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Abstract: Background: Studies that assessed predictors of patient delay to seek healthcare for acute myocardial infarction lack generalization to all patient population as it investigated patients who survived coronary events. Objectives: To evaluate utility of using surrogates to proxy patients who cannot be interviewed and to examine patients–surrogate agreement. Design: A cross-sectional descriptive survey study. The cognitive and emotional domains of the modified Response to Symptoms Questionnaire were used to interview participants. Participants and settings: A convenient sample of patient–surrogate pairs was collected (n =109). Hospitalized patients with acute myocardial infarction were eligible if they were at least 18 years old, hemodynamically stable, pain free or controlled pain during interview, and could identify a surrogate. Exclusions (n =45) were patients transferred from other hospitals or those who had acquired heart attack following their admission. A surrogate was defined as an individual who witnessed the onset of symptoms and whom the patient has articulated symptoms with prior to admission. Methods: Patient and surrogate were interviewed independently. Decision delay time was assessed by assisting participants and surrogates to triangulate the time of symptom onset and time of decision to seek help by placing it in the context of events that they would remember. The intraclass correlation coefficient was used to assess agreement. Results: Patients were mainly men (81%), married (79%) and ranged in age from 39 to 78 years while surrogates were mostly women (74%) and 55% of them were patients’ spouses. Surrogates ranged in age from 18 to 75 years. Intraclass correlation coefficients levels varied across different variables ranging from lack of agreement (p >0.05) to almost perfect agreement with decision delay time having the highest correlation coefficient (86%, p <0.05). Cognitive variables had higher agreement than emotional variables. Significant emotional variables’ agreement ranged form 28% to 39% and significant cognitive variables’ agreement ranged form 64% to 68%. Female surrogates (n =81) had higher agreement levels with their respective patients than male surrogates (n =28). Conclusions: Utilizing surrogates to proxy patients’ account of decision delay time and its cognitive predictors is practical and feasible. [ABSTRACT FROM AUTHOR]

Faculty at the University at Buffalo designed and implemented a mock cardiac arrest that involved joint participation by both undergraduate and graduate students. Various instruments were developed to evaluate the effectiveness of this teaching modality, including scales that measured pre- and postsimulation knowledge and confidence. Students were also asked to evaluate the strengths and weaknesses of the experience especially regarding teamwork during an emergency situation. Management of the arrest by the graduate students was evaluated using a scale that included competency criteria related to assessment, diagnosis, treatment, and resource management. Undergraduate students' performance was also evaluated. Using paired t-test statistics, postsimulation knowledge scores were significantly higher than presimulation scores (p = .000), while postsimulation confidence scores were not statistically significant (p = .177). Students at both levels reported high satisfaction with the experience and with the opportunity to participate in a simulated cardiac arrest as a member of the health team. The use of a computer-assisted human patient simulator involving different levels of nursing students appears to be an effective teaching method; more investigation into specific outcomes is needed. [ABSTRACT FROM AUTHOR]

The study was designed to compare the efficacy of controlled simulation mannequin (SM) assisted learning and case study presentation on knowledge and confidence of nurse practitioner (NP) students in managing a cardiac event. Twenty-three volunteer students were randomly assigned to the experimental (simulation) or control (case study presentation) group. All participants were instructed on atrial arrhythmias, were pre- and post-tested on knowledge and confidence, and completed an evaluation of the experience. There were no statistically significant differences in knowledge test scores, although the control group scored significantly higher on post- test confidence (p=.040). Both groups rated their experience as valuable. The simulation and case study presentation had similar outcomes. Additional research is needed to determine the effectiveness of this teaching modality. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine changes in self-efficacy after attending a pulmonary rehabilitation program. Twenty-nine subjects with chronic obstructive pulmonary disease (COPD) were enrolled in the program, which was designed to increase patients' confidence in their own ability to manage breathing difficulty in certain situations. Results showed a significant improvement (p < .05) in scores on the COPD Self-Efficacy Scale between preprogram and postprogram attendance. These findings were still evident at 6 months following program attendance. Incorporation of self-efficacy theory should be considered in the rehabilitation of individuals with COPD. [ABSTRACT FROM AUTHOR]

