ISSN:0029-6562    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundAlthough intimate partner violence is recognized as a major threat to women’s health, few interventions have been developed or tested.ObjectiveTo test an intervention administered to abused women in order to increase safety-seeking behaviors.MethodA two-group clinical trial randomized 75 abused women to receive six telephone intervention sessions on safety behaviors. A control group of 75 women received standard care. Women in both groups were re-interviewed at 3 months and 6 months post-initial measurement.ResultsUsing repeated measures analysis of variance (ANOVA), we found significantly [F (2,146) 5.11,p= .007] more adopted safety behaviors reported by women in the intervention group than by women in the control group at both the 3-month [F (91,74) = 19.70,p< .001] and 6-month [F (1,74) = 15.90,p< .001] interviews. The effect size (ES) of the intervention was large at 3 months (ES = 1.5) and remained substantial at 6 months (ES = 0.56).DiscussionThese findings demonstrate that an intervention to increase safety behaviors of abused women is highly effective when offered following an abusive incident and remains effective for 6 months.

ISSN:0029-6562    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundMedicare reimbursement for home healthcare (HHC) services has changed dramatically in recent years. A clear understanding of the determinants of Medicare HHC services use is needed so that HHC agencies can meet the demand for services from an aging population while remaining financially sound.ObjectivesThe purpose of the study was to identify the determinants of Medicare HHC service within the framework of the Andersen Behavioral Model.MethodsThis cross-sectional secondary analysis used data from the 1996 Medical Expenditures Panel Survey to examine characteristics of 239 subjects who had received Medicare reimbursed HHC services. Predisposing characteristics, enabling resources, and need characteristics were examined to explain Medicare HHC service use. Two criterion measures, annual Medicare expenditures and days of care, were employed in hierarchical regression analyses.ResultsVariance in annual Medicare expenditures was explained by both the predisposing (R2= .16,p< .001) and need characteristics (R2= .09,p< .001). Variance in days of care was explained by predisposing characteristics (R2= .12,p< .001) and need characteristics (R2= .15,p< .001). The adjustedR2for the total model was .21 for annual Medicare expenditures and .25 for days of care.ConclusionsWhile Andersen’s Behavioral Model is useful in explaining Medicare HHC service use, it may be important to use multiple measures as criterion variables since the amount and proportion of variance explained differs with the variable used.

ISSN:0029-6562    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundEighty percent of persons with Alzheimer’s disease and related disorders are cared for by family members who often lack adequate support and training for this all-consuming job.ObjectiveTo evaluate the efficacy of a longitudinal, multisite, community-based intervention designed to teach home caregivers to manage behavioral problems in persons with Alzheimer’s disease.MethodsUsable data were analyzed from 237 caregiver/care recipient dyads (n= 132 Experimental;n= 105 Comparison). The experimental group received a psychoeducational nursing intervention that was conceptually grounded in the Progressively Lowered Stress Threshold model (Hall & Buckwalter, 1987). The comparison group received routine information and referrals for case management, community-based services, and support groups. Although a variety of psychosocial outcomes were compared between caregivers in the two groups, this article focuses on frequency and response to behavioral problems and functional decline.ResultsThe Progressively Lowered Stress Threshold intervention had a statistically significant effect on spousal response to memory/behavioral problems (p< .01) for all caregivers and on response to activities of daily living problems(p< .01) for spousal caregivers. In addition, nonspouses in the experimental group reported a reduction in the frequency of memory/behavioral problems (p< .01). No intervention effect on reports of activities of daily living frequencies was found for either spouses or nonspouses.ConclusionsThis Progressively Lowered Stress Threshold-based intervention had a positive impact on both the frequency of and response to problem behaviors among spousal caregivers.

ISSN:0029-6562    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundPreterm and acutely ill term neonates who are hospitalized in a neonatal intensive care unit are subjected to multiple frequent invasive and painful procedures aimed at improving their outcome. Although several trials to determine the efficacy of sucrose for managing procedural pain in preterm and acutely ill term neonates have been developed, these have generally lacked methodological rigor and have not provided clinicians with clear practice guidelines.ObjectivesTo compare the efficacy and safety of three interventions for relieving procedural pain associated with heel lances in preterm and term neonates, and to explore the influence of contextual factors including sex, severity of illness, and prior painful procedures on pain responses.MethodsIn a randomized controlled trial, 190 neonates were stratified by gestational age and then randomized to receive (a) sucrose and nonnutritive sucking (n= 64), (b) sucrose alone (n= 62), or (c) sterile water and nonnutritive sucking (control) (n= 64) to evaluate the efficacy (pain response as measured using the Premature Infant Pain Profile) (Stevens, Johnson, Petryshen, & Taddio, 1996) and safety (adverse events) following a scheduled heel lance during the first week of life. Stratification was used to control for the effects of age on pain response.ResultsSignificant differences in pain response existed among treatment groups (F= 22.49,p< .001), with the lowest mean Premature Infant Pain Profile scores in the sucrose and nonnutritive sucking group. Efficacy of sucrose following a heel lance was not affected by severity of illness, postnatal age, or number of painful procedures. Intervention group and sex explained 12% of the variance in Premature Infant Pain Profile scores. Few adverse events occurred (n= 6), and none of them required medical or nursing interventionsConclusionsThe combination of sucrose and nonnutritive sucking is the most efficacious intervention for single heel lances. Research on the effects of gestational age on the efficacy and safety of repeated doses of sucrose is required.

