bluuebunny/crossref_metadata_2025 huggingface dataset:
Transpelvic Urethrostomy in 11 Cats Using an Ischial Ostectomy
Authors: Bernarde A. , Viguier E.
Published: April 2004

Objective—To investigate the feasibility and long‐term outcome of a modified subpubic urethrostomy technique termed transpelvic urethrostomy (TPU) in cats.

Study Design—Prospective clinical study.

Animals—Eleven male cats with obstructive lower urinary tract disease that could not be relieved, and requiring a surgical urinary diversion, were selected for TPU.

Methods—With the cat in dorsal recumbency, the penis was exposed and the ventral pelvis was denuded by median adductor muscle elevation. An ∼12 mm×15 mm area of ischium was removed. The pelvic urethra, 8–20 mm cranial to the bulbourethral glands, was incised longitudinally and sutured to the skin to create a urethrostomy.

Results—All cats were neutered males (2–9 years); none were uremic or hyperkalemic at admission. Urine was cultured if there was leukocyturia, nitrituria, and/or bacteriua. Bacteria were isolated from 2 specimens. A patent urethrostomy was created in all cats without operative complications. Except for 1 cat without associated clinical signs, stricture was not evident between 9 and 42 months after urethrostomy. One cat had postoperative urinary incontinence (UI) that resolved within 4 weeks. Two cats each had 1 episode of idiopathic lower urinary tract disease after 6‐month follow‐up; both responded to medical therapy.

Conclusions—TPU was used as a successful urinary diversion procedure relieving signs of urinary tract obstruction and preventing further obstruction, with few complications. The incidence of UI after TPU remains minimal.

Clinical Relevance—TPU should be considered as a salvage urinary diversion procedure in cats (as an alternative to prepubic and subpubic techniques). TPU may also be considered as a possible primary urinary diversion solution (an alternative to perineal urethrostomy) for obstructive lower urinary tract disease in cats.
Information Needs of Elderly Postsurgical Cancer Patients During the Transition from Hospital to Home
Authors: Hughes Linda C. , Hodgson Nancy A. , Muller Pat , Robinson Linda A. , McCorkle Ruth
Published: April 2004

Purpose:To describe information needs of elderly postsurgical cancer patients. Few reports have described learning needs of postsurgical cancer patients during the initial weeks after hospitalization. Responding to information needs during the transition to home is important for helping patients and families to appropriately manage illness.

Design:Descriptive, using records kept for patients assigned to the experimental group in a larger study completed in 1996. The sample was 148 American patients surgically treated for a new diagnosis of prostate, breast, gastrointestinal, lung, or head and neck cancer. Information needs were identified from topics addressed by advanced practice nurses during 4‐week episodes of home care.

Methods:Content analysis of 3,280 statements of teaching interventions.

Findings:Teaching themes were instructing on postoperative self‐care, advising on symptom management, clarifying the illness experience, discussing psychological responses, and preparing patients and families to coordinate follow‐up care. Topics included describing the expected course of illness, informing about community resources, identifying events that require physician notification, and advising on pain management. Topic emphasis varied by site of cancer.

Conclusions:Information needs of elderly postsurgical cancer patients during transition from hospital to home are extensive. Teaching interventions ranged from giving concrete instructions about care of a surgical wound to interpreting complex information about options for cancer treatment. Elderly postsurgical cancer patients need informational support during the transition from hospital to home.
Sleep in Acute Care Settings: An Integrative Review
Authors: Redeker Nancy S.
Published: April 2004

Purpose:To report an integrative review about sleep patterns, factors that influence sleep, and sleep interventions in acutely ill hospitalized adults; discuss methodological challenges associated with studying sleep in this population; and propose future research.

Organizing framework:Research literature on sleep patterns of acutely ill hospitalized adults, obtained using computerized searches of Medline and CINAHL, was reviewed. Studies of patients on intensive care and medical‐surgical units conducted in a range of health disciplines over a span of almost 30 years were included. Studies were organized into the following categories: descriptive studies of sleep using objective and subjective measures; correlational studies of personal, health status, and environmental variables and sleep; and intervention studies.

Findings:Sleep disturbance is a common but highly variable experience during acute care hospitalization. Multiple personal, health status, and environmental factors are related to sleep disturbance. Behavioral interventions show promise as a means to modify factors related to sleep. Few studies have shown the outcomes of sleep disturbance in acute care settings.