In patients with asthma, is budesonide (BUD) plus formoterol (FORM) (BUDFORM) for both maintenance and symptom approximately C relief more effective than fixed dosing using BUDFORM or a 4 fold higher dose of BUD, both with a short acting (beta2 agonist (SABA), for reducing the rate of severe asthma exacerbations?METHODSDesign: randomised controlled trial.Allocation: concealed.Blinding: blinded (patients and healthcare providers). Follow up period: 1 yearSetting: 246 centres in 22 countries.Patients: 2760 outpatients (mean age 36 y, 55% women/girls; 12% children 4-11 y) with asthma who were using inhaled corticosteroids (ICSs).Intervention: BUDFORM (BUD, 80 microg plus FORM, 4.5 g) both for maintenance and as needed (BUDFORM for all, n = 925); BUDFORM for maintenance plus terbutaline, 0.4 mg as needed (BUDFORM plus SABA, n = 909); or BUD, 320 g, plus terbutaline (BUD plus SABA, n= 926). All maintenance treatments were twice daily for patients 12--80 years of age and once daily for children 4-11 years of age.Outcomes: time to first severe asthma exacerbation (deterioration in asthma resulting in hospital admission or emergency department treatment, oral steroid treatment, or morning peak expiratory flow 70% of baseline on 2 consecutive days).Patient follow up: 99.7% of patients were included in the intention to treat analyses.MAIN RESULTSTime to first severe exacerbation was longer in the BUDFORM-for-all group than in the BUDFORM plus SABA group or BUD plus SABA group (p values <0.001). Fewer patients in the BUDFORM-for-all group than in the BUDFORM plus SABA group or BUD plus SABA group had >/= 1 severe asthma exacerbation (table).CONCLUSIONIn patients with asthma, budesonide plus formoterol (BUDFORM) for both maintenance and symptom relief was more effective than fixed dosing using BUDFORM or a 4 fold higher dose of budesonide, both with a short acting beta[2] agonist, for reducing severe asthma exacerbations. [ABSTRACT FROM AUTHOR]

In patients with acute asthma, is inhalation of beta2 agonists from a metered dose inhaler (MDI) with a holding chamber more effective than inhalation from a nebuliser for reducing hospital admission rates or duration of inpatient stay?METHODSData sources: Cochrane Airways Group Trials Register (November 2002), the Cochrane Library (2002, Issue 3), bibliographies of relevant articles, and individual researchers in the field.Study selection and assessment: randomised controlled trials (RCTs) published in any language that compared any beta2 agonist given by an MDI with any holding chamber with the same beta2 agonist given by any nebuliser in adults or children with acute asthma presenting for medical assistance in the hospital emergency department.Outcomes: admission to hospital and duration of inpatient stay.MAIN RESULTS22 RCTs (444 adults and 1076 children) from emergency and community settings and 5 RCTs (28 adults and 184 children) of inpatients met the selection criteria. Meta-analyses were completed using a fixed effect model. RCTs from emergency and community settings. The groups did not differ for rates of hospital admission in adults or children (table). In children, duration of stay in the emergency department was shorter in the holding chamber group than in the nebuliser group (weighted mean difference [WMD) -0.47 h, 95% CI -0.58 to -0.37) (2 RCTs). In adults, the groups did not differ for duration of stay in the emergency department (WMD 0.02 h, CI -0.4 to 0.44) (2 RCTs). RCTs of inpatients. Meta-analysis of 2 RCTs showed that the groups did not differ for duration of admission (WMD 0.26 h, CI -0.23 to 0.75).CONCLUSIONIn patients with acute asthma, inhalation of beta2 agonists from a metered dose inhaler with a holding chamber is as effective as inhalation from a nebuliser for reducing hospital admission rates and duration of inpatient stay. [ABSTRACT FROM AUTHOR]

