The Effectiveness of a Standardized Educational Program for Children Using Patient-Controlled Analgesia

purpose . To examine the effectiveness of two types of preoperative education (routine education and a standardized educational program) for children undergoing spinal fusion.

design.

design. Two group, phase-lag design.

setting.

setting. Tertiary pediatric hospital.

participants.

participants. Children ages 8-18 years (N = 93)

main outcome measures.

main outcome measures. Adolescent Pediatric Pain Tool, Child Pain Scale, Post-PCA Satisfaction Interview, and PCA infusion pump data.

results.

results. No statistically significant differences between the groups on any of the main outcome variables. Children and parents reported, however, that the SEP provided them with invaluable information regarding the use of PCA and alleviated their concerns about getting "hooked on drugs," overdosing, side effects, and being able to get pain relief when needed.

conclusion.

conclusion. Children having spine fusion surgery experienced severe postoperative pain that was not ameliorated by optimizing use of PCA through standardized education. Further testing of the SEP with other populations is needed in order to more fully realize its potential for influencing pain outcomes.     

Learning the Baby: A Maternal Thinking and Problem-Solving Process

purpose. To describe a maternal problem-solving process from new mothers' day-to-day experience of caring for and developing a relationship with their babies

design.

design. Qualitative study using grounded theory approach

setting.

setting. Mothers' homes (n = 23) and workplaces (n = 2)

participants.

participants. 25 mothers of babies from 2 weeks to 7 months

main outcome measures.

main outcome measures. Semi-structured interviews

results.

results. "Learning the Baby" was a major thinking process that emerged. Systematic thinking dominated mothers' problem-solving. Even after the babies were comforted, mothers were not certain their efforts alleviated the babies' problems, because they usually were not certain of the problem.

conclusions.

conclusions. Mothers' thinking directs their caregiving actions. The findings were related to previous problem-solving and women's thinking perspectives. Nurses must use planned and unplanned encounters effectively to collaborate with and teach mothers about baby behavior and health care.     

Influence of Managed Care on Professional Nursing Practice

To explore how nurses in one U.S. state perceived that managed care influenced professional nursing in that state. The nursing community is challenged to move with haste in demonstrating, through research, the clinical and economic value that nurses add to cost-effective outcomes.

Design:

A Delphi survey in 1996 of a convenience sample of 84 clinical nurse specialists (CNSs) and nurse practitioners (NPs) in California.

Methods:

CNSs and NPs contributed to the list of managed care influences on nursing practice. Fifty-seven (68%) completed the third and final round.

Findings:

Panelist agreement was the highest for (a) exploring new approaches to providing quality care more cost-effectively, (b) expanding nurse practitioners' rote in primary care, and (c) more effectively partnering with clients in helping them assume greater self-responsibility for their health. Greatest threats were perceived to be hassles involved in seeking authorization for care and responding to payment denials; the tenuous job market for nurses; and encroachment on nursing practice by others.

Conclusions:

The findings can assist nurses in states with low managed-care concentration to create their preferred future within health care delivery. A more highly educated nurse workforce will be needed for 21st century health systems in which more care is likely to be delivered outside hospitals.     

A Randomized Trial of Heparin and Saline for Maintaining Intravenous Locks in Neonates

purpose . To determine, the effects of saline, heparin 2 units (U) per ml saline, and heparin 10 U/ml saline flush solutions on the duration of intravenous (IV) locks and the incidence of IV infiltration in neonates.

design.

design. Randomized double-blind experiment.

setting.

setting. Tertiary-care nursery.

participants.

participants. Neonates (N = 90) hospitalized at birth in the intensive, intermediate care, or newborn units.

main outcome measures.

main outcome measures. Total hours from the time the IV was inserted to the time the IV was removed; hours from the time the IV was first flushed to the time the IV was removed; number of IVs removed because of infiltration.

results.

results. No statistical or clinical differences between the three groups for duration of IV nor for incidence of complications.

conclusions.

conclusions. The use of heparin in IV lock flush solution did not affect the duration of IV locks nor the incidence of infiltration in neonates.     

