Rehabilitation for developmental disabilities

This article describes the role of physical and occupational therapists in the rehabilitation of children with a variety of developmental disabilities. Emphasis has been placed on alerting the pediatrician to the types of assessment and treatments provided in order to encourage early referral of clients.

From competent novice to competent expert: a discussion of competence in the light of the post registration and practice project (PREPP)

The nursing profession in the UK, is today faced with major changes in the light of the Post Registration and Practice Project (PREPP) (UKCC 1990). This paper raises questions about how the maintenance of professional competence as detailed in PREPP can be assured. Through a discussion of professional porfolios and continuing education, the subjectivity of guaranteeing a practitioner's competence at tri-annual re-registration is raised. With reference to Benner's (1984) work, the paper suggests that there may be some similarities on the 'novice to expert' continuum that relate directly to the UKCC's proposals. However, the inherent deficiencies with such a mandatory approach to professional development are discussed and questions posed about the extent of nurses' continuing education needs being met. In view of the controversy that still surrounds who will finance the changes, and what format the portfolios will adopt, practitioners are at risk of conforming to the changes but being denied the opportunity of ensuring that they possess the necessary skills and framework, that are essential in ensuring the maintenance of clinical competence. The paper suggests that a concerted effort will be required by both educators and service personnel to ensure that the PREPP proposals are successful.

Describing the health-related quality of life impact of HIV infection: findings from a study using the HIV Overview of Problems--Evaluation System (HOPES)

This study aimed to describe the results of findings from data collected with an HIV-specific health-related quality of life tool, and to examine the relationship between clinical and biological factors and health-related quality of life (HRQL). Data were collected as a cross-sectional, patient-completed assessment of health-related quality of life. Laboratory data were abstracted from the medical chart. Patients (n = 318) with HIV infection including asymptomatic (37%), ARC (20%), AIDS (25%), and AIDS with cancer (18%) were receiving health services at one of the medical centres serving HIV-infected patients in the Los Angeles community, including UCLA, community physicians, Veterans Affairs Medical Centers, and a county hospital. Additional data were contributed by the Johns Hopkins University Medical Center CMV Retinitis Clinic. Symptomatic patients and patients with the lowest CD4 counts reported poorer HRQL than asymptomatic patients and patients with higher CD4 counts. However, medical and demographic variables explained only 35% of the variability of HRQL ratings in this sample of HIV-infected patients. While clinical status and Karnofsky performance status may be used to estimate the impact of HIV infection on HRQL, they are not a substitute for independent assessment of HRQL by the patient.

The roles and functions of clinical nurse specialists

This paper examines the research conducted on the role and function of Clinical Nurse Specialists (CNS). Four research themes have evolved over the past few decades: perceptions of the role; CNS' time allocation; effects of CNS on patient and family outcomes and cost of care; and, the actual functions of CNS. The authors identify areas for future research to demonstrate the differences that CNS make in health outcomes.

Application of a model for public health nursing program planning

Community health nurse (CHN) specialists have advanced educational preparation in both nursing and the public health sciences. They are called on to perform numerous advanced practice roles in public health and other community agencies, one of which is program planning. To perform this role effectively, CHN specialists should use conceptual models to guide application of the nursing process in a population-based practice. One such model developed by a nurse for use in planning community health programs is the McLaughlin model. It was used to address the community diagnosis of risk for childhood lead poisoning, a long-standing public health problem currently receiving renewed attention from federal public health authorities. Applications of conceptual models in practice settings can test such model's efficacy, enrich the scientific basis of community health nursing practice, and ultimately improve the health of the community.

The future of the specialist nurse teacher: two different models explored

The demand for more specialised nurse educators is increasing, yet the nature and direction of this specialisation remains unclear. In this paper the strengths and limitations of two different models are evaluated focusing on the organisation and management of education, integration of theory with practice, the skill of teaching itself and the implications for clinical practice.

Social support and HIV

This paper reviews research about the relationship between social support and health for people with HIV. Current studies linking social support and HIV are described and the major findings summarized in order to identify gaps in the literature. It is argued that, to date, research in this area has focused primarily upon gay white men in the USA at a symptomatic stage of the illness. There are few studies which have considered the impact of social position on the relationship between social support and health, and few which have included HIV-negative controls. Whilst there is evidence of a link between social support and the psychological well-being of people with HIV, research is still in its infancy. Much information is required about which particular aspects of social support and health are associated, how this association changes over time according to the stage of the disease, and with the socio-economic and cultural characteristics of those with HIV.

Family coping and premenstrual symptomatology

OBJECTIVE

To examine how families cope when the woman experiences premenstrual symptomatology.

DESIGN

A descriptive panel design and purposive, nonprobability sampling through interviews and questionnaires.

SETTING

Participants' homes.

PARTICIPANTS

One hundred four couples who met the study criteria were recruited from medical practices and community seminars and through media announcements.

MEASURES

Study outcome measures were formulated after data collection.