Conclusions:More systematic research is needed to determine correlates of sleep disturbance in acutely ill hospitalized adults. Such studies can help investigators to identify patients who are most at risk for sleep disturbance and to provide the theoretical and conceptual bases for sleep‐promoting interventions. Methodological challenges include characteristics of acute care patients and hospital environments, as well as the complexity of measuring sleep.
Reducing Negative Thinking and Depressive Symptoms in College Women
Authors: Peden Ann R. , Hall Lynne A. , Rayens Mary Kay , Beebe Lora L.
Published: April 2004

Purpose: Although cognitive‐behavioral interventions have been successful in treating depression, no studies were found that focused solely on reducing negative thinking via group intervention as a means of preventing depression in at‐risk groups. The purpose of this randomized controlled trial was to test the effectiveness of a cognitive‐behavioral group intervention in reducing depressive symptoms, decreasing negative thinking, and enhancing self‐esteem in young women at risk for depression.

Design: A randomized controlled trial with 92 college women ages 18 to 24 who were at risk for depression was conducted.

Methods: Participants were randomly assigned to either the control or experimental group. The experimental group participated in a 6‐week cognitive‐behavioral group intervention. Data on self‐esteem, depressive symptoms, and negative thinking were collected via selfreport questionnaires from control and experimental groups at baseline, 1 month after the intervention, and at 6‐month follow‐up. Data were analyzed using mixed‐model methodology and the Cochran‐Mantel‐Haenszel chi‐square test.

Findings: Compared to those in the control group, women who received the intervention had a greater decrease in depressive symptoms and negative thinking and a greater increase in self‐esteem, and these beneficial effects were maintained over 6‐months.

Conclusions: The findings document the effectiveness of this cognitive‐behavioral group intervention and indicate empirical support for the beneficial effects of reducing negative thinking by the use of affirmations and thought‐stopping techniques on women's mental health.
A Test of Braden's Self‐Help Model in Adults with Chronic Pain
Authors: LeFort Sandra M.
Published: April 2004

Purpose:To test hypothesized relationships in Braden's Self‐Help Model in a sample of people with idiopathic chronic pain. Testing theoretical explanations and predictions with various clinical populations under different sociocultural, economic, climatic, and health system environments provides evidence about the applicability of the underlying theory among diverse populations.

Design:This study was part of a larger randomized, controlled trial of a community‐based nursing psycho‐educational intervention: the Chronic Pain Self‐Management Program (CPSMP). Pretest and posttest data were collected in 1995–1996 in Newfoundland, Canada.

Methods:Participants completed a battery of valid and reliable self‐report instruments to measure pain, disability, uncertainty, resourcefulness, self‐efficacy, adult role behaviors, and life satisfaction. Two tests of the self‐help model were performed, the first with pretest data (N=110) and the second with 3‐month posttest data (N=102) after half the sample had participated in the CPSMP intervention. Causal modeling path analysis was done with the Statistical Package for the Social Sciences (SPSS) program and tests of goodness‐of‐fit were conducted using EQS for Windows.

Results:Results supported the overall hypothesized pattern of relationships in the self‐help model. Amounts of variance explained in the two major outcomes of the model (self‐help: 42% to 53% and life quality: 45% to 47%) were consistent with results from other studies. Indices of goodness of fit showed an adequate fit of the model to the data, particularly the posttest data.

Conclusions:Braden's Self‐Help Model appears to be robust in a variety of clinical populations, among different settings and environmental conditions, and provides a useful framework to guide nursing psycho‐educational interventions in chronic illness.
Health Status of Young Offenders and Their Families
Authors: Shelton Deborah
Published: April 2004

Purpose: To describe the health status of youth committed and detained by the Maryland Department of Juvenile Justice. The problem of complex health needs of young offenders is gaining importance as the number of youth under the care of state juvenile justice systems steadily increases.

Methods: The health status of a random sample (N = 350) of male and female committed or detained young offenders was assessed utilizing a record review and a self‐report health survey.

Results: Ninety‐seven percent of the sample reported levels of physical discomfort and 92% reported emotional discomfort. Nearly half (45%) of the youth had some medical condition, 53% had been abused, 20% injured, 16% sustained a gunshot or stab wound. Of youth reporting physical injury, 12% did not receive treatment. Family members, including siblings experienced similar health problems.

Conclusions: Patterns of physical and behavioral health problems were noted within these families, as were patterns of criminal behavior. Trans‐generational patterns of at‐risk behaviors were evident. Most youth (86%) perceived themselves to be healthy. However, when specific health indicators were examined, discrepancies between health status and health perceptions were noted.
Evidence‐Based Practice and Reviews of Therapeutic Touch
Authors: O'Mathúna Dónal P.
Published: April 2004

Purpose:To present principles for accurately representing research for evidence‐based practice and health care policies, and to evaluate how original research results indicated adherence to those principles in literature reviews of therapeutic touch.

Organizing constructs:Critical thinking and scientific integrity.

Sources:Reviews of therapeutic touch literature published in nursing journals between 1994 and 1998 and the research studies cited in those reviews.

Methods:Statements made in reviews about the efficacy of therapeutic touch were compared with the results and conclusions of the research cited. General conclusions reported in reviews were evaluated against a broad range of therapeutic touch (TT) research studies, including many not cited in reviews. How accurately reviewers represented the research studies was evaluated by comparing reviewers' conclusions with those of the researchers.

