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Objective. To evaluate the effectiveness of a decision aid developed specifically for family members considering whether or not their relative with dementia should be admitted to a care facility. Design. One-group non-randomized before and after study. Setting. Ottawa-Carleton, Ontario, Canada. Participants. Convenience sample of 27 family members responsible for making care decisions on behalf of a relative with dementia living at home. Intervention. Family members completed a self-administered decision aid fashioned as a workbook to learn about long-term care options available to persons with dementia. Main outcome measures. Decisional conflict (uncertainty about which course of action to take), knowledge of long-term care options, stages of change (pre-contemplation, contemplation, preparation, action and maintenance), choice predisposition (care at home versus admission to a care facility) as well as satisfaction with the decision aid and the decision making process. Results. After using the decision aid, family members had a significant reduction in decisional conflict and a significant increase in knowledge. The decision aid had a minimal effect on choice predisposition and appeared to be more useful to those in the contemplation stage. Generally, family members were satisfied with the decision aid but felt it was less successful at preparing them to make a better decision, to organize their thoughts, to look at the wishes of their relative with dementia, and to communicate their opinion about the options. Nevertheless, the majority reported that they would definitely recommend the decision aid to other family members facing the same decision. Conclusions. The decision aid shows promise in helping family members of persons with dementia make decisions about location of care.

Objective. Development and reinforcement of self-management skills for patients with Chronic Obstructive Pulmonary Disease (COPD) is an ongoing challenge. As the disease advances, hospitalizations increase, managing respiratory infections and medication administration become more difficult for patients. Pulmonary rehabilitation programs assist patients with mastery of self-management skills but access is limited. In 1996 less than two percent of Canadian COPD patients participated in rehabilitation programs. Hospitalization provides opportunity for interventions aimed at reinforcing self-management strategies. The following study sought to determine the feasibility of providing and evaluating an education intervention tailored to hospitalized COPD patients. Design. Feasibility pre-test post-test method. Setting. Three medical wards of a tertiary care teaching hospital. Participants. Convenience sample of 20 patients admitted with COPD/COPD exacerbation. Intervention. Participants received a maximum of three, 40 minute sessions during hospitalization. Content delivery was tailored to participants' learning needs and low self-efficacy areas. Based on Self-Efficacy Theory, teaching strategies included performance accomplishment, role modeling, and positive reinforcement. Outcome measures. Learning needs, descriptive and clinical data, program evaluation, COPD Self-Efficacy Scale (CSES) and Dartmouth Functional Health Status (FHS) Charts. Results. Key learning needs included: inappropriate medication inhalation technique (n = 19), lack of disease acknowledgement (n = 16), no previous self-management education (n = 10). Health care providers identified the need for better access to educational materials for patients and family members. FHS, in five of the nine domains, and CSES scores (z = 3.51, p = .004) improved. Participants evaluated the experience as positive and recommended the intervention for other patients (n = 20). Conclusions. An educational intervention for hospitalized COPD patients can feasibly be developed, implemented and evaluated.

The Canadian Nursing Association promotes the use of evidence-based decision-making (EBDM) as a component of quality nursing care. A shift to a population health approach encourages public participation in health-related decision-making. Public health nurses (PHNs) participate in joint health-related decision-making with community partners. The purpose of this exploratory and descriptive study was to gain an in-depth understanding of EBDM from the perspective of the PHN. The meaning of EBDM, the perceived barriers and facilitators of using evidence, and the role of the PHN in bringing evidence to the joint decision-making process that they share with community partners was explored. A qualitative methodology known as ethnography was used and data were collected from two sources: observations at team meetings and semi-structured interviews with PHNs. Analysis of the data led to the identification of three sub-themes: holistically knowing the community, bridging 'evidence' to context, and actively managing information. All three sub-themes contribute to the main theme: the PHNs' role in fostering collaborative 'evidence-based' decision-making in the community. The PHNs' holistic view of evidence, which includes hard and soft data, contextual data and professional experience, is discussed. Basic steps in a shared EBDM process are described and dimensions of the context in which PHNs practice are explored. Implications for education, practice, research, and policy are discussed.

This descriptive correlational study explored the relationship between perceived social support and perceptions of illness for individuals living with New York Heart Association Class Two or Class Three congestive heart failure. A total of 34 participants were interviewed at the University of Ottawa Heart Institute, Ambulatory Heart Failure Clinic. Participants completed three questionnaires, which included a demographic questionnaire, a social support questionnaire (PRQ-85/Part Two), and the Meaning of Illness Questionnaire (MOIQ). Results indicated that subjects perceived their social support to be high. Perceived social support was seen to account for 24% of the variance in MOIQ Factor 3 (degree of stress, change in commitments, and secondary coping resources to deal with it), and 11% of the variance in MOIQ Factor 2 (type of stress, negative attitude of harm, loss or threat, and viewing the illness as disabling, disfiguring and deteriorating). Content analysis revealed six major themes which described the subjects' feelings about how heart failure had affected their lives. The themes that were elicited were: physical limitations, surprise and disbelief, a need for knowledge, adjustment, support from significant others, and getting in touch with one's spirituality. (Abstract shortened by UMI.)

Despite evidence that organizational outcomes are negatively affected when professionals have limited decision making and their practice is constrained, little is known about the relationship of decentralized decision making (DDM) structures to the professional practice environment (PPE). In this study, the relationship of DDM to clinical nurses' perceived aspects of a PPE was examined. DDM consisted of the hierarchy of authority for work decisions and participation in strategic and unit group decisions. The PPE aspects of interest to administrators in complex organizations who are charged with organizational effectiveness include: control over practice, professional development, innovation activity, and peer relationships. Using a correlational design, data were collected from a random sample of 320 clinical nurses employed in a university teaching hospital. Instruments used included the Index of Centralization and the Professional Practice Environment Scale. Multivariate procedures were used to test hypotheses and to construct models. Authority for work decisions was positively related to the four aspects of PPE. Participation in decision making was positively related to all aspects except control over practice. Several individual and situational characteristics were found to moderate the relationship between DDM and PPE. Work pressure was statistically controlled. Model building showed that unit decision making was the most important variable in the relationships with professional development and innovativeness. Results contribute to organizational and nursing administration theory and are a useful guide for administrators to enhance PPE as a way to help manage constant change.

Objective. To describe a profile of school-aged children (5--14 years) living in shelters in Ottawa including risk and protective factors commonly associated with health related outcomes in children. Design. A descriptive research study using a pre-tested survey questionnaire designed by the researcher, based on the literature, and guided by a resilience framework. Setting. Three emergency family shelters in Ottawa. Participants. 34 parents with 61 children (aged 5 to 14 years) living at the shelters. Conclusions. Risk and protective factors at the individual, family, and community levels are presented. Protective factors of children living in shelters should be recognised, strengthened, and maintained. Efforts to minimise the risk factors should be undertaken. Implications for nursing practice and research are discussed. (Abstract shortened by UMI.)