Limited evidence exists as to the most effective ways to provide simulation experiences to maximize student learning. This quasi-experimental study investigated 2 different strategies repeated versus 1 exposure and participation versus observation on student outcomes following exposure to a high-fidelity acute asthma exacerbation of asthma scenario. Immediate repeated exposure resulted in significantly higher scores on knowledge, student satisfaction and self-confidence, and clinical performance measures than a single exposure. Significant intergroup differences were found on participants' satisfaction and self-confidence as compared with observers. Implications for nurse educators include expanding the observer role when designing repeated exposure to simulations and integrating technical, cognitive, and behavioral outcomes as a way for faculty to evaluate students' clinical performance., (Published by Elsevier Inc.)

Purpose: The study was to understand the facilitators and barriers to exercise using exergames among assisted living residents, particularly in the area of cognitive, physical, and psychosocial effects., Design: Self-efficacy theory was incorporated into the design of the Wii Fit exergaming program., Method: Fifteen participants (mean age: 87.07 ± 3.92) received the program twice a week for 4 weeks. Semi-structural individual interview was conducted after the program. Interview responses were analyzed using basic content analysis methods., Findings: Five themes emerged that facilitated participants? desire to exercise: (1) health and mobility; (2) increased alertness; (3) elevated mindset; (4) social interaction; and (5) structured program. Barriers to engage in exercise included: (1) age- or health-related impairments to exercise; and (2) unpleasant experiences related to exercise., Conclusions: An intervention incorporating self-efficacy and Wii exergames did result in the identification of cognitive, physical, and psychosocial benefits and barriers to exercise., (© 2015 Association of Rehabilitation Nurses.)

The aims of this study were to develop, implement, and evaluate a novel interprofessional standardized patient exercise (ISPE) with oral-systemic and interprofessional collaborative practice (IPCP) components. Dental students and doctor of nursing practice (DNP) students at one U.S. university participated in the simulation, which was primarily designed to test their teamwork skills. In spring 2014, DNP students worked in the dental clinics with dental students under the supervision of nursing and dental faculty members. To test the teamwork outcomes for both groups of students, a standardized patient (SP) scenario was designed to include multiple chronic medical diagnoses and an oral-systemic component. The exercise was filmed for later review. Outcomes measures included SP and student self-evaluations and faculty evaluation of student documentation. The primary outcome of interest from a dental standpoint was faculty evaluation of IPCP competencies derived from the Core Competencies of Interprofessional Collaborative Practice and were deemed to be observable by faculty when viewing the videotaped scenario. Eight teams of students participated with an SP trained in the scenario. Each team consisted of a DNP student, a fourth-year dental student, and a second-year dental student. All eligible students in the DNP class (n=20) and eight students from each dental class (approximately 110 each) participated. The results showed that the teams scored highest on the role/responsibilities subscale, indicating students were respectful of each other's roles and expertise and effectively engaged each other to develop strategies to meet the patient's needs. Scores on the three other subscales (values/ethics, interprofessional communication, and teams/teamwork) were also high. These findings appeared to support IPCP as a method to foster knowledge and respect for other roles and responsibilities, improve appreciation of teamwork, and encourage better communication among health care providers. The ISPE scenario provided an effective way to evaluate IPCP competencies.

The purpose of this study was to investigate the physical and psychosocial effects of the Wii Fit exergames incorporating self-efficacy theory on assisted living residents. The study was a quasi-experimental pre/post-test design. Thirty-two participants were recruited from two assisted living facilities. Sixteen participants received the Wii Fit exergames incorporating self-efficacy theory twice a week for 4 weeks. The other participants received a health education program. Physical function, fear of falling, depression, and quality of life were evaluated. T tests were used for data analysis. After the 4-week intervention, the Wii Fit group showed significant improvements in balance (p < .01), mobility (p < .01), and depression (p < .05). The education group showed no significant improvement in any of the outcomes. Integrating concepts of self-efficacy theory with the exergames show promise as a potential tool to improve and maintain physical and psychosocial health for older adults., (© The Author(s) 2014.)

