Nursing Diagnosis or Patient Problem?

Viewpoint provides a forum for scholarly discussion about the theoretical, philosophical, and practical issues related to nursing language and classification systems. The sometimes controversial view's are intended to stimulate readers' comments and perspectives. We welcome brief, informal responses to published viewpoints. If you have a viewpoint you want to submit, or if you want to discuss it beforehand, contact the column editor: judithwilkinsatt.net; 913.631.1089.
In this Viewpoint, Dr. Suzanne Beyea relates how her thinking about nursing diagnosis may be changing in response to emerging realities in health care.     

Childhood and adolescent attention-deficit hyperactivity disorder: Diagnosis, clinical practice guidelines, and social implications

Purpose: To review the diagnostic criteria for attention-deficit hyperactivity disorder (ADHD), present an overview of the effects that ADHD has on family dynamics, school performance, and substance abuse, and provide an overview of the American Academy of Pediatrics (AAP) clinical practice and treatment guidelines.
Data sources: An extensive health science literature review was carried out using PubMed and Cumulative Index to Nursing and Allied Health Literature. Other information was collected by searching reference lists of published reports.
Conclusions: The diagnostic criteria and guidelines are important to make an accurate clinical assessment and manage a child with ADHD. Early diagnosis and treatment of ADHD decreases academic failure, family conflict, social isolation, substance abuse, and occupational adversity in later years for these children.
Implications for practice: Often primary care nurse practitioners are the first healthcare provider a child with ADHD will see. Awareness of the diagnostic criteria and treatment for children with ADHD can assist with early identification and perhaps eliminate much impairment that accompanies this chronic disorder.     

The new woman: Health‐promoting and health‐damaging behaviors

Compared with their mothers, contemporary women are better educated, live alone more of their adult lives, and participate in the labor force more consistently throughout their lives. Most studies of the New Woman have focused on the effects of the configuration of her roles on her health and health‐related behavior. Few have considered both the influence of women's roles and the broader context of their lives on their health. Moreover, investigators have devoted little attention to the health behavior patterns of the New Woman, despite the demonstrable impact of health‐related behaviors on mortality and morbidity. The present study was designed to test models relating women's roles, gender role norms, social demands and resources, and health‐promoting and ‐damaging behaviors. Women who resided in middle‐income and racially mixed neighborhoods (N = 659) were interviewed in their homes. The women were a mean age of 32.7 years and had an educational level of 14.2 years. Approximately 57% were married or partnered, and 76% reported some level of employment outside the home. Women who had fewer life stressors and were better educated performed more health‐promoting behaviors. Women who experienced more stressors, were less well educated, had more contemporary attitudes toward women, were not partnered, or experienced depressed mood engaged in more health‐damaging behaviors. These results underscore the importance of considering women's social context in health promotion efforts and as a deterrent to health‐damaging behaviors.     

Selection of Deep Brain Stimulation Candidates in Private Neurology Practices: Referral May Be Simpler than a Computerized Triage System

Objective: The objective of this study is to compare a computerized deep brain stimulation (DBS) screening module (Comparing Private Practice vs. Academic Centers in Selection of DBS Candidates [COMPRESS], NeuroTrax Corp., Bellaire, TX, USA) with traditional triage by a movement disorders specialized neurologist as the gold standard. Methods: The COMPRESS consists of a combination of the Florida Surgical Questionnaire for Parkinson disease (FLASQ‐PD), a cognitive assessment battery provided by MindStreams® (NeuroTrax Corp.), and the Geriatric Depression Scale and the Zung Anxiety Self‐Assessment Scale. COMPRESS resulted in the classification of patients into three categories: “optimal candidate,”“probable candidate,” and “not a good candidate.” Similar categorical ratings made by a referring private practice neurologist and by a trained movement disorders specialist were compared with the ratings generated by COMPRESS. Results: A total of 19 subjects with Parkinson's disease were enrolled from five private neurological practices. The clinical impressions of the private practice neurologist vs. those of the movement disorders specialist were in agreement approximately half the time (10/19 cases). The movement disorders specialist and COMPRESS agreed on 15/19 cases. A further comparison between outcomes from the entire COMPRESS module and the FLASQ‐PD questionnaire by itself resulted in high agreement (18/19 cases in agreement). Conclusions: The COMPRESS agreed with an in‐person evaluation by a movement disorders neurologist approximately 80% of the time. The computerized COMPRESS did not provide any screening advantage over the short FLASQ‐PD paper questionnaire. Larger studies will be needed to assess the utility and cost effectiveness of this computerized triage method for DBS.     

Intergenerational Concepts of Adolescent Sexuality: Implications for Community-Based Reproductive Health Care with Haitian Immigrants

Intergenerational conflict occurs when immigrant parents hold different values from those of their more rapidly acculturating offspring. These conflicts frequently involve disparate views related to sex roles and reproduction. A community-based study of 19 immigrant Haitian parent-adolescent pairs in South Florida compared their attitudes and values about sexuality and reproduction. Data were obtained through focused, open-ended interviews. Content analysis procedures at the level of words and phrases facilitated the categorization of responses. Data revealed considerable differences between parents and adolescents about the sources and types of information learned about reproduction and contraception, when such information is learned, and expectations regarding premarital sexual intercourse. Both parents and adolescents lacked accurate biomedical information about contraception, placed responsibility for contraceptive use primarily on the female partner, considered reproduction a natural rather than a medical event, and believed parents have the major responsibility for educating children about reproduction and contraception. Implications for culturally-appropriate health care center on increasing the role of the public health nurse in health education, minimizing intergenerational and intercultural conflict, and engaging the Haitian immigrant community in the promotion of reproductive health.