Findings were organized into principles to guide evidence‐based reviews.

Findings:Literature reviews about therapeutic touch often cited only research with favorable findings. When citing studies with contradictory findings, only the favorable findings were usually mentioned. In many reviews, research cited as indicating the efficacy of therapeutic touch indicated it was ineffective. Every review examined had at least one significant mistake concerning how research studies were represented.

Conclusions:Accurate presentation of original research results is needed to make evidence‐based decisions and to ensure that limited healthcare resources are used effectively and safely. Evidence‐based principles should be followed in reviewing therapies and practices, including alternative therapies.
Access to Health Care: Effects of Public Funding On The Uninsured
Authors: Smith‐Campbell Betty
Published: April 2004

Purpose: To determine whether a state funding policy influenced access to health care for the uninsured in one county of the American Midwest.

Design: The Aday, Andersen, and Fleming (1980) Access Framework guided this descriptive study. The Framework indicates that health policy may directly affect the characteristics of the health care system, which in turn may affect utilization patterns and satisfaction of consumers.

Methods: A descriptive cross‐sectional survey in 1996 was used to explore client satisfaction with care at Health Care Access (HCA), the only organization in the county that received funding under a new state policy. HCA's purpose was to provide primary health care to the medically underserved. Satisfaction was measured using an adapted version of the Patient Satisfaction with Health Care Provider Scale (Marsh, 1996). To measure utilization patterns according to insurance status, data were collected to determine visits to the Emergency Department (ED) at the only hospital (LMH) in the county before and after implementation of the state policy. ED data were collected for 1988, 1990, 1993, and 1995; initial funding to HCA began in April 1992.

Findings: Within 3 years after state funding was initiated, uninsured visits to the ED decreased by almost 40%, while insured visits continued to increase. The survey results showed that HCA clients had a high level of satisfaction.

Conclusions: This descriptive study showed that the change in state policy increased access to health care for the medically underserved.
Health Systems and Maternal and Child Survival in Central Asian Republics
Authors: Veenema Tenaer Goodwin
Published: April 2004

Purpose: To describe the status of health care systems in five Central Asian Republics (CAR): Kyrgzstan, Kazakhstan, Uzbekistan, Turkmenistan, and Tajikistan, with particular attention to women's and children's health.

Organizing construct: Changing mortality profiles are investigated using the “protractedpolarized” model of epidemiologic transition.

Sources: Empirical evidence was drawn from the World Health Organization (WHO) database for the region, along with additional evidence presented at a maternal‐child health conference held in Bishkek, Kyrgyzstan, on November 11–14, 1998. The conference was sponsored by the Albert Schweitzer Institute and the Soros Foundation. This evidence is evaluated for completeness, validity, and reliability. Trends are identified using the 1998 and 1999 World Health Reports and 1999/2000 World Bank Development Report.

Findings: Incomplete data prohibited comprehensive analysis. Available data indicated high but variable rates of maternal and child mortality and overall declines in health status and the health care infrastructure in the 1990s.

Conclusions: Data collection and analysis from this part of the world are often incomplete and unreliable. Future research should focus on improving maternal and child health indicators by enhancing resource sharing and opportunities for international collaboration.
Attachment Theory and Violence Toward Women by Male Intimate Partners
Authors: McClellan Ann C. , Killeen Maureen Reed
Published: April 2004

Purpose: Explore whether understanding of violence toward women by their male intimate partners is enhanced by attachment theory.

Organizing Framework: This review was focused on the evidence that men prone to intimate partner violence were insecurely attached as infants, and as a consequence, their internal working models of attachment relationships include the use of aggression to gain power and control. These internal working models are brought to their adult relationships with intimate partners. The intergenerational transmission of violence occurs when children who witness episodes of violence in their homes, or experience violence directly as victims, become aggressive in adult relationships. Parallels between concepts of infant attachment and adult romantic attachment, such as maintaining proximity to attachment figures, were examined.

Methods: The literature on attachment theory and intimate partner violence was reviewed. References were identified from electronic databases and from a manual search of the literature.

Conclusions: Evidence about intimate partner violence is consistent with attachment theory. This framework is a base for extension of knowledge of intimate partner violence. Changes in practice, research, and policy to support an attachment perspective are discussed.
Feeling Safe: The Psychosocial Needs of ICU Patients
Authors: Hupcey Judith E.
Published: April 2004

Purpose: To describe the psychosocial needs of critically ill patients, including descriptions of patients' experiences when these needs are not met, and behaviors of families, friends, and ICU staff that help or impede meeting these needs.

Design: A qualitative research design was used. Participants were 45 adult critically ill patients in the medical or surgical ICU for a minimum of 3 days in a large, rural American tertiary care center.

