bluuebunny/crossref_metadata_2025_split huggingface dataset:
Persistence of Self in Advanced Alzheimer's Disease
Authors: Tappen Ruth M. , Williams Christine , Fishman Sarah , Touhy Theris 
Published: June 2007

Purpose:To determine if evidence of the persistence of a sense of self or personal identity could be found in people in the middle and late stages of Alzheimer's disease. The theme of diminishing self pervades both the popular and professional literature on Alzheimer's disease.Design:Qualitative using conversational analysis. The purposive sample was 23 residents of two urban nursing homes in the southeastern United States who were in the middle and late stages of Alzheimer's disease. Their mean Mini‐Mental State examination score was 10.65. Nineteen subjects were women, four were men in this 1993‐1997 study.Methods:Analysis of 45 conversations lasting 30 minutes with nursing home residents with a diagnosis of probable Alzheimer's disease. Use of the first person indexical and other evidence, such as awareness and reactions to the changes that had taken place, in support of and counter to the notion of persistence of self, were sought in conversational analysis.Findings:Respondents used the first person indexical frequently, freely, and coherently. Evidence was also present that participants were aware of their cognitive changes. Many struggled to provide an explanation, but none mentioned Alzheimer's disease.Conclusions:Evidence suggests the persistence of awareness of self into the middle and late stages of Alzheimer's disease. Failure to recognize the continuing awareness of self and the human experience of the person in the middle and late stages can lead to task‐oriented care and low expectations for therapeutic interventions. The bafflement noted in respondents suggests that people should be told their diagnosis and offered an explanation of what this diagnosis means.
Sleep Patterns of Sheltered Battered Women
Authors: Humphreys Janice C. , Lee Kathryn A. , Neylan Thomas C. , Marmar Charles R. 
Published: June 2007

Purpose:To describe sheltered battered women's sleep patterns and resulting daytime fatigue. The model for symptom management framed this study to describe one component of the model—symptom experience. Beginning evidence suggests that sheltered battered women experience disturbed sleep and fatigue that can interfere with vital activities.Design:Descriptive using a convenience sample of 50 ethnically diverse women residing at least 21 days in battered women's shelters located in one western U.S. city. The study was done in 1997.Methods:The Pittsburgh Sleep Quality Index (PSQI), the Mini Motionlogger Actigraph, a sleep diary, the Visual Analogue Scale for Fatigue, and an open‐ended interview were used to collect data. Descriptive and inferential statistics were used to analyze the quantitative data. Qualitative data were analyzed to determine patterns and themes.Findings:Seventy percent of the women had global PSQI scores of greater than five indicating poor sleep and 17 (34%) had a sleep efficiency index of 80% or less. Fourteen (28%) of the women went to bed very fatigued (>66 mm) and 20 (40%) woke up very fatigued (>33mm).Conclusions:The majority of sheltered battered women experienced disturbed sleep and daytime fatigue. Both personal and environmental variables were found to significantly affect sleep patterns. Sheltered battered women can benefit from information about sleep disturbances and sleep enhancing self‐care strategies.
Influence of Managed Care on Professional Nursing Practice
Authors: Harrison Janet K. 
Published: June 2007

Purpose:To explore how nurses in one U.S. state perceived that managed care influenced professional nursing in that state. The nursing community is challenged to move with haste in demonstrating, through research, the clinical and economic value that nurses add to cost‐effective outcomes.Design:A Delphi survey in 1996 of a convenience sample of 84 clinical nurse specialists (CNSs) and nurse practitioners (NPs) in California.Methods:CNSs and NPs contributed to the list of managed care influences on nursing practice. Fifty‐seven (68%) completed the third and final round.Findings:Panelist agreement was the highest for (a) exploring new approaches to providing quality care more cost‐effectively, (b) expanding nurse practitioners' rote in primary care, and (c) more effectively partnering with clients in helping them assume greater self‐responsibility for their health. Greatest threats were perceived to be hassles involved in seeking authorization for care and responding to payment denials; the tenuous job market for nurses; and encroachment on nursing practice by others.Conclusions:The findings can assist nurses in states with low managed‐care concentration to create their preferred future within health care delivery. A more highly educated nurse workforce will be needed for 21st century health systems in which more care is likely to be delivered outside hospitals.
Reimbursement to Advanced Practice Nurses (APNs) Through Medicare
Authors: Wong Sabrina T. 
Published: June 2007