The incidence of congestive heart failure (CHF) rises annually and, despite advances in medical treatments, the prognosis remains poor. Since CHF has no cure, the treatment is mostly supportive symptom management and prevention of exacerbation. Studies examining the impact of social support on CHF have found that social support helps to prevent hospitalization and helps patients with CHF adhere to the prescribed medication and lifestyle changes. The purpose of this study was to explore the meaning of social support to Arab Canadians with CHF. The Arab immigrant population is at risk of many health problems because of traumas associated with the immigration experience and limited knowledge of a complex health care system. The qualitative method of particularistic ethnography was used to gain a better understanding of the meaning of support in this cultural group. In depth, semi-structured, audio-taped interviews were conducted with a sample of 7 Lebanese Christian participants. The data analysis revealed 3 themes: "My family will take care of me"; "I rely on God"; and The illness is not important. Nursing implications and recommendations have been proposed to address the needs of this cultural group.

The nature of nursing judgment in clinical practice situations remains incompletely explored. It is known that nurses perform endotracheal suctioning as part of the nursing care of critically ill children. However, the ways in which nurses judge the need for suctioning and the method used to suction are not well understood. This research study was conducted to describe the cues that expert pediatric critical care nurses use in making the judgment to suction and to describe how those cues are used in determining the timing of endotracheal suctioning. A qualitative naturalistic study was conducted in a quaternary pediatric critical care unit in Central Canada. A purposive sample of seven expert pediatric critical care nurses participated in the study. Data were collected using three methods---participant observations (field notes), think aloud (concurrent verbalizations) and semi-structured interviews (retrospective verbalizations)---as participants cared for ventilated, critically ill children. (Abstract shortened by UMI.)

Cette thèse tente d'apporter une réponse nouvelle à la question de savoir comment pourrait être soulagée la souffrance humaine associée à l'annonce de l'imminence de la mort . Elle pose d'abord la question des savoirs disponibles quant aux causes de la souffrance en question, puis la question des pouvoirs permis par ces savoirs, qui permettraient de l'atténuer ou de l'éliminer. À chacune des questions, elle répond en termes des acquis disponibles ainsi qu'en termes de prolongements inédits. Elle procède, dans un premier temps, à l'identification d'invariants conceptuels dans tout discours sur la question de l'acquisition des connaissances, qu'il s'intéresse à des savoirs ou à des pouvoirs. Cette présentation culmine dans la proposition & un design computationnel, le Design Cognitif Universel, ou DCU, établissant une matrice formelle présentée comme pouvant servir à la formalisation de quelque fonction cognitive que ce soit. Au chapitre des savoirs , la thèse prolonge à la fois une tradition de recherche sur la douleur et la souffrance, et une tradition de recherche sur le Soi. La souffrance s'y trouve définie en référence à une comptabilité inhérente aux processus de gestion des structures de contrôle caractérisant l'individu, ces structures étant définies comme des mises en rapport d' intentionnalités et d' attentionnalités spécifiques se cristallisant sous la forme de divers Sois. Le nouvel éventail de Sois proposé s'inscrit sur deux axes, un premier axe métaphysique/physique et un second axe individuel/collectif, définissant un plan identitaire . La séquence des Sois physiques définissant la portion physique de l'axe métaphysique/physique est établie dans la foulée de la perspective génétique piagétienne. La notion d' Identité , comme schème-synthèse de la variété des Sois disponibles à chaque niveau de développement vient coiffer cette proposition générale. La souffrance associée à l'annonce de l'imminence de la mort devient souffrance associée à l'imminence de la perte du corps, au substrat physique, et devient le fait d'une menace Jugée incontournable aux rapports d'intentionnalité/attentionnalité constituant l' Identité Substrative . L'Identité Substrative ne reposant que sur une synthèse des Sois substratifs, à l'exclusion des Sois métaphysiques, la possibilité de développer, par le biais du Soi Formel, une Identité Transsubstrative, i.e. incluant les Sois métaphysiques en plus des Sois physiques, est évoquée. Cette Identité Trans-substrative est présentée comme dominant la mort, dont la portée ne peut, formellement, être conçue comme portant au-delà du domaine substratif, et comme permettant de contenir la souffrance associée à son imminence. Au chapitre des pouvoirs , la thèse prolonge une tradition de recherche sur les environnements d'apprentissage, en proposant de mettre au service de ceux et celles qui souffrent de l'annonce de l'imminence de la mort, un micromonde pédagogique, appelé micromonde corps/esprit, susceptible de favoriser leur transition d'une Identité Substrative à une Identité Trans-substrative.

In order to plan for a new community leg ulcer service, local evidence was required on the regional population with venous leg ulcers and the current state of community practice. There is strong evidence in the literature supporting the assessment and management of venous leg ulcers, but little is known about the local population profile or whether they were receiving the internationally recommended care. This is a manuscript-based thesis that consists of three distinct papers intended for submission for publication. The first two papers detail the planning studies that were undertaken to generate local evidence in order to design a new nurse-led community leg ulcer service. The first paper provides a population profile of the venous leg ulcer population receiving home care in one Ontario region. The second paper provides a critical appraisal of the state of community venous leg ulcer care. In the final paper, an advanced practice nurse (APN) reflects on her role in the design and implementation of the new service. The new leg ulcer service was designed using the evidence from the population profile and to address the gaps and inconsistencies in the provision of "best practice" that were identified in the appraisal of care. In this third paper, a number of barriers to the new evidence-based service were identified on a number of different levels and the multiple strategies tailored to the barriers were described.

This hermeneutic phenomenological inquiry centered on the broad questions: how do practising nurses experience reflection? Where, when, and how does reflection enter the experience of practising nurses? Seven long-term care nurses, a culturally cohesive sample, each participated in two audiotaped conversational interviews. Through these conversations, I gathered and explored experiential narrative material. A focus group with long-term care nurses from a different region enabled expansion, clarification and verification of the data. Descriptions and patterns emerged from the texts/data and I linked them to reflection dimensions and four fundamental lifeworld themes. Images of watching a movie, puzzling through, and putting the pieces together, capture the complexity of reflection. Three constructions illuminate the nurses' experience of reflection: reflection and the geography of everyday life; reflection in the between; and reflection is relation. These original and innovative understandings address an absence of practising nurses' experiences in the extant literature and contribute to scholarly knowledge. Implications for practice include accepting the challenge from the College of Nurses, reflective inquiry culture and reflection for practice. Reflection is in two modes, annual and everyday. A culture of reflective inquiry frames practice. The nurses act knowledge in practice. There is a curious absence of reflection in action/practice, and an environment unsympathetic to reflection and reflective practice. Reflection in the geography of everyday life is a remarkable contrast to the almost reified conceptions of or formulae for reflection. The language of the everyday characterizes these nurses' experience of reflection. Reflection terminology has infiltrated practice, but it is unclear if practice has changed. Does reflection contribute to improvement in nursing practice and patient outcomes? The intersubjective nature of nursing and reflection is so strong that relationships, rather than individual functioning, might become the primary unit for reflection reflecting. In the geography of everyday life, reflection moves from the mountain tops to the everyday. This creates the potential to develop a new and potentially different reflection discourse. This construction provides a direction for developing new ways of speaking in and about practice.

