ISSN:0029-6562    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0029-6562    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundNurse staffing levels are an important working condition issue for nurses and believed to be a determinant of the quality of nursing care and patient outcomes.ObjectivesTo examine the effects of nurse staffing on adverse events, morbidity, mortality, and medical costs.MethodsUsing two existing databases, the study sample included 232 acute care California hospitals and 124,204 patients in 20 surgical diagnosis-related groups. The adverse events included patient fall/injury, pressure ulcer, adverse drug event, pneumonia, urinary tract infection, wound infection, and sepsis. Multilevel analysis was employed to examine, simultaneously, the effects of nurse staffing and patient and hospital characteristics on patient outcomes.ResultsThree statistically significant relationships were found between nurse staffing and adverse events. An increase of 1 hour worked by registered nurses (RN) per patient day was associated with an 8.9% decrease in the odds of pneumonia. Similarly, a 10% increase in RN Proportion was associated with a 9.5% decrease in the odds of pneumonia. Providing a greater number of nursing hours per patient day was associated with a higher probability of pressure ulcers. The occurrence of each adverse event was associated with a significantly prolonged length of stay and increased medical costs. Patients who had pneumonia, wound infection or sepsis had a greater probability of death during hospitalization.ConclusionPatients are experiencing adverse events during hospitalization. Care systems to reduce adverse events and their consequences are needed. Having appropriate nurse staffing is a significant consideration in some cases.

ISSN:0029-6562    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundAlthough there are many known benefits to exercise, only 10–30% of older adults report regular exercise. Understanding the factors that explain exercise behavior in older adults will help structure interventions that motivate these individuals to initiate and adhere to regular exercise.ObjectiveThe purpose of this study was to test the impact of components from two theoretical perspectives that explain exercise behavior, social cognitive theory, and the transtheoretical model.MethodsThis was a descriptive study using a sample of 179 older adults living independently in an East Coast continuing care retirement community (CCRC). A single one-time interview was completed and included: (a) stage of change for exercise, (b) self-efficacy and outcome expectations, (c) health status, (d) fear of falling, and (e) exercise activity. Model testing used structural equation modeling.ResultsTesting of the hypothesized model showed that 11 of the 22 paths were statistically significant. Health status and social support influenced self-efficacy and outcome expectations which directly influenced stage of change and exercise. Social support likewise directly influenced stage of change. Together the variables in the model explained 64% of exercise behavior in older adults. There was a poor fit of the hypothesized model to the data with a χ2of 144.7, degrees of freedom (df) of 23 and a ratio of 6.3. The revised model fit the data better χ2= 80.5,df= 19,p< .05, χ2/df= 4.2) and there was improved fit when compared to the hypothesized model (χ2difference of 64.0,dfdifference of 4,p≤ l.DiscussionThe combined testing of the mediating components of the theory of self-efficacy as well as the incorporation of the stage of change to explain exercise behavior in older adults suggests that both of these approaches are useful. Stage of change may be particularly useful to help determine the most appropriate intervention to increase activity and exercise in older adults.

ISSN:0029-6562    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundThe effectiveness of psycho-educational interventions for cancer patients is well documented, but less is known about moderating characteristics that determine which subgroups of patients are most likely to benefit.ObjectivesThe aim of this study was to determine whether certain individual characteristics of African-American and White men with localized prostate cancer moderated the effects of a psycho-educational Uncertainty Management Intervention on the outcomes of cancer knowledge and patient-provider communication.MethodsMen were blocked by ethnicity and randomly assigned to one of three conditions: Uncertainty Management Intervention provided to the patient only, Uncertainty Management Intervention supplemented by delivery to the patient and family member, or usual care. The individual characteristics explored were education, sources for information, and intrinsic and extrinsic religiosity.ResultsUsing repeated measures multivariate analysis of variance, findings indicated that there were no significant moderator effects for intrinsic religiosity on any of the outcomes. Lower level of education was a significant moderator for improvement in cancer knowledge. For the outcome of patient-provider communication, fewer sources for cancer information was a significant moderator for the amount told the patient by the nurse and other staff. Less extrinsic religiosity was a significant moderator for three areas of patient provider communication. The three areas are the amount (a) the physician tells the patient; (b) the patient helps with planning treatment; and (c) the patient tells the physician.ConclusionsTesting for moderator effects provides important information regarding beneficiaries of interventions. In the current study, men’s levels of education, amount of sources for information, and extrinsic religiosity influenced the efficacy of the Uncertainty Management Intervention on important outcomes.

ISSN:0029-6562    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundThere is limited information available to help women gauge their functional status following coronary artery bypass graft surgery.ObjectiveThis article describes changes in functional status and the influence of comorbidity, household composition, fatigue, and surgical pain on functional status in women during the first 6 weeks at home following coronary artery bypass surgery.MethodA single-group longitudinal design was used for this research. Women were interviewed in person before hospital discharge and by telephone at 2, 4, and 6 weeks after discharge. Functional status was assessed by (a) the Inventory of Functional Status in the Elderly and subscales of the Sickness Impact Profile; (b) comorbid conditions by simple tally; and (c) fatigue and surgical pain by the Energy/Fatigue and Pain Severity subscales of the MOS Patient Assessment Questionnaire.ResultsWomen experienced significant gains in functional status over 6 weeks, particularly between 2 and 4 weeks. They engaged most frequently in personal care and low-level household activities during the study period, and most reported improvement in their overall functional status. None of the women were completely recovered or had regained baseline functional status by 6 weeks. The women experienced significant decreases in fatigue and surgical pain, but continued to experience both at 6 weeks. Fatigue and surgical pain were significantly correlated at all time periods.DiscussionInformation about recovery following coronary artery bypass graft, and particularly the finding that recovery is incomplete by 6 weeks, should be incorporated into discharge planning and follow-up for this patient population.