Parental Self-Efficacy and Asthma Self-Management Skills

P urpose . To determine whether a formal asthma self-management program and social support using lay health advisors increases parent self-efficacy in the management of their child's asthma, and whether parent self-efficacy predicts asthma self-management skills.

DESIGN.

DESIGN. Quasi-experimental with four time points measured over 2 years.

PARTICIPANTS.

PARTICIPANTS. Low-income, primarily Hispanic parents (N = 303) of children with moderately severe to severe asthma.

SETTING.

SETTING. A Southwestern university medical setting in a rural state.

MAIN OUTCOME MEASURES.

MAIN OUTCOME MEASURES. Parent self-efficacy and parent asthma self-management skill score scales.

RESULTS.

RESULTS. Parent self-efficacy increased significantly from baseline, but there were no significant differences between the control and treatment groups. The increase in self-efficacy was apparent at 6 months, then leveled off. Parent self-efficacy at either baseline or 12 months did not predict parents' asthma self-management skill score.

CONCLUSIONS.

CONCLUSIONS. Individual education was just as effective as group education in increasing parental self-efficacy. Parents felt more comfortable treating asthma episodes than preventing them, thus clinicians need to spend time teaching preventive strategies.     

Quality Care in an Era of Retrenchment

source and purpose. Constraints in the healthcare delivery system are resulting in unprecedented challenges to quality nursing care. In response to concerns expressed by readers in a JSPN survey, we solicited input from prominent SPN members.

conclusions.

conclusions. Quality care can be sustained through nurses' creativity, flexibility, leadership, and collaboration. The context for quality care is an organizatinal environment with attention to critical analysis, careful resource utilization, and improved outcomes.

practice implications.

practice implications. Nurses can not only maintain premium standards of quality care but, by assuming leadership, help shape the future of health care.     

Ethical and Policy Considerations for Centenarians—The Oldest Old

To illustrate the incongruence of ethical standards and fiscal and policy constraints on quality care for the oldest old. As the fastest growing demographic segment in the United States, care needs of the oldest old are a special challenge to the health care system.

Design:

Narrative analysis of interviews with centenarians who used nursing home services. The sample was three participants of the Georgia Centenarian Study who had been community dwelling and cognitively intact at the onset of participation (between 1988 and 1997). Interviews were conducted in nursing homes or after discharge.

Methods:

Case histories were constructed from interviews in 1997 to improve understanding of quality of care.

Findings:

Less-than-optimal care was provided for these elders, and little consideration was given to their input to care decisions and prospects for medical improvement. Appropriate consideration was not given to providing least-restrictive environments, appropriate restraint use, and options for community care.

Conclusions:

Six policy reforms are suggested for meeting the needs of the oldest-old before and after institutionalization. These include: integration of resident involvement in care decisions; development of alternate models of care; greater input from nurses concerning nursing care of special populations; more effective family and community involvement in the caring of elderly populations; increased research to promote function and independence; and increased education of personnel and nursing students to allow for more accurate assessment of cognitive and physical status.     

Language Plus for International Graduate Students in Nursing

To provide information about an English-language support program that focuses on the needs of international graduate nursing students. The growing presence of these students coincides with the increasing numbers of universities committed to world health. Crucial social and language competence affect the success and progress of international students in graduate nursing programs.

Design:

Reviewed literature was 1980 to 1998, in nursing and applied linguistic research including second-language acquisition, phonology, discourse analysis, and language pragmatics to identify social and language phenomena.

Findings:

Investigators suggest essential elements such as conventions of academic writing, reading comprehension, vocabulary, and pronunciation skills be included in the supportive Language Plus program.

Conclusions:

Ongoing development of the Language Plus program can promote collaboration between nurses and linguists and increase the success of international graduate nursing students.     