This study, conducted as a needs assessment, was guided by O'Connor's Decision Support Framework (DSF). The DSF describes a process of providing to both parents and practitioners decision support by identifying the sub-optimal determinants of the decision. The objectives of the study were to describe the decision making needs of parents making choices about neonatal male circumcision and the needs of prenatal instructors who inform parents about options. The study design was across-sectional survey of 88 mothers and 67 fathers and 10 prenatal instructors. Structured questionnaires were used, eliciting variables based on the DSF, such as: the perception of the decision; perception of others regarding the decision; resources to make the decision; and participant characteristics. Although all instructors stated that circumcision was discussed, the content of the discussion varied according to the instructor's experience and perception of the decision. Most instructors (9/10) believed parents lacked both information about options and chances of the benefits and risks. Few of the instructors (2/10) saw their role as instrumental in the decision. (Abstract shortened by UMI.)

Objective. To determine the perceptions of primary caregivers of premature and/or medically complex infants regarding information received prior to discharge from hospital and information and support needs four weeks after discharge from a Neonatal Intensive Care Unit (NICU). Design. Non-experimental descriptive design with administration of two questionnaires prior to and four weeks after discharge. Demographic information was collected prior to discharge. Setting. Prior to discharge, the NICU of a regional pediatric teaching hospital and four weeks after discharge, the home environment. Participants. Thirty of thirty-two (94%) consecutively discharged primary caregivers of premature and/or medically complex infants enrolled over a four-month period. Results. Information related to basic infant care was perceived to have been provided. Information related to infant environment, behaviour and development, the unique characteristics of premature infants and recognition of changes in infant's health status require more attention. Written information and a number of a place to call for information were wanted. Conclusions. Primary caregivers indicate the need for reinforcement of information provided in hospital once they are at home, especially in the area of infant behaviour and development and characteristics specific to the premature infant. This is relevant to program planning and a method to deliver and/or reinforce this information should be developed.

En depit de l'urgence d'evaluer la qualite des soins infirmiers en sante communautaire, ce domaine de recherche demeure peu explore. L'evaluation de la qualite des soins infirmiers en sante communautaire exige un cadre de reference capable de tenir compte des realites inherentes a l'exercice infirmier communautaire. Dans un domaine ou les habiletes relationnelles ont preseance sur les habiletes techniques, le cadre de reference supportant l'evaluation doit faire une place preponderante a la relation infirmiitre-client. Dans ce contexte, le concept du caring, tel que definit par Watson, apparai t un indicateur pertinent de la qualite des soins infirmiers. S'appuyant sur la theorie de Watson, cette recherche descriptive a pour but d'identifier les comportements infirmiers qui sont percus par les clients en sante communautaire comme demontrant du caring. Pour ce faire, une liste de 98 items correspondants aux dix facteurs de caring fut elaboree. Des 684 clients francophones ayant recu des soins infirmiers a domicile dans un CLSC de l'Outaouais, 158 retournerent le questionnaire dament rempli. Les resultats obtenus permettent de determiner la valeur relative des comportements infinniers et des dix facteurs de caring, telle qu'attribuee par les repondants. Ainsi, les clients en sante communautaire placent en premiere priorite les comportements infirmiers qui sont empreints d'humanisme et qui temoignent de la competence relationnelle de l'infirmiere. Les resultats suggerent egalement l'existence de differences dans les perceptions selon les besoins de sante, l'age et le degre de scolarite des participants. Le concept de caring apparait un indicateur de qualite valable et devrait etre integre a un modele d'evaluation de la qualite en soins infirmiers en sante communautaire.

Cette étude phénoménologique Heideggerienne vise à explorer et à décrire l'expérience de la souffrance et de la détresse spirituelle telles que vécues par des femmes atteintes d'un cancer du sein. L'échantillon se compose de six femmes sélectionnées dans un centre de cancérologie. Une entrevue servi-structurée a été réalisée auprès des participantes et les transcriptions verbatims ont constitué les données de ce projet de recherche. D'une part, la multidimentionnalité de la souffrance provoque de multiples pertes qui amène la destruction de l'entièreté de la femme. D'autre part, en réponse à l'expérience de la souffrance, les résultats d'analyse révèlent l'existence d'un processus dynamique de guérison en profondeur de nature spirituelle. Le cheminement évolue selon le cycle des cinq saisons de l'Arbre de Vie qui représente les différentes phases à compléter: (1) signal d'alarme; (2) perte; (3) métamorphose; (4) travail à accomplir et (5) guérison en profondeur. Des éléments clés tels que les réactions à la maladie, le soutien, l'espoir, le travail sur soi et la recherche de sens, favorisent le parachèvement de ce travail personnel menant vers la réconciliation de soi. La pierre angulaire de ce processus est une transformation intérieure qui implique une impression d'être accompagné par une présence supra-moi. De nombreuses implications pour les soins infirmiers découlent des résultats de cette étude ainsi que des pistes de recherche futures à réaliser auprès de femmes atteintes d'un cancer du sein.

Traumatic injury occurs without warning leaving no time to prepare. The patient may be frightened about the unknown, their future, or the prognosis. The patient arrives in the Emergency Department (ED) where assessment and management of injuries begins. Little is known about the patient's experience of trauma resuscitation. Therefore, a qualitative study using interpretive phenomenology was undertaken to describe the lived experience of trauma resuscitation in the ED. A total of seven participants were interviewed after they experienced trauma resuscitation in the ED of a Lead Trauma Hospital. Tape-recorded interviews were conducted on the in-patient Trauma Unit between day 2 and day 7 post trauma resuscitation. Follow-up interviews were conducted with four participant's seven to twelve months after the initial interview. Data analysis utilized Colaizzi's eight-step analytical process. Four themes were revealed in the data analysis: I Remember, I Was Scared, I Felt Safe, and I Will Be OK. The findings also revealed that initial perceptions of vulnerability subsided as a sense of feeling safe became prominent. System factors were acknowledged to influence the overall conviction that it was a positive experience. Lastly, nursing interventions were important in contributing to the participants' feelings of being safe. This suggests that comfort care measures need to be at the forefront of trauma nursing care as well as measures aimed at attaining physiological stability.

