ISSN:0029-6562    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background:Previous research on nurses' responses to ethical dilemmas has focused either on nurse characteristics or on practice environment characteristics, but has not examined both influences concurrently.Objective:To explore the relative contributions of practice environment characteristics and nurse personal and professional characteristics to perinatal nurses' willingness to be involved in activities to resolve clinical ethical dilemmas.Methods:A descriptive correlational design and hierarchical multiple regression were used to examine responses of 127 perinatal nurses to three instruments: the Nursing Ethical Involvement Scales (NEIS), Perinatal Values Questionnaire (PVQ), and Demographic Data Sheet (DDS).Results:The organizational variable, nursing influence, accounted for the greatest amount of variance in nurses' reported resolution actions, with nurses' concern about ethics and consequentialist values also contributing significantly. The three predictors together accounted for 31% (24% adjusted) of the variance in actions to resolve clinical ethical dilemmas. Level of nursing education was not a statistically significant influence.Conclusions:These results suggest that nurses are more likely to be involved in dilemma resolution activities when they perceive themselves to have higher levels of influence in their practice environments and higher levels of concern about the ethical aspects of clinical situations. Nurses who emphasize consideration of morally relevant aspects of individual patient situations (consequentialist value orientation) and deemphasize adherence to abstract standards, rules, and policies also are more likely to be involved in dilemma resolution.

ISSN:0029-6562    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background:Few studies have investigated the role that spiritual activities play in the adaptational outcomes of women with human immunodeficiency virus (HIV) disease.Objective:To examine the role of spiritual activities as a resource that may reduce the negative effects of disease-related stressors on the adaptational outcomes in HIV-infected women.Methods:A theoretically based causal model was tested to examine the role of spiritual activities as a moderator of the impact of HIV-related stressors (functional impairment, work impairment, and HIV-related symptoms) on two stress-related adaptational outcomes (emotional distress and quality of life), using a clinic-based sample of 184 HIV-positive women.Results:Findings indicated that as spiritual activities increased, emotional distress decreased even when adjustments were made for HIV-related stressors. A positive relationship between spiritual activities and quality of life was found, which approached significance. Findings showed that HIV-related stressors have a significant negative effect on both emotional distress and quality of life.Conclusions:The findings support the hypothesis that spiritual activities are an important psychological resource accounting for individual variability in adjustment to the stressors associated with HIV disease.

ISSN:0029-6562    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background:Both occupational conditions and individual factors have been shown as contributors to the likelihood of substance use among health professionals.Objectives:To assess the use ofWinick's (1974)model for explaining nurses' substance use, which asserts that groups with access to substances, freedom from negative proscriptions, and role strain have an increased likelihood of drug dependence.Methods:Data were analyzed from the 3,600 working nurses participating in the Nurses Worklife and Health Study, a nationally representative survey of registered nurses in the United States. A structural equation model was tested fitting workplace access to substances (availability, frequency of administration, and knowledge), freedom from negative proscriptions (internal: religiosity; external: social network), and role strain (job demands and depressive symptoms) to the frequency of past year alcohol, marijuana/cocaine, and prescription-type drug use.Results:Nurses were more likely to use substances when workplace access to substances increased (p< 0.001), with social networks containing more drug users, and when religiosity decreased (p< 0.001). Role strain (measured through job demands and depressive symptoms) also was related to substance use. Depressive symptoms were related directly and negatively to substance use (p< 0.01), whereas job demands were related indirectly to substance use through depressive symptoms.Conclusions:Winick's model has use in explaining nurses' substance use. Research and preventive initiatives should consider the multidimensional aspects of substance use in nurses.

ISSN:0029-6562    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background:Alternative strategies for exercises that provide both training and relaxation benefits are optimal for persons with very low functional capacities who also are at high risk for complications. T'ai Chi C'hih, a modified form of traditional T'ai Chi, is a series of slow balanced movements and breathing promoted to increase energy levels and induce relaxationObjectives:To estimate the energy costs and cardiovascular effects of T'ai Chi C'hih. Measured energy costs of specific activities can assist with safe exercise prescription for individuals with very low energy reserves.Methods:A convenience sample (n= 26) of healthy adults participated in this study, which involved completion of surveys to estimate functional capacity and exercise participation, training in a select series of nine T'ai Chi C'hih movements, and oxygen consumption testing while movements are performed. Movements involving front to back and lateral moves of the lower extremity, full shoulder range of motion of upper extremity, and deep forced inhalation and stepped exhalations were performed at slow to fast cadences in sitting and standing positions. The Human Activity Profile was used to estimate lifestyle energy consumption. Exercise participation was quantified as Kcal/Kg1expended per week.Results:Metabolic equivalents (METs) for sitting T'ai Chi C'hih movements were estimated to be 1.5 ± 0.17 and 2.3 ± 0.34 for slow standing, and 2.6 ± 0.47 for fast standing. Mean maximum heart rates ranged from 43% to 49% of predicted maximum heart rates. Mean increases in both systolic and diastolic blood pressures over resting were 8%. Mean METs of breathing exercises ranged from 3 to 3.6. There were no differences in responses to the movements by gender or experience with T'ai Chi exercise.Conclusion:The movements used to perform T'ai Chi C'hih require energy expenditure comparable with that for activities of daily living and for low level exercises currently recommended for persons with low exercise tolerance. Therefore, T'ai Chi C'hih may be an alternative approach to health promotion in many populations with chronic disease.