Objective: The purpose of this review is to summarize and synthesize the impact of using the Nintendo Wii™ exergames in older adults., Method: A database search was conducted to identify relevant studies. The search was limited to empirical studies, with particular attention paid to the effects of Wii exergames intervention on cognition, physical function, and psychosocial outcomes in older adults., Results: A total of 22 empirical studies met inclusion criteria and were included in this review. Positive effects included improving physical function, decreasing depression, and increasing cognition and quality of life in older adults. Improved socialization and motivation to exercise were also reported., Discussion: Using Wii exergames does show promise as an intervention to improve physical function, cognition, and psychosocial outcomes in older adults. Evidence supports that Wii exergames is a safe and feasible tool to encourage older adults to engage in exercise., (© The Author(s) 2014.)

The physical and psychosocial benefits of exergames have been reported in various literature. A pre-posttest, single-group design was used to test the effects of an exergames-based intervention on cognition, depression, and health-related quality of life (QOL) in assisted living residents. Bandura's self-efficacy theory was applied. Seven residents (mean age = 86, SD = 5 years) participated in the program two times per week for 8 weeks. Outcome measures included cognition, depression, and health-related QOL. No statistically significant differences were found in any of the outcomes after the intervention. A tendency toward improved cognition occurred, but the outcomes of depression and health-related QOL did not follow a similar trend. However, improved socialization and motivation to exercise were reported. Continued research is needed to investigate the cognitive and psychosocial effects of exergames on this population. Nurses can collaborate with other health care professionals to engage residents in exercise and thus improve residents' QOL., (Copyright 2014, SLACK Incorporated.)

Pain in the spine is the most frequently described pain problem in primary care, afflicting at least 54 million Americans. When spinal pain becomes chronic, the prognosis for recovery is poor, often leading to disability and reduced quality of life. Clinical treatment is inadequate, often focusing on physical pathology alone. To improve treatment outcomes for chronic pain as recommended by current guidelines, the Biobehavioral Pain Profile (BPP), which includes six pain response subscales, was developed to guide cognitive behavioral therapy (CBT). The purpose of this study was to describe the BPP in 100 individuals with chronic spine pain and examine the associations between the BPP and important clinical outcomes, including chronic pain, disability, and quality of life. Participants reported a high level of pain, a low quality of life, and a high level of disability despite receiving treatment with opioids. Scores on BPP subscales including evaluating loss of control, past and current experience, physiologic responsivity, and thoughts of disease progression were elevated, indicating a need for CBT. Five of the six BPP subscales had a significant association with quality of life, chronic pain, and disability with the thought of disease progression being a strong factor for most of the clinical outcome variables. By identifying BPP, clinicians can provide appropriate treatments to improve individuals' quality of life and prevent further disability. Further study using the BPP to guide CBT is needed., (Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

The purpose of this study was to examine the feasibility of a self-efficacy based intervention using Wii exergames in assisted living residents. The study was a single-group pre- and post-test design. Seven older adults (aged 80-94 years) were instructed to engage in exergames twice a week for 8 weeks. Physical function (balance, mobility, and walking distance), fear of falling, self-efficacy for exercise, and outcome expectations for exercise were evaluated. All participants had enjoyable experiences and no serious adverse events were reported. Participants had significant improvement on balance. Although not significant, there were trends indicating that participants improved mobility, walking endurance, and decreased fear of falling. The use of Wii exergames was an acceptable, safe, and potentially effective approach to promote physical activity in older adults. Findings provide support for the applications of integrating self-efficacy theory into exergames as a mechanism to encourage older adults to engage in exercise., (Copyright © 2013 Mosby, Inc. All rights reserved.)