Au moyen d'une recherche qualitative de type exploratoire, la question de la prise en charge d'un proche parent âgé est abordée dans une problématique des rapports sociaux de sexe. Ce cadre analytique oriente nos réflexions nous permettant de faire ressortir l'importance des capacités intellectuelles d'organisation dans l'exécution du travail de soins effectué par les femmes et d'interroger la participation des conjoints. Les témoignages recueillis à partir d'entrevues réalisées auprès de femmes adultes s'occupant de leur mère ou belle-mère révèlent que le travail de soins nécessite l'élaboration d'une gestion temporelle par la prise en considération de temps institutionnels, dont les horaires des services spécialisés et des experts en santé ainsi que les temps personnels, dont le rythme de la personne âgée. Cet ensemble complexe et diversifié des tâches de soins et des autres activités de la vie quotidienne exige également une gestion de l'espace. L'accroissement du temps consacré aux soins de la personne âgée entraîne une réduction des déplacements. Les sorties à l'extérieur de la maison, en plus d'être réduites, sont davantage calculées et planifiées. Par ailleurs, l'analyse des données révèle l'importance du soutien affectif apporté par les conjoints à la retraite. Pour mettre en relief la gestion proprement dite des activités de soins et de la vie quotidienne et pour mettre en évidence la préoccupation constante exprimée par les filles se retrouvant dans des «échanges inégaux» avec leur mère nécessitant toujours plus de soins, nous suggérons d'utiliser la notion de «poids mental».

The purpose of this research was to investigate and describe the clinical learning environment, specifically how the clinical instructor in nursing education interacts with that environment to foster learning. Three supplemental questions were asked: what are the elements which comprise the clinical learning environment, what are the characteristics of these elements, and how does the clinical instructor cope with, adapt to, influence, and manipulate the environment? Symbolic interaction formed the philosophic foundation for the research approach used in the study. Key participants (clinical instructors, students, staff nurses, and head nurses) were invited to explain their experiences in their own works. These insights were coupled with participant observation and document analysis. The analysis of transcript units was facilitated by the use of a microcomputer and database software. All fields in the data base were identified by name of informant, date, site, and type of data (transcript, field note, memo), and further categorized as the data were analysed. As the data were unitized, key words and phrases were used to code the idea contained in the unit. As the number of units increased, themes and patterns began to emerge, and the units were constantly reevaluated and compared in light of these themes. Instructors were observed to be carrying out five major functions: personal orientation activities, preparation of the nursing unit to receive students, preparation of students for their clinical experiences on the unit, instructional activities, and monitoring and evaluation exercises. Four roles characterized her practice: coach, consultant, colleague, and counsellor. The clinical learning environment was conceived as being comprised of seven dimensions: personal, physical, social, curricular, contextual, political, and economic. A model was proposed to illustrate the environmental dimensions. No attempt was made to determine which dimensions of the clinical learning environment were most important. The intent of the study was to determine which elements existed and to describe them. In any given clinical learning situation all dimensions were more or less present. The teacher based her response to any situation on the prominence or salience of each dimension. The clinical learning environment was characterized by a set of four common characteristics, or properties. These properties were complexity, structure, stability, and opportunity. In attempting to manage the environment, the instructor viewed the clinical milieu in relation to her connection to the students and their learning needs. She wanted to be able to intervene directly in the milieu without her actions or decisions being mediated, compromised or thwarted by others. She viewed each clinical situation as a potential learning opportunity for her student, and worked to alter conditions where student learning might be hindered. Instructors acted to integrate college circular requirements with clinical experiences, creating circumstances from which students could learn what they needed and prepare themselves for their future roles and responsibilities in the profession. The author suggests that clinical instructors must begin to practice their craft with theoretical rationale for their strategies. There is a need for more planned educational and experiential preparation of clinical instructors. (Abstract shortened by UMI.)

The present investigation sought to investigate the coping strategies of chronic pain, acute pain patients and pain-free controls in three areas: (1) Clinical pain; (2) Experimental acute pain and (3) Non-pain stressors. Clinical pain coping strategies were assessed with the Coping Strategy Questionnaire (CSQ) while coping with a non-pain stressor was assessed by the Ways of Coping. Experimental acute pain was induced with a pressure pain device. Pain tolerance and pain ratings were taken. Following the acute-pain induction procedure, each subject's cognitions were scored and rated for the presence of two types of cognitions: catastrophizing and non-catastrophizing. The results indicated that non-catastrophizers kept their finger in the pain apparatus longer and rated the sensations as less painful. No significant differences however, were found among the three groups with respect to pain tolerance, pain ratings or cognitive style. The chronic pain group scored higher than the control group on a subscale measuring catastrophizing strategies. (Abstract shortened by UMI.)

The study was designed to answer questions about the amount of professional time required to manage the referrals made to the Ottawa-Carleton Health Department for public health nursing service to individuals and families. The basic assumption of the study was that variation in referral management time would be shown to be the product of both client-centred and provider-centred factors. The study design was both descriptive and exploratory in nature. The study population consisted of 1143 clients referred for public health nursing service during the latter months of 1987. To collect the necessary information, a data collection system was devised in which public health nurses recorded the amount of time they spent providing service for each new case. Based on the study results, modifications were proposed to the weighting system which had been used to predict the referral management component of the public health nursing workload. (Abstract shortened by UMI.)

There is a paucity of research that addresses the needs of families of persons with a brain injury. In addition, no studies have been found to date that focused on the nurses' perceptions of family needs in this population. Neuman Systems Model, which is based on stress and the reaction to stress, guided the study that was conducted on two neuroscience units in Ottawa, Ontario. The model is based on stress and the reaction to stress. The following objectives were addressed: (1) to identify the needs of family members of acutely brain injured patients (Traumatic Brain Injuries (TBI) and stroke) on a neuroscience unit; (2) to determine the relationship between nurses and family members in identifying family needs of patients with acute brain injuries; (3) to determine whether the family members perceive their needs are met and by whom; and (4) to compare the needs of family members of patients with TBI and stroke. (Abstract shortened by UMI.)

Nurses encounter many different populations of people every day and they must know how to treat them. Adopted children are a population that nurses encounter and there are disagreements concerning whether they are at an increased risk for developing behavioral problems as compared to biological children. It is also debated whether genetics or environment plays a more prominent role in childhood development. Most studies conclude that adopted children are at an increased risk for more behavioral problems due to the unique struggles and challenges they must overcome with genetics playing a bigger role than environment. Nurses can use this information to treat adopted children and their families more efficiently.

A 1998 research study lead by Dr. Andrew Wakefield linked the measles-mumps-rubella (MMR) vaccination as a probable cause to autism spectrum disorder. This publication has started a significant debate among healthcare professionals and instigated an anti-vaccination movement within the general population. This vaccination controversy was started by parents who readily accepted Wakefield's findings as truth and frequently would choose to withdrawal the administration of vaccinations from their children's care plans. There has also been disapproval by healthcare professionals over Wakefield's study since numerous research teams have been unable to replicate his findings. This disagreement surrounding the MMR vaccination is likely putting millions of people, mostly children, at risk of contracting horrific diseases. Brian Deer established the fraud in Wakefield's original study and rejected Wakefield's null hypothesis. Deer's seven years of investigation affirmed the countless research studies that rejected Wakefield's null hypothesis. Deer's analysis of Dr. Wakefield's study demonstrates how the public and the media can be blindly misled by scientific studies. When information has reached people's grasp, it is hard to retract false information once it has permeated millions of households, which is what needs to be accomplished regarding the truth behind the relationship between the MMR vaccination and autism. The medical world could benefit from knowing the cause of this detrimental disorder, in an effort to treat patients better and possibly someday cure them.