Methods: Data collection and analysis were conducted using methods of grounded theory, including theoretical sampling and the constant comparative process. Unstructured taperecorded interviews were conducted with patients once they were stable in the ICU or immediately following their transfer to a general unit. Data were collected and analyzed simultaneously. This process continued until saturation was reached and a model of the psychosocial needs of ICU patients was developed.

Findings: The overwhelming need of ICU patients was to feel safe. The perception of feeling safe was influenced by family and friends, ICU staff, religious beliefs, and feelings of knowing, regaining control, hoping, and trusting.

Conclusions: ICU patients in this study said that feeling safe was their overarching need. Patients described feelings of distress when they did not feel safe and stated how family, staff, and religion could both positively and negatively affect this feeling. Nurses can intervene in numerous areas to foster the feeling of safety in critically ill patients.
Accuracy of Children's Self‐Reported Adherence to Treatment
Authors: Burkhart Patricia V. , Dunbar‐Jacob Jacqueline M. , Rohay Jeffrey M.
Published: April 2004

Purpose: To examine the relationship between self‐reported and electronically monitored adherence to a recommended asthma treatment and to assess the accuracy of the diary data reported by school‐age children.

Design: A randomized, controlled clinical trial of the effectiveness of an asthma self‐management program. The relationship between self‐reported and electronically recorded daily peak expiratory flow rate (PEFR) adherence was assessed in a sample of 42 children, ages 7 through 11 years with moderate to severe asthma in one community in West Virginia, USA. Cognitive social learning theory served as the framework for the intervention.

Methods: At‐home adherence to PEFR monitoring during the 5‐week study was evaluated using the self‐report Asthma Diary and an electronic PEFR meter. Recommended twice daily (morning and evening) PEFR monitoring was measured.

Results: Self‐reported and electronically recorded PEFR adherence were modestly correlated. Self‐reported adherence was significantly higher than electronically monitored adherence during Week 5. Accuracy of the self‐reported PEFR declined over time, and over half of the children fabricated at least one PEFR value during the final week of the study.

Conclusions: Clinicians often evaluate the efficacy of prescribed treatment for children with chronic conditions based on the children's self‐reported diary data. The findings indicate that these children's self‐reported adherence behaviors contained errors. Parent education regarding supervision of children's adherence, including validating the accuracy of diary data, is critical for successful self‐management in children with chronic conditions.
History and Trends in Clinical Information Systems in the United States
Authors: Staggers Nancy , Thompson Cheryl Bagley , Snyder‐Halpern Rita
Published: April 2004

Purpose: To provide a synopsis of issues about clinical information systems for nurses not schooled in nursing informatics.

Organizing construct: The past, present, and future of clinical computing, including major factors resulting in the early hospital information systems (HIS) and decision support systems (DSS) in the United States, current advances and issues in managing clinical information, and future trends and issues.

Methods: Literature review and analysis.

Findings and Conclusions: The first HIS and DSS were used in the late 1960s and were focused on applications for acute care. The change from fee‐for‐service to managed care required a change in the design of clinical information systems toward more patient‐centered systems that span the care continuum, such as the computer‐based patient record (CPR). Current difficulties with CPR systems include lack of systems integration, data standardization, and implementation. Increased advances in information and technology integration and increased use of the Internet for health information will shape the future of clinical information systems.
An Exploratory Study of Clinical Decision‐Making in Five Countries
Authors: Lauri Sirkka , Salanterä Sanna , Chalmers Karen , Ekman Sirkka‐Liisa , Kim Hesook Suzie , Käppeli Sylvia , MacLeod Martha
Published: April 2004

Purpose: To identify the cognitive processes nurses use in their decision‐making in long‐ and short‐term care settings in five countries, and the demographic variables associated with their decision‐making.

Method and Samples: The instrument used was a 56‐item questionnaire that has been shown to be reliable in earlier studies. The sample consisted of five convenience samples of registered nurses working in either geriatric wards (n = 236) or acute medical‐surgical wards (n = 223) in hospitals or nursing homes in Canada, Finland, Sweden, Switzerland, and the United States.

Findings: Five models of decision‐making were identified on the basis of factor analysis. They represent both analytical and intuitive cognitive processes. Analytical cognitive processes were emphasized in information collection, problem definition, and planning of care, and intuitive cognitive processes were emphasized in planning, implementing, and evaluating care. Professional education, practical experience, field of practice, and type of knowledge were significantly associated with decision‐making models as well as with country of residence of the participants. The highest proportion of analytically oriented decision‐makers was found among nurses in long‐term care, the decision‐making of nurses in short‐term care was more intuitively oriented.