Purpose:To analyze why U.S. legislation for direct Medicare reimbursement to advanced practice nurses (APNs) was approved during the 105th congressional session. Help in understanding the complexities of policy making and in strategizing future policy activities is needed. Given their vast numbers, nurses are a formidable group with potential to influence policy.Organizing Construct:Kingdon's (1995) framework indicates that policy formation involves constant interaction among participants and the problem, its politics, and policy. When a policy is enacted into legislation, the three come together and an opportunity for policy formation exists, if even fora short period. Methods for data extraction included telephone interviews, information provided by the American Nurses Association (ANA), and information from the internet to access information.Findings:Lack of access to health care by Medicare beneficiaries, tagging a policy proposal onto the Balanced Budget Act of 1997, the national mood to provide cost‐effective quality care, and lobbying by interest groups helped to make direct Medicare reimbursement for advanced practice nurses a reality.Conclusions:When lobbying for the enactment of legislation, nurses should decrease their tendency to fragment. Nurses should be more effectively organized and concentrate on specific agendas. Working together can influence policy and change clinical situations to improve patient care.
Slow Growth in the United States of the Number of Minorities in the RN Workforce
Authors: Buerhaus Peter I. , Auerbach David 
Published: June 2007

Purpose:To assess the extent to which the number of minority RNs has grown during the past 20 years, and to identify and compare key trends in personal and professional characteristics among minority groups and between minority and majority populations of RNs. Nursing education programs, employers, philanthropic organizations, and governments have expended considerable effort and resources to increase the number of minorities in nursing.Design:Longitudinal analysis of trends in the number, education, employment, and earnings of minority RNs from 1977 to 1997.Methods:Descriptive analysis of data from the U.S. National Sample Surveys of the Population of Registered Nurses, 1977‐1996; and data from the U.S. Bureau of the Census Current Population Survey (CPS) Outgoing Rotation Croup Annual Merged Files, 1977‐1997.Findings:In the past 20 years, the number of minority RNs has grown from 87,386 (or 6.3% of the total supply of RNs) in 1977 to 246,364 RNs (9.7%) in 1996. The number of Black (nonHispanic), Asian Pacific/Islanders, and American Indian/Alaskan Native nurses nearly tripled in this period while the number of Hispanics doubled. Although these rates of growth are impressive, the percentage of minorities in nursing lags considerably behind the percentage (18.3%) who are teachers, and the percentage (28.2%) in the U.S. population.Conclusions:Studies are needed to determine the barriers that exist in nursing education programs, health care organizations, and society in general that deter minorities from a nursing career. Without this understanding, efforts to design and implement ideas to attract, educate, and retain minorities in nursing education and later in the workplace are hampered.
Clarifying the Concept of Normalization
Authors: Deatrick Janet A. , Knafl Kathleen A. , Murphy‐Moore Carol 
Published: June 2007

Purpose:To refine and develop the concept of normalization. While firsthand accounts, clinical observation, and numerous studies suggest that parents of children with chronic conditions often strive to lead a normal family life, the distinguishing characteristics of normalization need to be understood before evaluating the feasibility and consequences. Conceptualizing these efforts as normalization, researchers have identified cognitive and behavioral strategies used by parents to normalize family life.Sources:A total of 33 articles representing 14 studies were selected through computer‐assisted searches of the topic from 1966‐1997, hand searches of nursing journals from 1970‐1997, and analysis of reference lists. Key words in the searches included: adaptation, psychological; chronic disease; disabled persons; family; child; adolescence; parent‐child relations; models, psychological; and nursing theory. Articles (N= 19) that applied and expanded the concept comprised the sample used in the analysis. A normalization construct was used.Methods:Attributes for normalization were inductively derived based on the most recent methods for refining and developing concepts, with special attention to how family and illness affect manifestations of normalization.Findings:The attributes identified in 1986 remained relevant, but required revision and expansion to reflect a contemporary understanding of normalization. Unique manifestations of normalization were identified within certain illness and family contexts.Conclusions:Knowledge synthesized from previous studies can enhance how normalization is used in future qualitative and quantitative research and in theory development. Findings indicate the need for researchers to build on the current state of knowledge and continue to further develop the concept. Understanding the findings can also sensitize clinicians to the complex process of normalizing when a child has a chronic condition.
Clarification and Integration of Similar Quality of Life Concepts
Authors: Haas Barbara K. 
Published: June 2007