Recently, there has been a growing controversy, especially among evangelicals, over whether the birth control pill might have an abortifacient mechanism that sometimes causes early chemical abortions. An understanding of this controversy necessitates a clear definition of abortion, abortifacient, pregnancy, implantation, and especially personhood. If a zygote (fertilized egg) is not a person, then it has no fundamental rights and there is essentially no debate concerning the possible link between birth control pills and abortion. There is strong indirect evidence of post-fertilization, or abortive, effects of hormonal birth control. If zygotes are people, and birth control pills do kill them, health professionals and the public, especially Christians, need to be informed about the situation.

Hip fractures in elderly patients have very high postoperative mortality rates and the number of hip fractures in the United States is expected to increase exponentially before 2030. Early surgery is essential to improve outcomes, but patients on clopidogrel (Plavix) have a high risk for increased bleeding if surgery is performed within the usual 72 hour window. This paper presents literature and research addressing the dangers of delaying surgery versus undergoing surgery before the effects of the clopidogrel are gone. Based on articles published after 2006, most researchers advocated earlier surgical intervention than previously recommended and emphasized an individualized approached based on the clients' comorbidities and susceptibilities to select postoperative complications.

Obesity has become an epidemic in the United States, affecting individuals of all ages. Adolescents are particularly susceptible to obesity due to their decrease in physical activity, as well as to the greater availability of foods void of nutritional value. Adolescents' impressionable natures and changing bodies also contribute to their increased weights. To combat the problem of obesity, many schools have implemented obesity prevention programs. Most of these programs are based on physical education and nutrition education. However, some schools have started mentorship programs, or worked with organizations that employ mentorship programs, to prevent obesity. The Lynchburg Healthy Living program was created to teach at-risk adolescents about exercise and nutrition, as well as to provide them with a role model and coach in how to live a healthy life. The study examined effects of the program on participants' body mass index (BMI), self-reported nutrition and physical activity habits, and perceived health knowledge.

This case study attempted to discover and comprehend the relationship of students and contributing factors of success, of one Licensed Practical Nurse (LPN) to Associate Degree in Nursing (ADN) program, to formulate an understanding of which contributing factors are most beneficial to enable students to persist to graduation and/or successfully pass the national nursing licensure examination. Multiple methods of data collection were used; a survey mailed to each of the 86 nursing graduates, three follow up focus group interviews with six graduates per group, a focus group interview with four nursing faculty, observation in classroom and clinical settings, and document analysis. Participants interested in participating in the study gave voluntary consent by returning the research consent form. The data gathered through the results of the survey, interviews, observations, and document analysis provided a basis for determining the noncognitive contributing factors possessed by the students and how these factors are perceived, by the nursing graduate, as contributing to student success in the nursing program and on the national nursing licensure examination.

The purpose of this study was to describe depressive symptoms and sleep in first-time mothers. Predictors of postpartum depressive symptoms, including perceived stress, social support, and maternal adjustment were also examined. Another purpose was to compare objective and subjective sleep in mothers with and without depressive symptoms in the third trimester (Time 1) and at 12 weeks postpartum (Time 2).This descriptive, correlational, longitudinal, secondary analysis utilized data from two randomized clinical trials. Depressive symptoms, psychosocial measures, and subjective and objective sleep measures were collected on a sample of 161 first-time mothers between the ages of 18 and 43 years.The Center for Epidemiologic Studies Depression Scale (CES-D) was used to measure depressive symptoms. Mean CES-D scores at Time 1 (12.2 ± 7.0) significantly improved at Time 2 (8.8 ± 6.7). However, of the 46 women scoring in the depressed range at Time 1, 32.6 % (n = 15) continued to experience depressive symptoms at 12 weeks postpartum. Of the 115 women with minimal symptoms at Time 1, 7% (n = 8) experienced depressive symptoms at 12 weeks postpartum. Depressive symptoms and sleep disturbance were significantly associated at Time 1 and Time 2. Overall sleep disturbance, minutes to fall asleep, ability to stay asleep, and daytime sleepiness significantly improved from late pregnancy to 12 weeks postpartum. Women with depressive symptoms in the late third trimester and 12 weeks postpartum reported significantly more sleep disturbance, trouble falling asleep and more daytime sleepiness than women without depressive symptoms. Fifty-seven percent of the variance in mothers' depressive symptoms at 12 weeks postpartum was explained by six independent variables. However, antenatal CES-D score alone was a significant predictor of postpartum depression scores, accounting for 16.7% of the variance in depression scores at 12 weeks postpartum. The results of this study underscore the need for health care providers to assess depressive symptoms and sleep during pregnancy and during the first few postpartum months. Furthermore, results suggest that complaints of sleep disturbance, especially prolonged sleep onset latency and increased daytime sleepiness, may be relevant screening questions in relation to risk for postpartum depression.

Elderly Chinese residents in nursing homes in the United States experience cultural and language barriers, encounter Western health care practices, and have difficulty adjusting to a new environment. The purpose of this ethnographic study is to identify, describe, and analyze the factors: clinical, environmental, social, and cultural, that influence the care of elderly Chinese residents in nursing homes. Data were collected through participant observation and interviews on Chinese residents, their families, and nursing home staff at a 100-bed nursing home facility. The mission of this facility is to provide compassionate and quality care that recognizes the ethnic diversity of its residents. Kayser-Jones' Conceptual Model of Person-Environment Interaction was used to illustrate the effects that the interactions of multiple factors in the physical, organizational, personal-suprapersonal, and cultural and psychosocial environment have on elderly Chinese nursing home residents. It was found that the teamwork between the nursing home operator, Asian community, and the nursing home leadership team was important in helping this facility reach its goals in providing quality care. They have implemented and maintained an organizational structure with the goal of meeting the needs of the Chinese elders and the other residents in the facility (organizational environment). This affects the physical and cultural-psychosocial environment, as this team works together to provide a home-like environment sensitive to the needs of the Chinese residents (physical and cultural-psychosocial environment). Chinese elders seeking long-term care are thus drawn to this facility, one which supports an environment sensitive to the social, psychological, and cultural needs of this population (personal supra-personal environment). The outcome for the resident is that there is a good person-environment fit, resulting in high resident morale and self-esteem and thus, a high level of resident satisfaction. This research has shown that positive outcomes occur for Chinese elders in a nursing home providing culturally-specific care. These findings offer valuable information in helping to develop and implement interventions to improve the care of Chinese elders in nursing homes.

