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The purpose of this study was to develop and test a CD-ROM tutorial for nursing students to educate them on how the rules and regulations of the Health Insurance Portability and Accountability Act (HIPAA) affect them as they engage in patient care activities in hospitals. The project was completed in two parts, the first of which was production of a stand-alone, audio lecture, image and text self-instruction on CD-ROM to distribute to students as they began their clinical experience. The second part compared the effectiveness of learning the HIPAA content via CD-ROM to a text-directed, self study method. Students were pretested and randomly assigned to one of the types of instruction based on their seminar group assignment. One group received the CD-ROM, Getting Started with HIPAA, along with a journal article on HIPAA, while the other (control) group received only the journal article. All students were instructed to prepare for a test on their understanding about HIPAA by the end of the clinical rotation. The test was analyzed, and items clarified to yield a reliable Web-based examination with 20 questions, 18 of which were used in the analysis. The students' scores were analyzed before and after the instruction, and the methods of instruction were compared. The study findings demonstrated significant differences between experimental-group and control-group students' performance on a knowledge test of HIPAA, as well as overall satisfaction with learning the material by CD-ROM among students who used it. The tutorial is now available for all students, and the Web-based examination provides automatic scoring to a preestablished competence level. [ABSTRACT FROM AUTHOR]

Despite widespread availability of pain interventions in childbirth, for most women, childbirth is associated with labor pain that exceeds expectations. Although epidural is superior to other medical interventions, the choice to use epidural still remains a matter of patient and doctor preference. Whether racial or ethnic characteristics influence preference of physician use or interact with insurance coverage is still unknown. This study used a large national sample of women to measure significant determinants of epidural use in order to discuss disparities in pain management. The findings suggest the need for nurse leaders to foster health policies that are sensitive to diversity and economics. [ABSTRACT FROM AUTHOR]

With the complexity of technologies in medical centers today, family members are frequently confronted with situations that require decision making on behalf of a loved one. Some researchers have studied the needs of decision makers directly; however, the reality of asking opinions at the bedside of a dying patient makes it a difficult issue to research directly. The vignette method has been used to extrapolate data by asking study participants how they would act under certain circumstances. This vignette-based study explores potential decision-making processes collected from volunteers about how family members might make decisions for a loved one. Ninety-four students were asked to read vignettes as if they were caregivers. Students were randomly assigned to one of three clinical scenarios describing a family member at a critical decision point. The age of the family member, relationship, and medical condition were manipulated in the three otherwise identical scenarios. The results indicated that the ranked responses to the categories were different in the three age-group scenarios. In the group simulating parent decision making for the terminally ill infant, the participants reported 'quality of life' and 'chance of survival' most frequently as to compared to 'pain/comfort' or 'family relationships' for older patients. When making decisions in the infant scenario, participants were twice as likely to express religious or spiritual criteria for their decisions and half as likely to express cost concerns. Among the three scenarios, participants simulating family decisions for infants indicated that different caregiving values may apply. They were even more likely than the others to choose mechanical ventilation as an option when the prognosis is extremely poor. All family members making decisions for a loved one, regardless of age or relationship, need supportive assistance from nurses; however, pediatric nurses who develop relationships with parents of terminally ill infants especially need to understand their values in making decisions. [ABSTRACT FROM AUTHOR]