Purpose: To identify predictors of decision delay time for health care seeking among Jordanians with acute myocardial infarction (AMI)., Design: The study was a cross-sectional descriptive survey. A convenience sample of Jordanians with AMI were interviewed at the coronary care units of two teaching hospitals in Jordan., Methods: The Arabic version of the modified Response to Symptom Questionnaire was used to assess predictors of decision delay and patterns of health care-seeking behaviors. Decision delay was evaluated by assisting patients to triangulate time of symptom onset and time of decision to seek professional health care by placing both times in context of daily activities that participants could easily remember. Regression analysis was conducted to elicit predictors of decision delay., Findings: Decision delay time among Jordanian men (n=110) and women (n=24) with AMI was alarmingly long (medians 3.5 and 3.6 hours, respectively). Variables that correspondingly predicted decision delay among men and women were age, waiting for symptoms to go away, anxiety due to symptom presentation, and others' responses to patients' symptoms. While 16 other variables (cognitive, emotional, and clinical) independently predicted delay among men, equivalent evidence was not established among women due to the relatively small sample size., Conclusions: Similarities and differences existed between Jordanian men's and women's decision delay to seek health care for AMI. Decision delay time among Jordanians with AMI requires intervention that incorporates awareness of delay predictors. Future research needs to utilize adequate sample sizes of both sexes to obtain a better understanding of sex differences., Clinical Relevance: To reduce decision delay among Jordanians, health educators should emphasize early symptom recognition and the value of prompt health care-seeking behaviors.

Purpose: The purposes of this study were to survey nurse practitioners (NPs) to determine their comfort level with knowledge about caring for individuals aged 65 years and older and to obtain their input on enhancing geriatric content in the educational preparation of advanced practice nurses who provide care to older adults but are not specialists in gerontology., Data Sources: The sample consisted of 500 randomly selected NPs who were certified to practice in New York State. The Geriatric Curriculum Survey designed by the researchers was based on the 47 "Older Adult Care" competencies developed by the American Association of Colleges of Nursing. The survey was mailed to the subjects along with a stamped self-addressed envelope to facilitate its return. Two hundred and twenty-two surveys (44%) were returned., Conclusions: A majority of the respondents were comfortable with their assessment skill knowledge of individuals aged 65 years and older in all areas except those related to cultural/ethnic items. Over half of the respondents were only "somewhat comfortable" with knowledge of management of Alzheimer's disease, delirium, dementia, neurological problems, polypharmacy, and sleep issues. Finally, respondents were asked to rate their knowledge comfort level on topics relevant to physical and psychosocial issues of individuals aged 65 years and older. The majority of respondents only felt "somewhat comfortable" with their knowledge on all but one of the nine items in this category. Health promotion and disease prevention was the only item that over 50% of the respondents felt "very knowledgeable" about. Ninety-five percent indicated they would be better prepared to care for individuals aged 65 years and older if a didactic course in geriatrics was required in their program of study. Seventy percent indicated they would consider taking an online course in geriatrics., Implications for Practice: Based on the results of this study, an online, four-credit geriatric-focused course "Issues in Geriatric Management" was developed. The course is required in the acute care and adult NP programs. Eventually, this course will be offered as continuing education credit for practicing NPs. The offering of a course focused on geriatrics will help to better prepare NPs to care for the growing number of elderly in this country.

Full-body patient simulators have been used for a number of years to educate nurse anesthetists and anesthesiologists. These lifelike mannequins operate from a sophisticated computerized system with the ability to generate multiple physiologic events and respond to numerous pharmacologic stimuli. The authors recently integrated the use of the patient simulator into the curriculum to educate their acute care nurse practitioner students. The learning process was divided into three steps: the presimulation experience, the simulation experience, and the postsimulation experience. These steps are described as well as important principles that need to be integrated into each phase of the process. A case scenario on respiratory failure provides an example of the simulation experience. In addition, the advantages and disadvantages of this teaching method, as identified by faculty and students, are discussed.