Purpose:To identify major problems that obscure understanding of quality of life; to differentiate quality of life from other closely related concepts, and to offer a definition of quality of life. Quality of life is a term frequently used, but seldom defined, in nursing research. Multiple interpretations and measures make evaluating research difficult. The need to clarify concepts, develop nursing theory, and enhance communication is significant. Concept clarification is also essential for research instrument development and evaluation.Organizing Construct and Scope:Concept analysis as proposed by Walker and Avant. Preconceived theories were avoided to keep the analysis as unbiased as possible. The analyst considered many descriptions of quality of life, but eventually included only those in the scientific literature.Sources:CINAHL, Medline, Psych‐Info, ERIC, Social Science Abstracts, and reference lists from published articles in nursing, medicine, psychology, and sociology were used. Twenty‐seven theory‐based articles and book chapters published since 1989 and a convenience sample of 88 research articles published in 1997 were used. This sample was selected from 16,480 articles published 1993 to 1998.Methods:Concept clarification comparisons to identify the major attributes of several closely related concepts, including well‐being, satisfaction with life, and functional status. Major attributes were validated by a panel of cohorts who met weekly for five consecutive weeks for the purpose of analyzing various concepts.Findings:Quality of life is comprised of subjective indicators such as well‐being and satisfaction with life and objective indicators, such as functional status. Continued dialog and research is necessary to distinguish between the concepts of health and quality of life.Conclusions:A model showing the relationships among quality of life, well‐being, functional status, and satisfaction with life is provided and a definition of quality of life is offered. Researchers and authors should include the definition of quality of life used in their work. Instruments should reflect the theoretic definition used. Care should be taken to clarify if functional status, well‐being, satisfaction with life are the concepts under consideration as reflecting a part of overall quality of life.
Depression, Social Support, and Quality of Life in Older Adults With Osteoarthritis
Authors: Blixen Carol E. , Kippes Christopher 
Published: June 2007

Purpose:To develop an understanding of the quality of life of older adults with osteoarthritis (OA) with varying levels of depression and social supportas a basis for nursing interventions. Osteoarthritis in the United States is the number one chronic disease in late life and the major cause of disability in older adults. In addition to the functional disability and economic effect of OA, older people with this disease experience suffering, depression, and diminished quality of life.Design:For this cross‐sectional survey, a convenience sample of 50 older adults with OA was recruited from two U.S. hospital‐based arthritis clinics in northern Ohio for 3‐months during 1995.Methods:During face‐to‐face interviews, the Arthritis Impact Scales, Center for Epidemiological Studies Depression Scale, Social Support Questionnaire, and Quality of Life Survey, were used to measure osteoarthritis severity, depression, informal social support, and quality of life.Findings:Although few formal social support services were used, high levels of satisfaction from the subjects' large informal networks of family and friends were reported. In addition, satisfaction with subjects' quality of life was extremely high despite depression, co‐morbid conditions, pain, and functional limitation.Conclusions:Social support appeared to play an important role in moderating the effects of pain, functional limitation, and depression on these subjects' quality of life. Nurses who work with older adults are in a unique position to help them adjust to living with osteoarthritis by providing them the support needed to help them manage their disease.
Ethical and Policy Considerations for Centenarians—The Oldest Old
Authors: Eisner Robert J. F. , Quinn Mary Ellen , Fanning Sandra D. , Gueldner Sarah Hall , Poon Leonard W. 
Published: June 2007

Purpose:To illustrate the incongruence of ethical standards and fiscal and policy constraints on quality care for the oldest old. As the fastest growing demographic segment in the United States, care needs of the oldest old are a special challenge to the health care system.Design:Narrative analysis of interviews with centenarians who used nursing home services. The sample was three participants of the Georgia Centenarian Study who had been community dwelling and cognitively intact at the onset of participation (between 1988 and 1997). Interviews were conducted in nursing homes or after discharge.Methods:Case histories were constructed from interviews in 1997 to improve understanding of quality of care.Findings:Less‐than‐optimal care was provided for these elders, and little consideration was given to their input to care decisions and prospects for medical improvement. Appropriate consideration was not given to providing least‐restrictive environments, appropriate restraint use, and options for community care.Conclusions:Six policy reforms are suggested for meeting the needs of the oldest‐old before and after institutionalization. These include: integration of resident involvement in care decisions; development of alternate models of care; greater input from nurses concerning nursing care of special populations; more effective family and community involvement in the caring of elderly populations; increased research to promote function and independence; and increased education of personnel and nursing students to allow for more accurate assessment of cognitive and physical status.
A Model for Change to Evidence‐Based Practice
Authors: Rosswurm Mary Ann , Larrabee June H. 
Published: June 2007