A Model for Cognitive-Behavioral Interventions in Cancer Pain Management

To propose a model for predicting success with cognitive-behavioral interventions in cancer pain management. Practice guidelines are useful, however nurses currently have little theoretic or empiric basis for choosing one particular strategy over another. Moreover, nurses have no way of knowing if a particular intervention is likely to work.

Organizing construct:

The model indicates characteristics of a person in relation to interventions including skill and ability, outcome expectancies, perceived credibility, history of use, preferred coping style, and pain outcomes.

Sources:

The model was developed using sources identified through a literature search of relevant topics in MEDLINE, CINAHL, and Psychlit (1996-1997), as well as through clinical experience.

Conclusions:

Continued empiric testing of the model is necessary to confirm proposed relationships and to assess accuracy of the model's predictions with various cognitive-behavioral interventions. With this testing, the model can help nurses select appropriate interventions for individual patients.     

A Model of Chronic Dyspnea

To present an overview of dyspnea, differentiate chronic dyspnea from acute dyspnea, critique models of dyspnea found in the nursing literature, and propose a new model of chronic dyspnea to guide the care and evaluation of chronic dyspnea in patients living with chronic obstructive pulmonary disease (COPD). Dyspnea is the major symptom that impairs quality of life for nearly 16 million Americans who have COPD.

Methods and Sources:

Review of scholarly literature on dyspnea by searching CINAHL and MEDLINE (1980-1998) using dyspnea and chronic obstructive lung disease as key words. The search produced studies conducted by a variety of health care professions including those in nursing, medicine, exercise physiology, and respiratory therapy.

Findings:

The existing models fail to differentiate between acute and chronic dyspnea. These models were found to be inadequate for guiding interventions to decrease the long-term adverse consequences of chronic dyspnea.

Conclusions:

A useful model of chronic dyspnea defines chronic dyspnea as distress with varying levels of intensity and long-term physical, psychologic, and sociocultural consequences. The proposed model has implications for both research and clinical practice by identifying the consequences of chronic dyspnea as outcome measures of the effectiveness of treatment.     

Depression, Social Support, and Quality of Life in Older Adults With Osteoarthritis

To develop an understanding of the quality of life of older adults with osteoarthritis (OA) with varying levels of depression and social supportas a basis for nursing interventions. Osteoarthritis in the United States is the number one chronic disease in late life and the major cause of disability in older adults. In addition to the functional disability and economic effect of OA, older people with this disease experience suffering, depression, and diminished quality of life.

Design:

For this cross-sectional survey, a convenience sample of 50 older adults with OA was recruited from two U.S. hospital-based arthritis clinics in northern Ohio for 3-months during 1995.

Methods:

During face-to-face interviews, the Arthritis Impact Scales, Center for Epidemiological Studies Depression Scale, Social Support Questionnaire, and Quality of Life Survey, were used to measure osteoarthritis severity, depression, informal social support, and quality of life.

Findings:

Although few formal social support services were used, high levels of satisfaction from the subjects' large informal networks of family and friends were reported. In addition, satisfaction with subjects' quality of life was extremely high despite depression, co-morbid conditions, pain, and functional limitation.

Conclusions:

Social support appeared to play an important role in moderating the effects of pain, functional limitation, and depression on these subjects' quality of life. Nurses who work with older adults are in a unique position to help them adjust to living with osteoarthritis by providing them the support needed to help them manage their disease.     

Nebraska School Nurses Identify Emotional Maltreatment of School-Age Children: A Replication of an Ohio Study

P urpose . To determine how often school nurses identify emotional maltreatment using validated vignettes.

DESIGN.

DESIGN. Survey, with 16 behavior vignettes, mailed to 550 Nebraska school nurses. Four forms represented nonwhite and white, male and female children. Demographic questionnaire included.

SETTING.

SETTING. Survey mailed with regular spring school nurses' newsletter.

PARTICIPANTS.

PARTICIPANTS. One hundred twenty-one school nurses completed and returned surveys.