Squamous intraepithelial lesions (SIL) of the anal canal are similar in etiology and pathology to SIL of the cervix. Cervical cytology screening and colposcopy examination were adapted and validated for anal canal lesions. It is hypothesized that treatment of anal high grade SIL (HSIL), considered the cancer precursor lesion in both the cervix and anus, will prevent their progression to cancer similar to the decreased incidence of cervical cancer that occurred with the advent of cervical screening programs. Anal cytology and high resolution anoscopy (i.e., colposcopy of the anal canal) are becoming the standard of care, particularly for populations considered at risk which include immunocompromised individuals and men who have sex with men (MSM). This approach has led to an increased diagnosis of HSIL, an increased demand for clinicians trained in procedures to identify and diagnosis HSIL, and an increased need for treatment. The papers in this dissertation evaluate methods to improve the detection of anal HSIL as well as in vitro and in vivo studies of a treatment of HSIL using Traditional Chinese Medicine (TCM). The results indicate that lesion characteristics and Lugol's staining patterns associated with cervical HSIL are also associated with anal HSIL. The TCM ointment, used as part of a multi-modality treatment, was cytotoxic in three cervical cancer cell lines tested. Finally, the TCM treatment that consisted of weekly acupuncture and moxibustion, and daily self-applied TCM ointment and moxibustion was safe and feasible.

This dissertation considers how certified nursing assistants (CNAs) construct the bodies of nursing home residents and how they assign meaning to work that is commonly viewed in one way or another as "dirty", tainted, or undesirable. CNAs invoked dignifying discourses to reinterpret meanings of their stigmatized work to mitigate the degrading implications of their labors. Together, body constructions and dignifying discourses shape the hands-on, intimate care aides provide to nursing home residents.Observations and interviews were conducted with 27 aides in three different types of nursing homes in California. Other data included a content review of texts such as job descriptions and observations of aide training classes. All participants were people of color and, except for three aides, were first generation immigrants. Most were women and reflected U.S. demographics of CNAs working in metropolitan areas. Nursing assistants constructed three distinct views of residents: resident as fictive kin, resident as commodity, and resident as autonomous person. Related dignifying discourses supported each construct and helped produce enactments of care giving. Caring practices were influenced by institutional forces such as commodifying the physical body while cultural understandings entered the rhetorics of duty and caring. The dominant discourses did not arise from training or other official sources but were generated by aides themselves in the course of their work. These findings extend the concept of "dirty work" to nursing assistants and contest some conventional views that aides accept stigmatized labels of their work.Implications for practice confirm other studies that recommend changes in the length and content of aide training. These findings also offer possible directions for nursing home policies to enhance worker retention and satisfaction. Areas for future research include taking up the central inquires across several contexts, such as in rural nursing homes and among licensed nurses and residents and their families. Additionally, the increasing globalization of healthcare workers would benefit from a closer look at the way immigrant workers experience and practice carework.

Age Related Differences in Smoking Cessation OutcomesFor Women Hospitalized With Cardiovascular DiseaseDaniel M. Doolan RN, MSNABSTRACTBackground: Smoking is the number one preventable cause of death and disease. Smoking cessation has immediate health benefits, even among those who have smoked for many years. Despite the known risks of smoking and the benefits of cessation, the efficacy of smoking cessation interventions among older adults and women has received limited research attention. Objectives: To determine if there are age related clinical and demographic differences between older versus younger women with cardiovascular disease who smoke, and to determine if these two groups differ in their smoking cessation outcomes.Method: An existing data set from The Women's Initiative for Nonsmoking (WINS) is used for this study. The original WINS study was an RCT that tested the efficacy of a smoking cessation intervention for Bay Area women hospitalized with cardiovascular disease. The current study compares WINS participants who were 62 and older with those younger than 62. Results: The sample (n=277) contained 136 older smokers and 141 younger smokers. Older smokers were significantly more likely to be living alone, widowed, poorer, retired, have hypertension, and have multiple comorbidities. Older women were significantly less likely to be obese. Stanford Dependence Index scores showed older women had significantly lower levels of nicotine addiction. Older women were significantly less likely to have one or more housemates who smoke. At the 6 month follow-up, 52.1% of older smokers had quit smoking compared with 40.6% of younger smokers. At the 12 month follow-up, 52.0% of older smokers had quit smoking compared with 38.1% of younger smokers. The difference at 12 months was statistically significant. A Kaplan-Meier Survival Analysis found older women were significantly less likely to relapse over 12 months than younger women. Discussion: Older women with cardiovascular disease demonstrated extremely high rates of smoking cessation, higher even than younger women with cardiovascular disease. Further research is needed to determine how to optimize smoking cessation rates for older smokers. Clinicians should be sure to also include older smokers in smoking assessments and smoking cessation interventions.

Evaluations of Physiologic and Behavioral Responses to Noxious Procedures in Sedated, Ventilated Critically Ill Adult PatientsDenise Tsai-Yun Liu Li, RN, MS, PhDAbstractAcute pain is caused by strong noxious stimulation and is associated with unpleasant sensory and emotional signs and symptoms. The significance of acute pain in critically ill patients in the Intensive Care Unit (ICU) is well documented, yet a standardized objective measure of nociception for use in nonverbal ICU patients remains elusive. The purpose of this dissertation was to evaluate clinically useful physiologic and behavioral indicators of nociception for use in deeply sedated, nonverbal ICU patients. The first study was a prospective description of mechanically ventilated ICU patients' perceptions of pain, dyspnea, thirst, nausea, hunger, tired/fatigue, anxiety, generalized discomfort, depressed feelings. Fifteen medical and surgical patients who were able to self-reported symptom intensity rated their symptoms by was assessed by using numeric rating scales (0=none, 10 worst possible intensity). The study found that over 33% of the patients experienced moderate to severe pain, thirst, tiredness, anxiety, hunger, and generalized discomfort. The study highlighted the need to develop an objective measure for pain and other symptoms since many ICU patients are not able to provide a self-report. The second study addressed this problem by examining physiologic and behavioral indicators of pain as proxy measures in patients unable to provide a self-report. We compared changes in heart rate (HR), blood pressure (BP), pupil size, and cortical arousal per the Bispectral (BIS) Index, and behaviors between a noxious procedure [endotracheal suctioning (ETS) or turning] and a non-noxious procedure (gentle touch) in 48 sedated, ventilated ICU patients. Repeated measures of the outcome variables were taken at baseline, during the procedure, and after the procedure. The study found that HR, systolic BP, pupil size, and the BIS Index increased significantly during the noxious condition but not during the non-noxious condition (p

The purpose of this prospective, longitudinal repeated measures study was to explore the relationships between HIV-infected mothers' perceptions of uncertainty about infant HIV serostatus and maternal stress, distress, and social support during the infants' HIV viral testing. HIV-infected women were eligible to participate if they were at least 18 years old, English speaking, and were the primary caretaker for their infants. Six study visits were required: a visit during the third trimester of pregnancy and 5 postpartum visits clustered around infants' second and final HIV viral testing. Data collection included maternal and infant demographics, clinical variables, standardized questionnaires, and maternal responses to questions addressing their most worrisome concern. During the final study visit, maternal interviews about their infants' HIV testing were audiotaped and transcribed. Descriptive statistics, Pearson's r, and RMANOVA were used to analyze quantitative data; qualitative methods were used to analyze interviews. Twenty mothers enrolled: 40% African American, 40% white, 10% Hispanic, 10% Native American/Other; mean age = 32.25 years; mean education = 14.5 years. All infants in the study were determined to be HIV negative. Mothers were most concerned about infant health during the prenatal and early postpartum period. While infant concerns diminished after the second negative HIV test they rebounded prior to obtaining the final viral test. Family and psychosocial issues were the primary maternal concerns after infant viral testing was completed. Maternal health issues never surpassed infant or psychosocial issues as a primary concern. There was a significant decrease in maternal uncertainty about infant HIV serostatus over time (p