Purpose:To describe a model that guides nurses and other healthcare professionals through a systematic process for the change to evidence‐based practice. The tremendous increases in clinical research and accessibility to research findings have prepared the way for the paradigm shift from traditional and intuition‐driven practice to evidence‐based practice. Although several models have emerged to guide practitioners in research utilization, practitioners continue to have difficulty synthesizing empirical and contextual evidence and integrating evidence‐based changes into practice.Organizing Framework:The model is based on theoretical and research literature related to evidence‐based practice, research utilization, standardized language, and change theory. In this model, practitioners are guided through the entire process of developing and integrating an evidence‐based practice change. The model supports evidence‐based practice changes derived from a combination of quantitative and qualitative data, clinical expertise, and contextual evidence.Methods:The model was developed using sources identified on searches of Medline, CINAHL, and systematic reviews available on the Internet. Review topics were focused on evidence‐based medicine and nursing, research utilization, and change process. Other sources included clinical expertise and quality‐improvement information.Conclusions:Practitioners need skills and resources to appraise, synthesize, and diffuse the best evidence into practice. Patient outcomes must reflect discipline‐specific and interdisciplinary accountabilities. Collaboration between researchers and practitioners within and among disciplines will enhance the diffusion of evidence‐based practice innovations.
Accessing Young Adolescents and Their Families for Research
Authors: Riesch Susan K. , Tosi Charlene B. , Thurston Christine A. 
Published: June 2007

Purpose:To describe the strategies used to obtain and retain a sample of young adolescents and their families.Methods:The sample was 847 families with young adolescents aged 11 to 14 years who resided in a large urban Midwestern community of the U.S. The first design strategy was becoming credible within the community. For 5 years before conducting the intervention research in the community, surveys were conducted of the needs of middle‐school students as they entered adolescence, and programs were delivered to meet the assessed needs. The second design strategy was instituting developmentally appropriate recruitment and retention strategies based upon direct consultation with groups of young adolescents. The consultants recommended referring to young adolescents as young adults and holding the training sessions in sites not associated with schools. The third design strategy was setting up participation methods that were nonburdensome to schools and families.Conclusions:The successful recruitment of over 800 families and the retention of 80% of them for survey participation and 77% of them for the intervention protocol can be attributed to three major strategies: (a) community involvement; (b) adherence to principles of adolescent development; and (c) ease of participation for school personnel and families.
Women Dwelling with Violence
Authors: Draucker Claire Burke , Madsen Christian 
Published: June 2007

Purpose:To explore the Heideggerian concept of dwelling as revealed in the lives of women who have experienced sexual violence. Sexual violence against women by men known to them is a significant health problem, yet little is known about how such violence affects women's everyday experience.Methods:Phenomenologic, integrating (a) data collected in 1996 and 1997 from 10 American women who had experienced sexual violence, (b) Heideggerian philosophy, (c) other literature, and (d) excerpts from the communications media. In‐depth, open‐ended interviews with women, followed by analysis of transcripts using Heideggerian hermeneutics.Findings:Women “dwelling with violence” were living among and inseparable from violence, abuse, and maltreatment. Violence resulted in their “living‐in‐exile”—feeling uprooted, unsettled, unprotected, and distrustful. Yet their stories were about “preserving and sparing amidst violence”—caring for things they value, creating a safe place for themselves, guarding that which is essential to their nature, and seeking to protect others.Conclusions:Sexual violence can profoundly affect the lives of women. Women's narratives indicate complex and creative responses to living in a violent environment. Nurses who seek to understand the effects of violence on a woman's daily life should focus not only on symptomatic responses to a single violent event, but also should consider her life history, the social context of her daily experiences, the degree to which violence has alienated her from others, and her unique way of responding to violence.
A Situation‐Specific Theory of Korean Immigrant Women's Menopausal Transition
Authors: Im Eun‐Ok , Meleis Afaf Ibrahim 
Published: June 2007

Purpose:To extend the previous model of transitions by including the experiences of low‐income Korean immigrant women in the United States during their menopausal transition. The extension results in a situation‐specific theory of Korean immigrant women's menopausal transition.Design:Findings from a study of menopausal transition among Korean immigrant women were used as a main source for modification of the conceptual properties of transitions, conditions shaping the transitions, and indicators of healthy transitions. The study was cross‐sectional with methodologic triangulation. Quantitative analysis was based on data from 119 first‐generation Korean immigrant women who engaged in low‐status or low‐income work outside their homes; qualitative study using theoretical sampling method included 21 women.Methods:Analyses included descriptive and inferential statistics and thematic analysis. Integrative conceptual analysis using deductive and inductive reasoning was conducted to determine modifications in theory based on the descriptions of menopausal transition of Korean immigrant women.Findings:Three main themes were identified: (a) the women gave their menopausal transition far less attention than they did to their immigrant and work transition; (b) menopause was a hidden experience in cultural background; and (c) the women “normalized,” ignored, and endured symptoms. The findings indicated additions of the following concepts: (a) number, seriousness, and priority of transitions; (b) socioeconomic status; (c) gender; (d) context; (e) attitudes toward health and illness; (f) interrelationships among all conditions shaping transitions; and (g) symptom management.Conclusions:The proposed situation‐specific model is limited in scope. However, it provides understanding of the menopausal transition of Korean immigrant women in context, and is a guide for nursing interventions for immigrant women experiencing transition.