Conclusions: The results indicate that decision‐making of participants varied from country to country and in different nursing situations. Future research should be focused on reasons for these differences, the relationship between the task and the nurses' type of knowledge, and how nurses use their knowledge to make decisions in different nursing situations.
On Nursing Theories and Evidence
Authors: Fawcett Jacqueline , Watson Jean , Neuman Betty , Walker Patricia Hinton , Fitzpatrick Joyce J.
Published: April 2004

Purpose: To expand the understanding of what constitutes evidence for theory‐guided, evidence‐based nursing practice from a narrow focus on empirics to a more comprehensive focus on diverse patterns of knowing.

Organizing construct: Carper's four fundamental patterns of knowing in nursing—empirical, ethical, personal, and aesthetic—are required for nursing practice. A different mode of inquiry is required to develop knowledge about and evidence for each pattern.

Conclusions: Theory, inquiry, and evidence are inextricably linked. Each pattern of knowing can be considered a type of theory, and the modes of inquiry appropriate to the generation and testing of each type of theory provide diverse sources of data for evidence‐based nursing practice. Different kinds of nursing theories provide different lenses for critiquing and interpreting the different kinds of evidence essential for theory‐guided, evidence‐based holistic nursing practice.
A Quality of Health Outcomes Model for Guiding Obstetrical Practice
Authors: Mayberry Linda J. , Gennaro Susan
Published: April 2004

Purpose: To describe the application of the Quality of Health Outcomes Model, introduced by the American Academy of Nursing Expert Panel on Quality of Health Care, to obstetrical care, particularly second‐stage labor.

Organizing Framework: The model is different from the more linear structure‐process‐outcome frameworks used in the past to a dynamic conceptualization of reciprocal relationships among the system, intervention, client, and outcome components. Analysis of these components can provide a comprehensive picture of the complexity of patient care decision making in hospital labor and delivery units.

Conclusions: Research findings indicate that interventions such as cesarean delivery and epidural analgesia may result in several significant quality of health outcomes for women that should receive increased attention. Uses of this model for shaping best practices among physicians and nurses and for setting directions for priorities in future interdisciplinary research and health policy are discussed.
Cultural Practices and Social Support of Pregnant Women in a Northern New Mexico Community
Authors: Domian Elaine Williams
Published: April 2004

Purpose: To describe the experience of social support in Hispanic families during pregnancy.

Design: Ethnographic investigation, conducted from November 1995 to November 1997 in Rio Arriba County of northern New Mexico.

Methods: Seventy‐two transcribed verbatim interviews with Hispanic mothers, family members, and health care providers, along with fieldnotes from participant observation, historical data of the region, and area demographics comprised the data for qualitative analysis.

Findings: Pregnancy outcomes were positive because of a socialization process that helped pregnant Hispanic women and family members adapt and change to support the pregnancy. This mutual shaping helped reinforce the family structure, integrate cultural beliefs, define roles for both mother and family members, define the nature of mother‐child and family‐child relationships, and facilitate a positive process through a supportive orientation.

Conclusions: Findings showed the dynamics and context of relationships that constituted social support conducive to healthy birth outcomes in Hispanic families of northern New Mexico. The findings were enlightening concerning the pregnancy process, role adaptation, integration of health care beliefs, and provided ideas for intervention models that might benefit pregnant women, infants, family members, community members, and health care professionals.
Infant Exposure to Environmental Tobacco Smoke
Authors: Gaffney Kathleen F.
Published: April 2004

Purpose: To identify infant health outcomes that have been empirically associated with environmental tobacco smoke (ETS) exposure in current international research literature.

Methods: Reports of infant ETS exposure, obtained using computerized searches of CINAHL and Medline databases, were reviewed. Studies of infant health outcomes published between 1995 and 2000 were included if they met specific criteria including the selection of infant ETS exposure as a major study variable.

Findings: The 10 studies in this integrative review of the literature were conducted in a variety of international health care settings. Positive associations were found between infant ETS exposure and gastroesophageal reflux, colic, sudden infant death syndrome, lower respiratory tract infections, and other infant morbidities. Parental self‐reports were the predominant measures of ETS exposure. Maternal smoking was reported as a significant predictor of infant health outcomes.

Conclusions: Nurses who care for mother‐infant dyads in the first year of life are needed to support the development of a ‘gold standard’ for the measurement of ETS exposure that is reliable, valid, and economical. In the interim, the global nursing community may use the findings of these current studies as justification for directing infant health care resources to smoking cessation interventions specifically tailored to meet the needs of mothers who smoke.
Evaluation of an Instrument for Assessing Behavioral Change in Sedentary Women
Authors: Nies Mary A. , Hepworth Joseph T. , Wallston Kenneth A. , Kershaw Trace C.
Published: April 2004

Purpose: To construct and evaluate a psychometric instrument for the assessment of behavioral change as a means for gaining insight into the development of more effective programs for promoting physical activity in women.

Design: A 16‐item questionnaire was created and was administered three times (0, 6, and 12 months) to 181, 90, and 82 women, respectively, to determine the validity and reliability of the instrument. Participants were women 30–60 years of age, literate in English, and sedentary.