The Use of Transesophageal Echocardiography for the Assessment of Left Ventricular Volume and Function in Patients Undergoing Acute Normovolemic Hemodilution as a Human Hemorrhagic Model BACKGROUND: Since the development of the sphygmomanometer in 1896, the several methods to monitor volume resuscitation in hypovolemic trauma patients have been examined. Recently, transesophageal echocardiography (TEE) has been considered for this use. PURPOSE: This study examined the use of TEE for the assessment of left ventricular volume and function during graded blood removal in a human hemorrhagic model. DESIGN: Following IRB approval, 38 patients undergoing acute normovolemic hemodilution (ANH) intraoperatively were consented to have 15% of their total blood volume removed (according to ANH protocol) in 5% aliquots and stored in the operating room for re-infusion. After blood withdrawal, 5% aliquots of Hextend® was infused, equal the amount of blood removed. Left ventricular (LV) chamber dimensions and trans-mitral Doppler flow measurements were obtained with TEE at baseline and at each blood withdrawal and replacement of Hextend®. LV measurements analysis included: one-dimensional (1D) end-diastolic diameter (EDD), end-systolic diameter (ESD), and fractional shortening (FS); two-dimensional (2D) end-diastolic area (EDA), end-systolic area (ESA), and fractional area change (FAC); three-dimensional (3D) end-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction (EF); trans-mitral Doppler flow measurements of E and A-wave morphology. RESULTS: Statistically significant differences were demonstrated for measurements of: 1D EDD (p < .0001) and ESD (p < .0001); 2D EDA (p < .0001) and ESA (p < .0001) during blood removal. No statistically significant differences were observed for FS (p = .371) or FAC (p = .369). Statistically significant differences were demonstrated for 3D measurements of EDV (p < .0001) and EF (p = .002) during both blood removal and replacement with Hextend®. No statistical significance was observed with ESV measurements (p = .427). Only the trans-mitral Doppler measurement of peak E-wave velocity demonstrated a statistically significant difference (p < .0001). CONCLUSION: Although all measurements of LV dimensions can detect 5% changes during blood removal, 3D measurements of EDV and EF can detect changes during both blood removal and replacement of Hextend®, possibly making it better at guiding volume replacement during blood loss. Trans-mitral Doppler flow may not be as effective as a guide for fluid management.

This dissertation research examines Residential Care Facilities for the Elderly (RCFEs), often referred to as Assisted Living (AL), by considering policy and regulation, state licensing and monitoring systems and concerns regarding quality of care. The first study examines the intended and unintended consequences of federal and state policy and regulation affecting the Residential Care/Assisted Living industry. An economic framework forms the basis for the examination of two broad effects of policy: the availability of assisted living facilities, and residents' ability to afford those services. The conceptual framework is described and progresses through a description of illustrative policy domains and intended and unintended consequences are discussed. The second study proposes an adaptation of the Donabedian structure-process-outcome theory as a framework for designing and more effectively using the administrative data collected in the licensing and regulation of Residential Care/Assisted Living facilities. Structural components are represented by facility, staff and resident characteristics. Process components include the types of services available and safety and injury prevention. Possible outcome measures include deficiencies and complaints, changes of resident health status and quality indicators, and discharge and medical event data. Emphasis is on measures available in administrative records. The last study was designed to evaluate the applicability of adapting the State of California administrative data regarding Residential Care Facilities for the Elderly (RCFEs) into a statewide system to monitor the quality of care provided. A randomly selected sample of 340 facilities was identified from the 3349 facilities licensed in Northern and Central California. Stratification of the sample was by facility capacity and State district office. Data collection consisted of a five-year retrospective review of the public files maintained across offices. A conceptual framework was developed to identify components thought to be indicative of quality of care. Such information was abstracted from the public files for data analyses. Collected data were analyzed using various descriptive statistics. Findings suggest that substantial limitations in current State data sources exist, as do concerns regarding quality of care. Suggestions are made to inform future researchers to further evaluate and improve the current monitoring system and develop a comprehensive, accessible information system.

Background: Recent studies suggest that standard dose chemotherapy (CTX) may cross the blood-brain barrier. However, the evidence for CTX-induced cognitive impairments in breast cancer patients is inconsistent.Purposes: 1) to describe the literature about CTX-induced cognitive impairments in women with breast cancer; 2) to review the domains of cognitive function and their corresponding neuroanatomic structures as well as present current evidence for neurotoxicity associated with specific CTX agents and potential mechanisms for CTX-induced cognitive impairments; 3) to estimate the effect sizes for the effect of CTX on each domain of cognitive function; 4) to determine the sensitivity of neuropsychological tests which have been used to evaluate CTX-induced impairment in various domains of cognitive function in breast cancer patients; and 5) to assess changes in cognitive function over time in breast cancer patients receiving CTX, and evaluate potential relationships between cognitive function and anxiety, depression, fatigue, hemoglobin levels, menopausal status, and perceived cognitive function. Methods: We performed meta-analyses to measure effect sizes to determine CTX effect on various domains of cognitive function and to determine neurological test sensitivity. In the longitudinal study, we recruited a multicultural sample of thirty women with breast cancer for neuropsychological testing prior to the initiation and a week after completion of treatment with doxorubicin and cyclophosphamide CTX. Paired t-tests were used to evaluate changes in cognitive scores over time and linear mixed modeling was used to determine whether significant changes remained after controlling for anxiety, depression, fatigue, hemoglobin level, menopausal status, and perceived cognitive function.Findings: Only two domains of cognitive function (i.e., language, visual memory) had small albeit significant negative effect sizes in the meta-analysis of CTX-induced cognitive impairments in breast cancer patients. We evaluated thirty tests used to measure cognitive changes in breast cancer patients who received CTX, but found only six tests to be sensitive in detecting changes in four of eight domains of cognitive function (i.e., language, motor function, visuospatial skill, and verbal memory). In the longitudinal study significant decreases in cognitive function were found after CTX in visuospatial skill (p < .001) and total cognitive (p = .001) scores over time.