MAIN OUTCOME MEASURES.

MAIN OUTCOME MEASURES. Each vignette was an example of emotional abuse; subjects indicated "refer" or "not refer" decisions about the vignette. All items were positive for emotional abuse.

RESULTS.

RESULTS. Sixty-four of 121 (53%) respondents correctly identified 13 or more vignettes as referable for emotional maltreatment. No influence of child gender and race on reporting decision. No nurse characteristics correlated with referral rates.

CONCLUSIONS.

CONCLUSIONS. None of the variables studied significantly influenced school nurses' identification of emotional abuse. Further research is needed to ascertain correlation between text vignettes and reporting, and to identify interventions to increase the rate of identifying emotional abuse.     

Reimbursement to Advanced Practice Nurses (APNs) Through Medicare

To analyze why U.S. legislation for direct Medicare reimbursement to advanced practice nurses (APNs) was approved during the 105th congressional session. Help in understanding the complexities of policy making and in strategizing future policy activities is needed. Given their vast numbers, nurses are a formidable group with potential to influence policy.

Organizing Construct:

Kingdon's (1995) framework indicates that policy formation involves constant interaction among participants and the problem, its politics, and policy. When a policy is enacted into legislation, the three come together and an opportunity for policy formation exists, if even fora short period. Methods for data extraction included telephone interviews, information provided by the American Nurses Association (ANA), and information from the internet to access information.

Findings:

Lack of access to health care by Medicare beneficiaries, tagging a policy proposal onto the Balanced Budget Act of 1997, the national mood to provide cost-effective quality care, and lobbying by interest groups helped to make direct Medicare reimbursement for advanced practice nurses a reality.

Conclusions:

When lobbying for the enactment of legislation, nurses should decrease their tendency to fragment. Nurses should be more effectively organized and concentrate on specific agendas. Working together can influence policy and change clinical situations to improve patient care.     

Pediatric Nursing Resources in Cyberspace

P urpose . To provide information on pediatric nursing resources on the Internet.

POPULATION.

POPULATION. Pediatric nurses in all settings.

CONCLUSIONS.

CONCLUSIONS. A basic understanding of essentials for "surfing the web" will open the doors to unprecedented opportunities to query, find, and share information with others.

PRACTICE IMPLICATIONS.

PRACTICE IMPLICATIONS. Pediatric nurses in every setting can benefit from access to the Internet and knowledge of what resources are available to enhance their practice and support their clients.     

Parents'' Reports of "Tricks of the Trade" for Managing Childhood Chronic Illness

purpose . To examine how parents respond to and manage the challenges of childhood chronic illness.

design.

design. Qualitative, comparative, secondary analysis.

participants.

participants. Fifty-eight families (55 mothers, 44 fathers) with a school-age child (6-15 years old) with a chronic illness.

results.

results. Three approaches to illness management were identified: strict adherence, flexible adherence, and selective adherence. These approaches varied in the extent to which parents developed and relied on target management behaviors that concurred with or deviated from the treatment plan prescribed by healthcare providers.

conclusions .

conclusions . The three management approaches contribute to understanding the processes associated with differing interactions between healthcare professionals and parents when a child has a chronic illness.     

Parental Consent for Bone Marrow Transplantation in the Case of Genetic Disorders

purpose. To describe the responses of mothers and fathers who were offered bone marrow transplantation (BMT) for their children with genetic disorders

design.

design. Qualitative

setting.

setting. Private hospital rooms/offices

participants.

participants. Six mothers and 4 fathers of children with genetic disorders

results.

results. The basic social-psychological problem confronting the parents was the conflicting alternatives of life versus death for their children. It was certain that these children would die from their genetic disorders but without having to endure the pain and suffering of a BMT. The BMT would be difficult, possibly resulting in death, but with a chance of survival.

conclusions.

conclusions. Parents believed that BMT was the only chance of survival for their children, leaving them no choice except to pursue the BMT treatment