Purpose: The purpose of this study was to examine the relationship between knowledge, attitudes, and self-efficacy and compliance with prescribed medical regimen, number of emergency department (ED) visits, and hospitalizations in adults with asthma., Method: The sample consisted of 29 adults with a diagnosis of asthma. The relationship among knowledge, attitudes, self-efficacy, and compliance with medical regimen was explored through use of a survey design. The Knowledge, Attitude, and Self-Efficacy Asthma Questionnaire and the Asthma Management Questionnaire that measured compliance were mailed to subjects' homes. Once completed, questionnaires were returned, and demographic data and number of ED visits and hospitalizations were obtained through a retrospective chart review., Results: There was a significant correlation between knowledge and attitudes and knowledge and self-efficacy. The more positive persons' attitudes toward their asthma, the higher their knowledge and self-efficacy scores. There were significant correlations between select demographic variables and knowledge, attitude, and self-efficacy. Women scored higher on attitudes, persons with a college education scored higher on knowledge and attitudes, and persons with mild asthma scored highest on the self-efficacy scale. Compliance with use of peak-flow meters correlated with higher scores on the attitude and self-efficacy scales. The higher total compliance score group had significantly higher self-efficacy scores. In addition, higher self-efficacy scores correlated with lower numbers of hospitalizations., Conclusion: Attitudes and self-efficacy rather than knowledge had the most significant impact on compliance and number of ED visits and hospitalizations. The Knowledge, Attitude, and Self-Efficacy Asthma Questionnaire provides a means for nurses to assess patients' knowledge, attitudes, and self-efficacy regarding their asthma. Patients with low scores could be channeled into programs that would help them improve their ability to manage their asthma.

This study compared the effects on self-efficacy of participation by patients with chronic obstructive pulmonary disease (COPD) in a pulmonary rehabilitation program that combined education and supervised exercise training with the results demonstrated by participation in a program that provided education alone. Thirty-seven patients participated in the pulmonary rehabilitation program, and 22 patients participated in the education-only program. Self-efficacy, as it effects managing or avoiding breathing difficulty, was measured before and after the programs. Patients' self-efficacy scores significantly improved after the pulmonary rehabilitation program and remained significantly improved 6 months later. Education alone was also effective in significantly improving self-efficacy scores, but patients' scores 6 months later were not significantly better than preprogram scores. This study indicates that a rehabilitation program that combines education and exercise training is more effective in improving long-term self-efficacy in patients with COPD.

Objective: To determine the effect of attendance at an outpatient pulmonary rehabilitation (OPR) program on changes in self-efficacy, perception of dyspnea, and exercise endurance in patients with chronic obstructive pulmonary disease (COPD)., Design: Single-group, pretest and posttest design., Setting: A moderate sized, urban private hospital in western New York., Patients: Sixty patients with a diagnosis of COPD. Their ages ranged from 35 to 82 years (mean +/- SD = 65 +/- 0.75 years)., Outcome Measures: Scores on the COPD Self-Efficacy Scale (CSES) and the Dyspnea Scale and distance walked (feet) on the 12-minute walking-distance test (12 MD)., Intervention: The OPR consisted of an educational component and exercise training. Methods to increase self-efficacy were integrated into the rehabilitation program. Preprogram and postprogram measurements were obtained on the CSES, the Dyspnea Scale, and the 12 MD., Results: Paired t tests were used to examine the differences in mean scores between preprogram and postprogram results on the CSES, the Dyspnea Scale, and the 12 MD. There was a significant difference between preprogram and postprogram scores on the CSES (p < 0.01), the Dyspnea Scale (p = 0.01), and the 12 MD (p = 0.04). Pearson product moment correlations showed a significant negative correlation between scores on the CSES and scores on the Dyspnea Scale (r = -0.5566, p = 0.01) and a positive correlation between scores on the CSES and the 12 MD (r = 0.4293, p = 0.05). These results indicated that higher self-efficacy scores on the CSES were correlated with lowered perception of dyspnea and greater distances walked in 12 minutes., Conclusions: An OPR can improve self-efficacy or confidence in participants' ability to manage or avoid breathing difficulty. Improvement in self-efficacy also may be a factor in decreased perception of dyspnea and increased exercise endurance. Methods to increase self-efficacy expectations with education and exercise training provide an approach to assist persons with COPD to manage their breathing difficulty more effectively. Further studies using a randomized experimental, control design are needed to provide more conclusive direction with regard to effective methods in pulmonary rehabilitation.

