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The purpose of this study was to establish the reliability and validity of the Homeless Satisfaction With Care Scale, a measure of satisfaction with care among homeless clients; and to examine selected predictors of satisfaction with care. A descriptive cross-sectional study was conducted comparing an inductively developed measure of satisfaction with 2 established satisfaction measures in a sample of 168 homeless clients who used a rural or an urban clinic. The inductively developed satisfaction scale had good internal consistency reliability and was significantly related to the established measures of satisfaction, supporting its construct validity. Generally, patient characteristics were not associated with satisfaction level. However, Black clients had significantly lower satisfaction levels than White clients; satisfaction differed between the rural and urban sites. Race and clinical site explained 7% of variance in satisfaction. The inductively developed measure provides a salient and appropriate measure of satisfaction with care for future studies with the unique population of homeless.

Background: The southern Appalachian states show a high prevalence of smoking, with associated high rates of both heart disease and cancer, yet cultural differences raise questions concerning the applicability of the mostfrequently used model for smoking cessation, the transtheoretical model, for smokers from this region of the country. Objective To identify, by examining the applicability of the transtheoretical model for southern Appalachian smokers, the percentage of individuals in each of the five stages of change, the use of the processes of change from the transtheoretical model, and the scores on recognized predictors of smoking cessation including the temptation to smoke, the perceived barriers to cessation, the pros and cons of smoking, and nicotine dependence. Methods: This population-based, descriptive, cross-sectional study used a random sample of 3,800 telephone numbers, which were called up to eight times. The 659 smokers or former smokers who agreed to participate were mailed a written questionnaire consisting of six well-established scales that measure constructs from the transtheoretical model. The final sample consisted of 357 usable questionnaires. Results: The distribution of smokers in northeastern Tennessee differed from national samples across the first three stages of change, with 56% in precontemplation, as compared with previous findings of 40% in national samples. The subjects' scores for the pros of smoking were similar across the stages of change in this sample, and although the scores for the cons differed significantly across the stages in the sample, post hoc analysis indicated that the only significant change occurred between precontemplation and contemplation. The scores for temptation to smoke did not differ significantly across the stages of change in this sample. Discussion: Smokers from Appalachian Tennessee differ from smokers in other parts of the United States, and these findings raise questions about the applicability of the transtheoretical model for this population.

Women who are experiencing crisis situations, including homelessness, are often perceived as passive victims of their social, economic, and personal circumstances. A few studies have challenged the stereotype of homeless women as passive victims and demonstrated that they are active in seeking solutions to their problems (Hodnicki, Horner, & Boyle, 1992; Montgomery, 1994; Thrasher & Mowbray, 1995). This study surveyed women receiving assistance at a nurse-managed clinic that serves a homeless population to determine their health promotion strategies. On the basis of this study's findings, health care providers are encouraged to recognize and build on the strengths of women in crises at both the individual and community levels of care.

This study evaluated the outcomes of a series of health-screening clinics specifically developed to target the homeless population. Problems screened during this study were selected because of the high prevalence of each among the homeless and included hypertension, diabetes, anemia, tuberculosis, and foot problems. Screening clinics were developed and implemented by faculty and senior baccalaureate nursing students. Data were collected with a screening form that focused on risk factors and individual health history and by chart review. Two hundred fourteen clients were screened in 17 different screening clinics. Participation in the clinics ranged from 33 clients at a hypertension-screening clinic to 0 at one of the foot-screening clinics. Abnormalities were identified in 22% of the clients who were screened, and documentation was found that 80% of those with abnormalities received follow-up. Overall, the screening clinics appear to be an effective approach to disease prevention in a homeless population.

Satisfaction with a self-care intervention program was evaluated through this quantitative study of arthritis clients at home. The results indicate that the clients were highly satisfied with the intervention. In this era of consumer satisfaction with their care, nurse administrator's knowledge of which interventions are satisfying is important for staff development and case management in the community.