ISSN:0029-6562    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundResearch has shown that there are differences between women and men in the epidemiology, presentation, and outcomes of coronary heart disease.ObjectivesThe purpose of this study was to determine if there were sex differences in the symptoms of unstable angina (UA) and if so, to determine if these differences remained after controlling for age, diabetes, anxiety, depression, and functional status.MethodThis descriptive study used a nonexperimental, quantitative design. A convenience sample of 50 women and 50 men, hospitalized with UA, were recruited from an urban and a suburban medical center. Instruments included the Unstable Angina Symptoms Questionnaire (UASQ), the Hospital Anxiety and Depression Scale (HADS), and the Canadian Cardiovascular Society (CCS) classification of angina.ResultsMultivariate analysis indicated that women experienced significantly (p< .05) more shortness of breath (74% vs. 60%), weakness (74% vs. 48%), difficulty breathing (66% vs. 38%), nausea (42% vs. 22%), and loss of appetite (40% vs. 10%) than men. After controlling for age, diabetes, anxiety, depression, and functional status, women were still more likely than men to report weakness (p= .03), difficulty breathing (p= .02), nausea (p= .03), and loss of appetite (p= .02). Chi-square analysis of symptom descriptors revealed that women disclosed more (p< .05) upper back pain (42% vs. 18%), stabbing pain (32% vs. 12%), and knifelike pain (28% vs. 12%). Women also had a significantly higher incidence of depression (22% vs. 2%,p< .01).ConclusionsFindings suggest that women and men have similar symptoms during an episode of UA, however, a higher proportion of women have less typical symptoms.

ISSN:0029-6562    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundFew longitudinal studies exist to guide clinicians or administrators on what functional outcomes can be expected among nursing home residents with different levels of cognitive impairment. Extrapolating from cross-sectional studies or from longitudinal studies of community-dwelling residents may provide misleading estimates of prognosis, hindering efforts to target preventive care.ObjectiveTo describe patterns of change in physical function on a quarterly basis over 1 year among long-stay nursing home residents grouped according to their level of cognitive impairment on admission.MethodRetrospective analysis of activities of daily living dependence ratings were based on quarterly MDS+ assessments from 76,016 long-stay residents admitted to nursing homes during calendar years 1993 through 1996 in five states participating in the National Case Mix and Quality and Demonstration Project. Residents were stratified by level of cognitive impairment on admission using a 7-level Cognitive Performance Scale. The activities of daily living dependence was measured by a 20 point scale. Mean activities of daily living scores on admission to the hospital and at four quarterly intervals following admission were compared across cognitive impairment levels and by state of residence.ResultsA change in activities of daily living dependence over 1 year in most groups averaged 1 point or less. Three patterns of activities of daily living dependence were identified consistently across five states. Those with mild cognitive impairment on admission showed an initial reduction in dependence followed by slow increase; those with moderately severe impairment showed slow linear increased dependence; and those with severe cognitive impairment showed an initial improvement in dependence, followed by stability.ConclusionMore complex statistical models that take into account comorbid conditions at baseline, in addition to cognitive performance, might identify subgroups of nursing home residents who are at risk for rapid decline. Ways to better characterize declines in function are needed, otherwise relatively large samples will be required for intervention trials.

ISSN:0029-6562    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundChildren of adolescent mothers have higher rates of morbidity and unintentional injuries and hospitalizations during the first 5 years of life than do children of adult mothers.ObjectiveThe purpose of this study was to evaluate the 2-year postbirth infant health and maternal outcomes of an early intervention program (EIP) of home visitation by public health nurses (PHNs).MethodsIn a randomized controlled trial, a sample of predominantly Latina and African American adolescent mothers was followed from pregnancy through 2 years postpartum. The experimental group (EIP,n= 56) received preparation-for-motherhood classes plus intense home visitation by PHNs from pregnancy through 1 year postbirth; the control group (TPHNC,n= 45) received traditional public health nursing care (TPHNC). Health outcomes were determined based on medical record data; other measures evaluated selected maternal behaviors, social competence, and mother-child interactions.ResultsThe total days of non-birth-related infant hospitalizations during the first 24 months was significantly lower in the EIP (143 days) than the TPHNC group (211 days) and episodes of hospitalization were fewer; more EIP than THHNC infants were never seen in the emergency room. The EIP mothers had 15% fewer repeat pregnancies in the first 2 years postbirth than TPHNC mothers. The TPHNC mothers significantly increased marijuana use over time, whereas EIP mothers did not.ConclusionsThe EIP improved in selected areas of infant and maternal health, and these improvements were sustained for a period of 1 year following program termination. These findings have important implications for healthcare services.

ISSN:0029-6562    

出版商:OVID    

年代:2003

数据来源: OVID