The predominant debilitating symptom in patients with chronic obstructive pulmonary disease (COPD) is shortness of breath. Self-efficacy theory has been used in a case study approach to begin examining the expectations of a patient with COPD who attended a pulmonary education program. Mr. M. was selected for the case study because his condition typifies many of the problems encountered by patients with COPD. Mr. M.'s self-confidence in managing his breathing difficulty was measured by using the COPD Self-Efficacy Scale (CSES) before an educational program began and again 1 month and 6 months after the program. The CSES measures patients' confidence in their ability to manage or avoid breathing difficulty in a variety of situations. Mr. M.'s scores on the CSES improved in most areas. Incorporating programs to increase patients' self-efficacy may have implications for rehabilitation nurses who help patients with COPD manage their breathing difficulty.

The effect of a case study approach on attitudes of sophomore nursing students toward caring for patients with AIDS was examined. Pre- and post-program attitudes of 36 students were measured using an AIDS questionnaire. No significant differences were found between pre- and post-program scores on the questionnaire. An examination of change scores for individual items on the questionnaire indicated that the case study approach may have been helpful in making the students more aware of the multifaceted problems facing patients with AIDS.

Objective: To determine practice and attitudes of acute-critical care nurses toward the use of physical restraints., Design: Survey with a self-administered anonymous questionnaire., Subjects: A self-selected sample of 235 acute-critical care nurses from 17 states who were enrolled in critical care review classes., Measurements: Data were gathered by use of a questionnaire developed by the researchers. The questionnaire was designed to elicit information regarding demographic and professional characteristics, nursing practice, and attitudes toward the use of restraints. Nurses responded to the practice items on a three-point Likert Scale as to whether they "always," "sometimes," or "never" carried out the procedure. To obtain information on attitudes, nurses were asked to respond on a three-point Likert Scale as to whether they "agreed," were "undecided," or "disagreed" with the statement., Results: Responses indicated 78% of the sample "always" try alternative nursing measures before restraining the patient. However, when units were believed to be understaffed there was more reliance on restraints. Thirty-eight percent of the sample would "always" rather sedate patients than physically restrain them. The overall score on the attitude component of the questionnaire reflected positive or acceptable attitudes toward the use of restraints. Most (62%) "agreed" that a patient suffers a loss of dignity when placed in restraints. Significant relationships did exist between select demographic and professional characteristics and practice and attitudes regarding the use of restraints. The longer the respondents had worked in critical care the more appropriate (positive) their attitudes toward the use of restraints (r = -.211, p < .01)., Conclusions: In general, nursing practice and attitudes regarding the use of physical restraints indicated that respondents were using restraints in accordance with accepted practice. There is a need for additional research in this area, especially regarding the use of alternative measures to physical restraints.

The purpose of this study was to examine nurses' attitudes toward caring for patients with AIDS in a longitudinal context. Results of the 1990 survey were compared with those of a survey conducted in 1986 for the purpose of examining changes in attitudes over time. Findings indicated that there were no significant differences between the 1986 and 1990 scores on the attitude scales. The results of the study indicated that many nurses still have fears and concerns about caring for patients with AIDS.

A retrospective 5-year random sample of 196 charts of patients with asthma was obtained from two hospital-based outpatient clinics. The chart reviews showed that age- and severity-matched males and females with asthma were prescribed antihistamines in similar proportions; however, 16.8% of the females were prescribed a tranquilizer or sedative compared with 8.5% of the males. The females (8.7%) also were prescribed a combination of these drugs, or two tranquilizers; none of the males were prescribed more than one CNS depressant. Results showed that, in this study, females were prescribed CNS depressants three times as often as males.

