bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.