ISSN:0029-6562    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background:There have been no reports of validation studies on the nursing diagnosis of relocation stress syndrome (RSS).Objectives:To validate the presence of some defining characteristics of RSS in a group of long-term care residents relocated en masse to a new facilityMethods:This study measured the effects of relocation on 106 elderly residents moved from one long-term care facility to another. The presence of five characteristics defining the nursing diagnosis of RSS (dependency, confusion, anxiety, depression, and withdrawal) were measured using the Multidimensional Observation Scale for Elderly Subjects (MOSES) scale, a tool previously validated for use among similar groups of individuals. Using the Chenitz model of relocation, measures were taken twice before and twice after the move to examine changes in these characteristics over time. No extraordinary efforts were made to alleviate RSS.Results:Repeated measures analysis of variance indicated no differences in the mean scores (p< 0.05) on these factors overall or from one measurement period to another.Conclusion:On the basis of the findings from this research and supporting literature, the appropriateness of anticipating RSS during mass moves is questioned. Additional research with other measurement tools should be conducted to verify these results.

ISSN:0029-6562    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background:Information about fecal incontinence experienced by patients in acute-care settings is lacking. The relationship of fecal incontinence to several well-known nosocomial or iatrogenic causes of diarrhea has not been determined.Objectives:To determine the cumulative incidence of fecal incontinence in hospitalized patients who are acutely ill, and to ascertain the relationship between fecal incontinence and stool consistency, and between diarrhea and two well-known nosocomial or iatrogenic etiologies of diarrhea: Clostridium difficile and tube feeding. The relationship of fecal incontinence and risk factors for diarrhea associated withC. difficileand tube feeding in hospitalized patients was examined.Methods:Fecal incontinence, stool frequency and consistency, administration of tube feeding and medications, severity of illness, and nutritional data were prospectively recorded in 152 patients on acute or critical care units of a university-affiliated Veterans' Affairs Medical Center. Rectal swabs and stool specimens from patients were obtained weekly forC. difficileculture.C. difficileculture and cytotoxin assay were performed on diarrheal stools.HindIII restriction endonuclease analysis (REA) was used for typing ofC. difficileisolates.Results:In this study, 33% (50/152) of the patients had fecal incontinence. The proportion of total surveillance days with fecal incontinence in these patients was 0.50 ± 0.06. A greater percentage of patients with diarrhea had fecal incontinence than patients without diarrhea (23/53 [43%] vs. 27/99 [27%];p= 0.04). Incontinence was more frequent in patients with loose/liquid stool consistency than in patients with hard/soft stool consistency (48/50 [96%] vs. 71/100 [71%];p< 0.001). The proportion of surveillance days with fecal incontinence was related to the proportion of surveillance days with diarrhea (r= 0.69;p< 0.001) and the proportion of surveillance days with loose/liquid stools (r= 0.64;p< 0.001). Multivariate risk factors for fecal incontinence were unformed/loose or liquid consistency of stool (RR = 11.1; 95% confidence interval [CI] = 2.2, 56.7), severity of illness (RR = 5.7; CI = 2.6, 12.3), and age (RR = 1.1; CI = 1, 1.1).Conclusions:Fecal incontinence is common in hospitalized patients who are acutely ill, but the condition was not associated with any specific cause of diarrhea. Because loose or liquid stool consistency is a risk factor for fecal incontinence, use of treatments that result in a more formed stool may be beneficial in managing fecal incontinence. However, treatments that slow intestinal transit should be avoided in patients withC. difficile-associated diarrhea.

ISSN:0029-6562    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background:Subject dropout from a prospective, longitudinal trial can produce biases in the remaining sample that affect study findings and their interpretation, yet little is known about factors contributing to dropout.Objective:To determine characteristics differentiating those who complete from those who drop out of a longitudinal multicenter clinical trial.Methods:In this study, 578 parents and other caretakers of infants at risk for cardiopulmonary arrest enrolled in a longitudinal trial investigating the psychosocial impact of cardiopulmonary resuscitation training. In this secondary analysis, the baseline sociodemographic, emotional, psychosocial, and infant characteristics of those who dropped from the trial were compared with those who completed the study.Results:The study was completed by 60% (n= 347) of the participants. Those most likely to drop out were fathers or other caretakers (vs. mothers) employed outside the home who spoke English (vs. Spanish); were assigned to an experimental group (vs. a control group); had higher levels of depression, hostility, and overall psychosocial distress; and held negative views about health care.Conclusion:Although a few sociodemographic characteristics differentiated dropouts from completers, personal, emotional and psychosocial factors were the predominant predictors of dropouts. Other reputed sources of retention difficulties (e.g., income, education, minority status, lack of social support, or problems with family functioning) did not predict dropout.

ISSN:0029-6562    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background:Recognizing the increasing attention being given to reports of misconduct, fraud, and unethical behavior in biomedical research, it appears timely for nurse researchers to engage in an organized method of peer review.Objectives:To describe an auditing process for funded research grants, the guidelines used to conduct the research audit, and the results to date.Methods:The audit encompassed National Institutes of Health (NIH)-funded projects and their respective research teams, 12 faculty auditors using an audit worksheet developed by the Center for Nursing Research.Results:Overall, auditing of research grants was viewed positively by both investigators and faculty auditors. Minor problems were identified that could be corrected. Only one grant required a second review.Conclusions:Specific guidelines are proposed for future audits that include level of funding and timing of audits.

ISSN:0029-6562    

出版商:OVID    

年代:2000

数据来源: OVID