Assertive communication has been identified as key to maintaining safe operations in inpatient perinatal care. Perinatal nurses are positioned to detect and deflect evolving threats to patient safety, but evidence suggests nurses do not always take assertive action in response to clinical problems, and may be ignored when they do raise concerns. In contrast, evidence also suggests a direct effect for nursing on patient safety, but little is known specifically about how nurses keep patients safe. The purpose of this study was to articulate the direct contributions perinatal nurses make to maintaining safe care, and to identify processes affecting nurses' and other clinicians' agency for safety, or willingness to take a stand on issues of concern. This grounded theory study was conducted in two urban academic perinatal units with a purposive sample of 12 registered nurses, 5 physicians, and 2 certified nurse-midwives, using semi-structured interviews and participant observation. Data were collected and analyzed in an iterative fashion using the constant comparative method, dimensional, and situational analysis. Nurses maintained safety during labor and birth through skillful anticipation of the potential embedded in given clinical situations. They integrated medical and technical knowledge and skill with intimate knowledge of the woman and the operational context of care. Conditions and processes promoting skillful anticipation included being prepared, knowing, and envisioning the whole picture. Lack of available resources, fatigue, and environmental distractions challenged skillful anticipation and patient safety. Agency for safety fluctuated for all types of providers depending on the specifics of the situation. Agency was strongly influenced by interpersonal relationships. While physicians and CNMs believed they valued nurses' contributions to care, the units had deeply embedded hierarchies. Nurses were structurally excluded from important sources of information exchange and from contributing to the plan of care. Pervasive, mutually reinforcing segregation of activities by discipline impeded information flow, challenging safety. Nurses' confidence in their assessments was a key driver for asserting their concerns. Confidence was undermined in novel or ambiguous situations and by poor relationships, resulting in a process of redefining the situation as a problem of self and potential lack of persistence regarding their concerns.

Purpose: The purpose of this research was to describe registered nurses not working at all and those working in non-nursing compared to those working in nursing. Factors associated with registered nurses not working or working in non-nursing employment were examined in terms of sociodemographic characteristics, market factors, and political factors.Background & Significance: Empirical and anecdotal literature have demonstrated an exodus of registered nurses from the nursing profession. This study has policy implications for addressing these workplace losses.Conceptual Framework: This research was guided by economic labor market theory.Research Design & Methods: Secondary data from the 2004 National Sample Survey of Registered Nurses with a sample of 35,635 nurses was used for the analysis. A two-stage least squares model was estimated using a predicted market wage for all nurses in the sample and univariate probit equations were used. Key Findings: Nurses who worked in non-nursing and those who did not work at all were different from nurses who work in non-nursing. The main reason nurses gave for working in non-nursing was dissatisfaction with the nursing workplace. Salary was not a significant predictor controlling for other factors. Male nurses and nurses over the age of 45 were more likely to work in non-nursing than female nurses and younger nurses. Nurses with young children in the home, those with at least a baccalaureate degree in nursing, and those who lived in politically liberal counties were more likely to be employed in nursing than nurses without children, those in politically conservative states, and those with lesser education. Working in non-nursing was contingent upon not participating in the nursing market. Implications for Health Policy: New policy remedies are needed to recruit new nurses to nursing and to retain those who are leaving the profession. Continued salary enhancements in the absence of real changes in the nursing workplace will not contribute significant long-term solutions to the current nursing shortage.

Characteristics of Workers with Painful Acute and Chronic Low Back Pain in an Urban Occupational Medical Center Background: In the workplace, low back problems account for nearly a third of both occupational complaints and workers' compensation (WC) claims. Most low back pain (LBP) resolves within weeks or months. A small percentage becomes chronic or recurrent. This small group accounts for the largest percentage of costs in both personal and economic terms. Due to methodological variations in the literature, no firm conclusions regarding the natural history of work-related LBP can be reached. Objectives: To describe acute LBP in workers after recent injury (< 2 weeks) and determine the proportion that persist 3 months or greater. A second objective is to examine the relationship of predictor variables-gender, age, and history of previous LBP- and the outcome variable-development of chronic occupational low back disability. Design: The descriptive correlational study incorporates secondary data and a mailed questionnaire. Methodology: A database query identified 270 workers with LBP-related medical diagnosis codes (ICD-9) at an occupational medical clinic. A mailed questionnaire assessed post-injury symptoms, work status, and job satisfaction. Measures administered were the Oswestry Low Back Disability Index, Roland-Morris Disability Questionnaire, SF-12, and the Stanford Presenteeism Scale. Results: There were 38 workers with acute LBP in the sample; 65.8% attributed LBP to recent overexertion on the job. Twenty-three (60.5%) developed CLBP and fifteen (39.5%) had acute LBP that resolved within 3 months (binomial test, P = .10 (Z = 10.04, p < .0005). Predictors associated with CLBP were pain level, SF-12 Physical, Oswestry, Roland-Morris, previous LBP, radiating LBP, and perception of supervisor review of workers' rights. Conclusions: A high proportion of workers with acute LBP developed CLBP (60.5%). Fifteen (39.5%) had acute LBP that resolved within 3 months (median 38.0 days; QD 19.0). These finding suggest that acute OLBP, even when evaluated and treated early after report of injury, persists in many injured workers. This knowledge could support future prospective study of acute OLBP and early disability risk factors that predict CLBP disability.

Palliative care is an integral part of providing adequate care for pediatric oncology patients. Whether the cancer is terminal or treatable, palliative care helps patients live their lives to the fullest by improving quality of life. Therefore, it is important to have a system to define and measure quality of life. Once quality of life can be quantitatively measured, nurses can use pain and symptom relief, psychosocial support, and spiritual care to improve it. Pain management is essential to cancer recovery. Relief can be achieved through pharmacological or nonpharmacological methods; however, prophylactic pain relief is most beneficial. This means that the patient should be medicated or prepared to cope with the pain before experiencing the pain. Nonpharmacological methods are most valuable when adapted to the child's locus of control and cognitive coping skills. A caring nurse-patient relationship can encourage psychosocial and spiritual wellbeing through trust, understanding, presence, and support. Psychosocial support can help patients with any fears that they may be experiencing, such as the fear of losing normalcy or the fear of dying. Spiritual care can greatly influence the child's hope and purpose in life as well. These combined foci of palliative care can improve quality of life for pediatric oncology patients and help them to a more successful recovery.

Nurses play a vital role in the health and care of a patient. Through that care, the nurse has the ability to improve the patient's experience or ruin it. A vital component influencing the care provided are the emotions the nurse displays toward her coworkers, patients, and patients' family members. The emotions of a nurse may positively or negatively impact a patient. The studies that examine the impact of the nurse's emotions on patient's outcomes are varied and few. The communication and emotion of nurses are likely to impact their care and, from that, the patient's outcome; however, there is little solid research on the specific effects, be they positive or negative. A connection might be found in studies of Expressed Emotion in psychiatric patients. Expressed Emotion (EE) refers to the negative emotions the patients' family, and in newer research, that the patient's nurses, display to psychiatric patients that can lead to relapses in their condition. Correlations between emotion and outcome are strongly evidenced in EE research. Examining the empirical research that shows the impact of EE on patient outcomes may give insight on the impact of a nurse's attitude on patient outcomes as a whole.