patients' or families' plans to hasten dying, and providing varying types and degrees of direct AID. Their responses were context‐driven rather than rule‐mandated, and they drew a distinction between secondarily hastening and directly causing death.

Conclusions: Few nurses in this study unequivocally agreed or refused to directly help a patient die. Most struggled alone and in silence to find a morally and legally acceptable way to help patients who persisted in requesting AID. Regardless of how they responded, many described feelings of conflict, guilt, and moral distress.
Early Life Recorded in Archean Pillow Lavas
Authors: Furnes Harald , Banerjee Neil R. , Muehlenbachs Karlis , Staudigel Hubert , de Wit Maarten
Published: April 2004

Pillow lava rims from the Mesoarchean Barberton Greenstone Belt in South Africa contain micrometer-scale mineralized tubes that provide evidence of submarine microbial activity during the early history of Earth. The tubes formed during microbial etching of glass along fractures, as seen in pillow lavas from recent oceanic crust. The margins of the tubes contain organic carbon, and many of the pillow rims exhibit isotopically light bulk-rock carbonate δ
13
C values, supporting their biogenic origin. Overlapping metamorphic and magmatic dates from the pillow lavas suggest that microbial life colonized these subaqueous volcanic rocks soon after their eruption almost 3.5 billion years ago.
Why Animals Don't Lie
Authors: Stenseth Nils Chr. , Sætre Glenn-Peter
Published: April 2004

Animal Signals
. by John Maynard Smith and David Harper. Oxford University Press, Oxford, 2003. 176 pp. $99.50. ISBN 0-19-852684-9. Paper, $44.50. ISBN 0-19-852685-7.

The authors argue that the reliability of animal signals is maintained in a variety of ways that depend on particular circumstances.
Observational Properties of Pulsars
Authors: Manchester R. N.
Published: April 2004

Pulsars are remarkable clocklike celestial sources that are believed to be rotating neutron stars formed in supernova explosions. They are valuable tools for investigations into topics such as neutron star interiors, globular cluster dynamics, the structure of the interstellar medium, and gravitational physics. Searches at radio and x-ray wavelengths over the past 5 years have resulted in a large increase in the number of known pulsars and the discovery of new populations of pulsars, posing challenges to theories of binary and stellar evolution. Recent images at radio, optical, and x-ray wavelengths have revealed structures resulting from the interaction of pulsar winds with the surrounding interstellar medium, giving new insights into the physics of pulsars.