Methods: The data were analyzed using factor analysis to determine the most appropriate model for evaluating three theoretical constructs: (a) goal setting, (b) restructuring plans, and (c) relapse prevention and maintenance.

Results: A 3‐factor model was shown to be appropriate; the instrument adequately distinguished the constructs goal setting and relapse prevention and maintenance, but did less well with the concept of restructuring plans, indicating that this concept may not be a separate entity.

Conclusions: This study showed that this new instrument to evaluate behavioral change has important empirical applications. Each subscale can be used independently, depending on the needs of the investigator. This instrument will be useful for public health programs promoting physical activity in a sedentary population.
Genetic Counseling Outcomes Validation by Genetics Nurses in the UK and US
Authors: Williams Janet K. , Skirton Heather , Reed David , Johnson Marion , Maas Meridean , Daack‐Hirsch Sandra
Published: April 2004

Purpose: To validate genetic counseling outcomes with a sample of genetics nurses from the United Kingdom (UK), and to compare elements of genetic counseling outcomes with those from a sample of genetics nurses from the United States (US).

Design: Descriptive‐comparative survey.

Methods: Concept analysis and literature review were used to designate outcomes, and genetics nurses were surveyed to validate the outcomes. A revision of Fehring's 1987 methodology for assessing content validity was used to estimate content validity and sensitivity of the genetic counseling outcomes. Data are reported on a convenience sample of 50 UK nurse members of the Association of Genetic Nurses and Counsellors. Findings were correlated with prior data from a convenience sample of 92 U.S. nurse members of the International ociety of Nurses in Genetics, Inc., and data were compared between groups.

Findings: A significant positive correlation was found between samples of U.K. and U.S. nurses regarding components of outcomes of the genetic counseling process and between groups regarding extent of contribution of nurses to the outcomes. Strength of nursing contributions to knowledge of disease and indicators of coping varied according to country.

Conclusions: Genetics nurses in the UK and US had similar definitions of outcomes of genetic counseling, but priorities of indicators differed between countries. Terminology used in measures to identify outcomes of the process of genetic counseling must be consistent with cultural norms.
Factors Associated with Distress in Urban Residential Fire Survivors
Authors: Keane Anne , Houldin Arlene D. , Allison Paul D. , Jepson Christopher , Shults Justine , Nuamah Isaac F. , Brennan Ann Marie Walsh , Lowery Barbara J. , McCorkle Ruth
Published: April 2004

Purpose: To identify factors associated with recovery in a sample of urban residential fire survivors.

Design and Methods: 440 survivors of residential fires were interviewed at approximately 3, 6, and 13 months after the fire to measure psychological distress. A set of factors was identified that correlated with survivors' ability to recover from the fire event. Potential predictors of increased distress were identified. Hypotheses were that participants who were lower in socioeconomic status, who were minority members, who had less social support, who engaged in attributional thinking, and had greater concurrent life stresses would have greater psychological distress in response to a residential fire and would be less able to recover from the fire event.

Findings: Distress after fire was high at 3 months and decreased for the majority of participants, although one‐third of survivors had higher distress at 13 months than at 3 months. Loss of control and attributional variables had the strongest influence on psychological distress over time.

Conclusions: The findings are consistent with stress‐response tendencies expected after a stressful event. A set of predictor variables was identified to help clinicians target survivors at high risk for psychological distress after a residential fire.
Expressing Health Experience Through Embodied Language
Authors: Liehr Patricia , Takahashi Ryutaro , Nishimura Chie , Frazier Lorraine , Kuwajima Iwao , Pennebaker James W.
Published: April 2004

Purpose: To describe embodied language for Japanese elders who suffered a stroke or cardiac disease within the previous year. Embodied language is the overlap of feeling and temporal word use with blood pressure during descriptions of health experience.

Design: Exploratory.

Methods: Blood pressure and word use were recorded simultaneously when 17 cardiac and 20 stroke participants described their health experiences for 4 minutes. Blood pressure was measured using a tonometric monitor and word use was measured using linguistic analysis software. Descriptive and nonparametric statistics were used.

Findings: Participants with strokes retained higher blood pressure after talking than did cardiac participants. The two groups showed contrasting relationships between word use and blood pressure, particularly for temporal words.

Conclusions: This collaborative research between Japanese and American colleagues was a step toward deciphering shared values, which are important to understanding health for people who have lived through life‐changing illness events.
Validation of the Smoking Self‐efficacy Survey for Taiwanese Children
Authors: Chen Huey‐Shys , Horner Sharon D. , Percy Melanie S.
Published: April 2004

Purpose: To determine the psychometric properties of the Chinese version of the smoking self‐efficacy (SSE) survey.