ISSN:0029-6562    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundDespite its obvious need, a current, research-based list of informatics competencies for nurses is not available.ObjectiveTo produce a research-based master list of informatics competencies for nurses and differentiate these competencies by level of nursing practice.MethodsAfter a comprehensive literature review and item consolidation, an expert panel defined initial competencies. Subsequently, a three round Delphi study was conducted to validate the items. Participants were expert informatics nurse specialists in the United States of America.ResultsOf the initial 305 competencies proposed, 281 competencies achieved an 80% or greater agreement for both importance as a competency and appropriateness for the correct practice level. Five competencies were rejected. Six competencies were considered valid competencies but the appropriate level of practice could not be agreed upon. Thirteen competencies did not reach any consensus after the three Delphi rounds.DiscussionThe Delphi study had a high rate of participation, demonstrating the great level of interest and need for a list of informatics competencies for nurses. Out of the initial 305 competencies, only 24 items were not validated. Respondents commented during each round about whether computer skills should be considered informatics competencies. The authors propose that computer skills, while not high level, are one set of tools within the larger category of informatics competencies. This sample of experts did not deem programming skills as necessary for informatics nurses. This research study is an initial effort to fill the void of valid and reliable informatics competencies. It is the first study to span four levels of nurses, create competencies for both entry-level and experienced informatics nurse specialists, and examine the categories of computer skills, informatics knowledge and informatics skills.

ISSN:0029-6562    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundWhile little is known about the couple’s process of moving from diagnosis of prostate cancer to treatment, it is acknowledged that cancer—and prostate cancer in particular—affects the couple, not just the patient. This highlighted the need to illuminate this process as a foundation for development of nursing interventions.ObjectivesTo describe the experience of men who are diagnosed with prostate cancer and their wives, from the time of diagnosis through staging to the completion of radical prostatectomy.MethodsA qualitative cross-sectional approach was used to elicit couples’ experiences from diagnosis to the time of the interview including their response to diagnosis, their treatment decision-making process, and how the couple moved from the decision to have surgery through the staging process to the time that the surgery was completed. A total of 20 couples participated.ResultsAnalysis of the data revealed that a number of themes related to the couples’ process of moving from diagnosis to treatment. Initially, the diagnosis of prostate cancer represented a loss of control that led these couples to put themselves through a “crash course” on prostate cancer. The information gathered led these couples to conclude that prostate cancer was “good cancer.” This enabled them to refocus their energies and start their “quest for the best” treatment and surgeon. Once this was accomplished, the couples began to prepare for surgery that culminated in the turning over of complete control to the surgeon and hospital staff at the time of surgery.ConclusionsThe participants discovered they were able to manage the demands presented by the intrusion of a cancer diagnosis and mount a response to what at first threatened to be a “death sentence.” By engaging in the challenge of gathering a volume of facts and a variety of details, they could make informed decisions. Couples were able to regain a sense of control through the engagement in decision-making related to treatment, surgeon, and hospital, and through the transformation of the meaning of the malignant diagnosis to that of a “good cancer.”

ISSN:0029-6562    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundThe Braden Scale for Predicting Pressure Sore Risk©(Braden Scale) has been tested for predictive validity, but the cut-off scores for Blacks has not been compared to White populations.ObjectivesThe purpose of this brief report is to determine if the Braden Scale predicts pressure ulcer risk similarly for Blacks and Whites.MethodA multisite study of the predictive validity of the Braden Scale was conducted in nursing homes, tertiary care, and Veteran’s Administration Medical Centers in three cities (Omaha, Chicago, and Raleigh) selected to maximize ethnic diversity. A total of 843 subjects, 666 (79%) White, 159 (12%) Black were studied. Two nurses independently rated each randomly selected subject on admission and every other day until discharge, using the Braden Scale or the Skin Assessment Tool.ResultsWhites had a higher incidence of pressure ulcers (15%) than did Blacks (5%), but there was no statistically significant difference in the mean Braden Scale score between groups (×19.4,SD2.8, White versus×19.8,SD2.75, Black). A score of 18 best predicts risk for both groups (sensitivity 70%, specificity 77%, with 75% correct predictions for Whites and sensitivity 75%, specificity 76%, with percent correct 76% for Blacks). There was no difference in the area under the receiver-operator characteristic (ROC) curves (0.75,SE0.03, White and 0.82,SE0.07, Black subjects,z= .005).ConclusionsA score of 18 can be used for identifying Black and White individuals at risk for pressure ulcers.

ISSN:0029-6562    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundWhen the dependent variable consists of several categories that are not ordinal (i.e., they have no natural ordering), the ordinary least square estimator cannot be used. Instead, a maximum likelihood estimator like multinomial logit or probit should be used.ObjectivesThe purpose of this article is to understand the multinomial logit model (MLM) that uses maximum likelihood estimator and its application in nursing research.MethodThe research on “Racial differences in use of long-term care received by the elderly” (Kwak, 2001) is used to illustrate the multinomial logit model approach. This method assumes that the data satisfy a critical assumption called the “independence of irrelevant alternatives.” A diagnostic developed by Hausman is used to test the independence of irrelevant alternatives assumption. Models in which the dependent variable consists of several unordered categories can be estimated with the multinomial logit model, and these models can be easily interpreted.ConclusionsThis method can handle situations with several categories. There is no need to limit the analysis to pairs of categories, or to collapse the categories into two mutually exclusive groups so that the (more familiar) logit model can be used. Indeed, any strategy that eliminates observations or combines categories only leads to less efficient estimates.

ISSN:0029-6562    

出版商:OVID    

年代:2002

数据来源: OVID