The purpose of this research was to study the long-term effects of attendance at "Help Yourself to Better Breathing" classes on knowledge attainment, coping strategies, and anxiety, depression, and hostility in individuals with chronic obstructive pulmonary disease. Data were gathered immediately and six months following completion of the program. The results were then compared to those obtained before program attendance. The data showed a significant difference between the pretest, immediate post-test, and the six-month knowledge scores. Coping scores remained the same, which may indicate that not enough emphasis is placed on the development of these skills. There was a significant lowering of the depression scores at the six-month post-testing, and anxiety and hostility scores were lower, but not significantly so. In addition, some participants after the classes were completed chose to enroll in the Better Breathers Program support group and in a pulmonary rehabilitation program. Overall, this study indicates that beneficial effects are evidenced six months following attendance at "Help Yourself to Better Breathing" classes.

Although the use of physical or mechanical restraints is decreasing in long-term care facilities, there always will be some patients who require them. If a restraint is to be employed at all, it needs to be used correctly. A convenience sample of 118 nursing staff members who work in a county nursing home was asked to complete an 18-item knowledge questionnaire regarding restraint usage. Scores ranged from 6 to 17 (potential range 0-18), with a mean score of 13.2 (SD = 2.1). Overall, the staff's knowledge level can be considered good; however, there were some areas of concern. For example, a majority of the respondents (82.2%) believed that it was appropriate to keep a patient restrained lying flat in bed. Implications for administrators and rehabilitation nurse clinicians are identified.

Many clinical nurse specialists (CNSs) are involved in providing group teaching programs for individuals with chronic obstructive pulmonary disease (COPD). Although knowledge levels often are enhanced by these programs, what is less well known is whether such programs also can affect the coping methods used by those with this disease. The exploratory study described here was part of a larger research project aimed at determining patients' knowledge, specific psychological parameters (anxiety, hostility, depression), and coping strategies. Thirty people agreed to participate in the study. The Jalowiec Coping Scale (JCS) (Jalowiec & Powers, 1981) was used so that participants could rate each coping method according to the degree of use and to determine whether the methods employed were affective or problem-solving approaches. There was very little change in the pre- and posttest scores on the JCS, indicating that there was little change in coping strategies used. There also were no significant correlations between the JCS scores and the demographic characteristics of age, educational level, and the length of time since diagnosis of COPD. The results of this study seem to indicate that pulmonary rehabilitation programs should place more emphasis on appropriate coping strategies that the COPD patient can incorporate into his or her lifestyle.

This study provides a data base for developing intervention strategies aimed at helping staff cope with concerns regarding restraints. Most respondents believe patients should be restrained for safety even if it means loss of dignity, and that a caring manner should be conveyed to restrained patients. A large percentage felt that family members did not have the right to refuse the use of restraints, but that they should have that right if they were patients, suggesting negative attitudes toward restraints, of which they are unaware. Personal and professional characteristics, such as knowledge about restraints, years in geriatrics, and experience with elderly family members, showed no significant relationship to attitudes.

The purpose of this research was to study nurses' attitudes toward homosexuality and caring for homosexual patients. The results reported in this article are a component of a larger study of nurses' knowledge about and attitudes toward caring for patients with AIDS. The sample comprised 581 Registered Nurses residing in Erie County, New York. Data were gathered by mailed questionnaires. Results of the study indicate that issues concerning the care of patients with AIDS may be complicated by the fact that many of these individuals are homosexuals. The results of this research provide data for developing intervention strategies to help nurses cope with their concerns about caring for homosexual patients with AIDS.

This study describes knowledge about acquired immunodeficiency syndrome (AIDS) among a random sample of 581 registered nurses in Erie County, New York. Data were gathered by mailed questionnaires that included items about the epidemiology, pathophysiology, transmission, and treatment of AIDS. Substantial deficiencies in knowledge were observed. The mean score on an index of knowledge was slightly less than 70%. Respondents were most knowledgeable about the transmission of AIDS and least knowledgeable about issues pertaining to treatment and care. Nurses who had cared for patients with AIDS scored significantly higher overall than those without experience. These data document the need to provide continuing education programs for nurses to prepare them to meet the needs of the increasing AIDS crisis.