Design and Methods: The SSE survey was translated into Chinese then was back‐translated into English, reviewed for content validity, pilot tested, and administered to 401 children between December 1998 and August 1999. A random cluster sampling method was used in this study.

Findings: Reliability was indicated by Cronbach's alpha coefficient, .98. The validity of the SSE scale was determined by face validity, item‐total correlation coefficient, content validity index, and concurrent validity. Principal component analysis was done to determine the construct validity of the SSE scale. The revised SSE scale had three components accounting for 74.3% of the total variance with alpha of .96. The correlation coefficient between the SSE and revised SSE scale was .99.

Conclusions: Findings show that the revised SSE scale is not only parsimonious but also it is as reliable and valid as is the original SSE scale. This translated instrument is appropriate for use in studies of smoking behavior in Taiwanese children aged 11 to 14 years. Further research will be needed to validate the SSE scale with different populations and settings in Taiwan.
Maximizing Retention in Community‐based Clinical Trials
Authors: Davis Linda Lindsey , Broome Marion E. , Cox Ruth P.
Published: April 2004

Purpose: To identify and discuss retention strategies and their effectiveness in communitybased clinical trials in the last decade.

Methods: Online and hand searches for reports for the period 1990–1999. A total of 87 reports on 64 different trials were found; 21 of these published reports included a description of both retention strategies and outcomes. These studies, rank‐ordered on participant retention, were compared.

Findings: Despite differences in study populations, interventions, and endpoints, community‐based trials with the highest retention rates included a combination of retention strategies.

Conclusions: As more funding agencies emphasize clinical trials, more investigators will be held accountable for credible and generalizable findings based on retaining the projected number of study participants. The small number of published reports for the decade that identified both retention strategies and outcomes substantiates the need to better document these factors in future research reports.
Does International Nurse Recruitment Influence Practice Values in U.S. Hospitals?
Authors: Flynn Linda , Aiken Linda H.
Published: April 2004

Purpose: To determine if both U.S. and international nurses place high value on organizational attributes that comprises the elements of professional nursing practice and if the absence of these attributes is associated with high levels of burnout in both U.S. and international nurses.

Design: A secondary analysis of survey data was conducted with a sample of 799 nurses; 547 were born in the United States (US) and 252 were from 34 other countries.

Methods: Culture of origin was coded according to Hofstede's classification system. Nursing values related to the professional practice environment were measured using the Nursing Work Index, and burnout was measured using the Maslach Burnout Inventory. Analysis of variance and least‐squares regression procedures were used to test hypotheses.

Findings: No significant differences were found between U.S. and international nurses in the overall degree to which they valued a professional nursing practice environment. A professional practice environment had a significant, inverse effect on job‐related burnout on both U.S. and international nurses.

Conclusions: These findings challenge a prevailing sentiment that international nurses hold values inconsistent with professional practice models as defined in the U.S. context. These findings also show that absence of a professional practice environment will produce similar high levels of burnout in both U.S. and foreign‐born nurses. To address the nursing shortage, administrators should ensure that organizational attributes are consistent with a professional nursing practice environment.
State Policies and Nurses with Substance Use Disorders
Authors: Haack Mary R. , Yocom Carolyn J.
Published: April 2004

Purpose: To investigate the effects of two state regulatory policies on nurses with substance use disorders (SUD) on relapse rates and retention in the nursing workforce.

Design & Methods: This longitudinal comparative study consisted of six data‐collection points in 6 months. One sample of 100 registered nurses (RNs) and licensed practical nurses or vocational nurses (LPN/VNs) had disciplinary actions taken against their licenses by four U.S. state regulatory boards using a traditional, disciplinary approach. The alternative sample consisted of 119 RNs and LPN/VNs from three U.S. states where the regulatory board diverted nurses to programs for treatment and for determining suitability to return to practice. Data were collected via mailed surveys.

Findings: When compared to the sample, the alternative sample had more nurses with active licenses, fewer with criminal convictions, and more nurses employed in nursing. No difference in relapse rate was found. Fewer than 15% of nurses in either sample experienced one or more episodes of relapse during the 6‐month study. Of those who did relapse, the majority used alcohol or street drugs.

Conclusions: Alternative policies worked as well as disciplinary policies and were a more humane and rehabilitative approach. Alternative policy is consistent with the recommendation in Healthy People 2010 to eliminate financial barriers limiting access to treatment. Further investigation is needed to identify situations that trigger relapse.
The Systematic Development of Nursing Interventions
Authors: Whittemore Robin , Grey Margaret
Published: April 2004

Purpose: To propose guidelines for systematic and progressive testing of nursing interventions.

Organizing Framework: The National Institutes of Health has indicated four phases of clinical trials to guide research on treatments and interventions in the health sciences. Several important issues specific to nursing interventions need further clarification to enhance the interpretation of nursing clinical trials: (a) linking problem identification and nursing interventions, (b) articulating the content of interventions, (c) determining the strength and timing of interventions, (d) differentiating between efficacy and effectiveness research, and (e) incorporating multiple perspectives in intervention development.