Purpose: The purpose of this study was to evaluate the perceived preparedness of nurse practitioners (NPs) for practice after completing their basic NP educational programs and to evaluate NPs’ perceived preparedness in and their perceived importance of select clinical content areas basic to NP education. Data sources: This cross-sectional descriptive study used a written questionnaire consisting of 32 items, two of which contained 25 subitems. Subjects were asked to rate their overall level of preparedness when they completed their NP program and both their level of preparation in and the importance of 25 clinical content areas. The questionnaires were administered to attendees at two large national NP conferences in 2004; a total of 562 questionnaires were completed and used in the analysis. Conclusions: Ten percent of the sample perceived that they were very well prepared for practice as an NP after completing their basic NP education. Fifty-one percent perceived that they were only somewhat or minimally prepared. Current age, years since graduation from an NP program, and age when attending the NP program did not differ significantly for those who felt prepared versus those who did not. For a number of content areas, subjects did not perceive that they were well prepared in the same areas that they perceived were very important. Implications for practice: Our results indicate that formal NP education is not preparing new NPs to feel ready for practice and suggests several areas where NP educational programs need to be strengthened. Practicing NPs are the basis of the NP profession, and their views need to be sought, listened to, and reflected upon as we advance toward expanded preparation at the doctoral level.

This study evaluated the accomplishment of the Nursing Outcomes Classification (NOC) outcome "Health Seeking Behavior" in 5 nurse-managed clinics. Nurse practitioners and registered nurses rated patients on 11 indicators of health seeking behaviors, and recorded their level of knowledge of the patient. A total of 556 evaluations were collected. Health seeking behavior scores were lowest in a rural county school-based clinic and highest in a federally qualified health center. Ratings increased with nurses' knowledge of patients and for older patients.

This article explores homeless individuals' experiences of satisfaction with health care, and explores the interrelationship among experiences of being homeless, health perceptions of participants, and experiences of satisfaction with health care. It presents the findings of a phenomenological study that was conducted using participants selected from five sites in one southeastern state. Participant interviews were conducted at a nurse-managed primary health care clinic for homeless, at a night time soup-kitchen, and at three private, not-for-profit, homeless shelters in two different towns. The study was part of a larger study designed to develop and validate a reliable measure of client satisfaction with primary health care among homeless individuals. Face-to-face in-depth interviews with 17 homeless individuals were conducted, with the semistructured interview constituting the primary data source. Common themes were identified and the interrelationship of theme clusters was explored. Analysis of the data yielded five distinct themes that represent the lived experiences of satisfaction with health care. These themes were mediated and directly informed by five themes of homelessness and three themes of health identified in the shared experiences of the participants. The themes identified suggest that satisfaction with health care for homeless persons differs from currently identified dimensions of satisfaction with care, and that some aspects of homelessness are seen by participants as positive and health promoting.

This study examined the ability of two specific measures of stressors associated with smoking cessation to act as predictors of progress through the stages of smoking cessation as described by Prochaska and DiClemente (1983). Specifically, a 19-item scale measuring barriers to smoking cessation and a 14-item scale measuring smoking cessation self-efficacy were completed by 127 smokers and self-quitters at three time points over a six-month period. Subjects who made progress through the stages of smoking cessation had lower barriers scores initially and had significant changes in their self-efficacy and barriers scores over the six-month period. In contrast, non-progressors had no significant changes in either their self-efficacy or barriers scores over the time period. These results suggest that the two scales may provide clinically useful data to public health nurses working with smokers.

Despite the concern with medical malpractice suits and research about them, little is known about why some perceived injuries lead to claims of malpractice while other similar injuries do not. This paper presents a conceptualization and hypotheses regarding the determinants of an injury or perceived injury leading to suit. The conceptualization and hypotheses are tested using information collected from 113 medical malpractice plaintiffs' attorneys in three states. A series of proposed concepts prove useful in explaining patient willingness to pursue a suit as well as the plaintiff's success and award size. These are concepts of anger, reluctance to sue, patient and provider worthiness, affinity, economic burden and potential for compensation. Specific attributes of the injury, the patient, the provider, and the doctor-patient relationship relate to these concepts. Injury and doctor-patient relationship attributes prove more important than patient or provider attributes. However, the reported impact of the attributes of the patient and physician on plaintiff success and award is high and suggests that the impact of "non-relevant" variables in the medical malpractice process. Doctor-patient relationship variables hypothesized to reflect affinity are reported to be important in reducing patient willingness to pursue a case; and, certain populations, such as minorities, elderly, foreign-born, are perceived to have a reluctance to sue. The effect of specific characteristics of the patient, the doctor, the injury and the patient-doctor relationship on patient reaction and on disposition is reported, as well as evidence that relates to the validity of the overall conceptualization.