Conclusions: Systematic and progressive nursing intervention programs of research are needed to address these issues and to enhance the science and practice of nursing.
Barriers to Managing Chronic Pain of Older Adults with Arthritis
Authors: Davis Gail C. , Hiemenz Melinda L. , White Terri L.
Published: April 2004

Purpose: To explore barriers to pain management experienced by older adults with arthritis, identify themes, and develop a theoretical model of relationships among the themes.

Design and Methods: Focus groups were used to collect data with 57 older‐adult participants who had self‐reported arthritis. Coding techniques consistent with grounded theory methodology were used for data analysis.

Findings: Nine themes were identified to describe barriers to chronic pain management experienced by older people with arthritis. The resulting model shows personal decision‐making regarding the use of pain management methods.

Conclusions: Findings provide direction for enhancing independent older people's ability to manage chronic pain. The nine categories of barriers show direction for education of both clients and health care providers, as well as for planning other types of needed support. The theoretical model shows the complexity of barriers experienced by older adults with arthritis.
Early Risk Indicators of Substance Abuse Among Nurses
Authors: West Margaret Mary
Published: April 2004

Purpose: To investigate early risk factors that led to substance‐related disorders and to predict group differences between substance‐impaired (SI) and nonimpaired (NI) registered nurses.

Organizing Construct: Donovan's multifactorial model of impairment, and Rogers'Science of Unitary Human Beings.

Methods: Data were gathered from 100 previously SI and 100 NI nurses located through use of the Internet. Three questionnaires were used: the Zuckerman Sensation Seeking Scale (ZSSS), the Efinger Alcohol Risk Survey (EARS), and the Children of Alcoholics Screening Test (CAST).

Findings: Independent t‐test scores showed the two groups differed significantly on all three instruments' total scores. Discriminate analysis indicated a correct prediction of 87% for SI and 95% for NI nurses, with an overall rate of 91%. EARS scores were the best predictor of nurses with substance‐related disorders (.99), followed by ZSSS (.44) and CAST (.42) scores.

Conclusions: The three variables indicate early risk factors for substance‐abuse impairment. Identification of nurses at risk for impairment will allow for earlier intervention and possible prevention. Methods to reduce the number of modifiable risk factors are recommended.
Psychosocial and Environmental Influences on Physical Activity and Health Outcomes in Sedentary Women
Authors: Nies Mary A. , Kershaw Trace C.
Published: April 2004

Purpose: To develop a model of psychosocial and environmental influences on physical activity and psychophysiological health outcomes in women.

Design: A structural equation model was evaluated. Variables included 13 predictors (perceived benefits to exercise, self‐efficacy, goal setting, restructuring plans, relapse prevention, social support, work hassles, community hassles, family hassles, age, race, income, and education), two mediator variables assessing physical activity (performance, physical activity level), and three health outcome variables (body size, vigor, and fatigue).

Methods: A cross‐sectional sample of 198, self‐described sedentary women aged 30–60 years completed several paper‐and‐pencil tests, after which they were assessed physiologically by means of performance on a 1‐mile walk, BMI, and percentage of body fat measurements.

Results: Overall, the model showed good fit. Self‐efficacy, age, race, and income correlated with physical performance, and restructuring plans, relapse prevention, and age related to physical activity level. Performance was inversely correlated with body size, and physical activity level was directly related to perceived vigor.

Conclusions: Findings indicate that psychosocial determinants are important factors in understanding physical activity and psychophysiological health, and thus they should be incorporated into intervention programs focused on increasing physical activity and improving health outcomes in women.
The Health Effects of Work‐based Welfare
Authors: Hildebrandt Eugenie
Published: April 2004

Purpose: To identify effects of work‐based welfare on the health and well‐being of participants. Data included the needs and experiences of people in the work‐based welfare program.

Design: The population for this qualitative study was adults enrolled in the work‐based welfare program in a large urban community in the U.S. Midwest. The sample was 34 women who were enrolled in this program. The interview settings were an inner‐city adult education center, an inner‐city church, a subsidized housing development, or homes of participants. Data were collected between July 1999 and June 2000.

Methods: Snowball sampling was used to identify participants. Instruments used for this report were a semi‐structured interview guide, a demographic data sheet, and the General Wellbeing Schedule.

Findings: The human costs to people enrolled in work‐based welfare included anxiety and depression as well as negative effects on health and well‐being. Participants also reported positive effects on well‐being and empowerment.

Conclusions: The findings indicate the complex interplay of the socioeconomic environment, mental and physical health, and the well‐being of families. The women's perceptions of the effects that welfare policy has had on them and their families indicate the need for a broader response to poverty than the largely economic response of work‐based welfare.