RESULTS

High-symptom families used spiritual coping strategies more frequently than low-symptom families (R = .427, p = 0.003 in women, p < 0.001 in men). Husbands were more likely than wives to report that their families coped by believing that the problem would go away if they waited long enough (t = -3.06, p = 0.003). Husbands of women with high symptomatology reported that their families used this passive approach to a significant degree (t = -3.43, p = 0.001).

CONCLUSIONS

Religious or spiritual support may be especially important to families in which the woman suffers from premenstrual symptomatology. These families may also keep problems within the family and be socially detached. Nurses may help by encouraging the use of social supports, religious or spiritual support, and other family resources.

Reproductive technologies and court-ordered obstetrical interventions: the need for a feminist voice in nursing

As the developments in and increasing use of reproductive technologies continue and as court-ordered obstetrical interventions occur, questions regarding nurses' roles in these developments become increasingly important. In this article, I identify a number of issues surrounding these developments in reproductive health care and examine how nurses have dealt with these issues. I also attempt to encourage nurses to examine and discuss these developments from a critical, woman-centered perspective. A review of articles from the nursing literature (1985-1990) grouped together on the basis of the concerns identified, approach used, or subjects studied is presented. The majority of researchers view reproductive technologies as either acceptable or as requiring legislation and control. Few researchers in nursing have identified concerns about reproductive technologies or court-ordered obstetrical interventions from a feminist perspective. It is crucial that questions be raised about the underlying assumptions of these measures and about their implications for women as patients and for nurses as practitioners, women, and promoters of health. Otherwise, nurses may be supporting technologies and other measures that harm women and nursing itself.

Assessing the needs and quality of life of patients with HIV infection: development of the HIV Overview of Problems-Evaluation System (HOPES)

OBJECTIVE

To develop and evaluate the psychometric properties (reliability, validity etc.) of a comprehensive Quality of Life (QOL) tool, for patients infected with the human immunodeficiency virus (HIV), that was adapted from a previously validated cancer tool.

DESIGN

Cross-sectional, patient completed written surveys and interviews.

SETTING

The Medical Centers serving HIV infected patients in the Los Angeles community including UCLA, community physicians, Veterans Affairs Medical Centers, and a County hospital: and additional data contributed from Johns Hopkins University Medical Center CMV Retinitis Clinic.

PATIENTS

Patients (n = 318) with HIV infection including asymptomatic (37%), ARC (20%), AIDS (25%) and AIDS with Cancer (18%) receiving health services at one of the above sites.

MEASUREMENTS

The patients self-administered the newly developed instrument, the HOPES (HIV Overview of Problems-Evaluation System), other QOL related tools including the Medical Outcomes Study instrument adapted for HIV (MOS-HIV) the Profile of Mood States (POMS), the Perceived Adjustment to Chronic Illness Scale (PACIS), and the Physical Activity Scale (PAS). Brief interview to assess the Karnofsky Performance Status Score (KPS). Measured sociodemographic characteristics included age, sex, race, HIV risk factor, education etc. Assessed medical history, current medications, HIV clinical classification.

MAIN RESULTS

The sociodemographic and medical characteristics of the sample resemble those of the general population with HIV infection in this geographic area: 96% male, 28% nonwhite, 84% homosexual contact as risk factor, 75% receiving antiretroviral therapy. The adaptation of the cancer QOL instrument to HIV appears to have face and content validity according to patients and health professionals who care for HIV infected patients. Analyses of the psychometric properties found that the HOPES has a similar structure to its parent instrument following factor analyses which results in five summary scales representing the Physical, Psychosocial, Medical Interaction, Sexual and Significant Other/Partners domains in addition to a Global Score. Internal consistency of 35 subscales is high with a mean alpha coefficient of 0.82. Correlations of the HOPES summary scales with other QOL instruments are in the predicted directions. Comparing patients within the HIV clinical diagnostic categories on the HOPES Global, Physical, and Psychosocial Summary Scales indicates that Asymptomatic Patients have better QOL than symptomatic patients. This finding is also found in the other QOL instruments which provides evidence of construct validity.

CONCLUSIONS

The HOPES is an excellent tool for identifying the problems and needs of patients with HIV infection and for assessing their quality of life. It is reliable, valid and acceptable to patients. The tool may be especially useful in developing a normative data base.

Caring for the professional caregiver: the application of Caplan's model of consultation in the era of HIV

Nurses as well as other health-care professionals have been impacted by the current human immunodeficiency virus (HIV) epidemic. Issues related to virus transmission, voluntary testing, and professional requirements to provide care for those infected can trigger emotional as well as cognitive responses for all involved. The heavy emotional needs of patients and the regular confrontation of death increase the risk of burnout for those caring for the growing number of patients with acquired immunodeficiency syndrome. In an effort to retain and to recruit nurses who are willing to become involved in the care of those infected with the virus, it is imperative that nursing administration provide psychosocial support services for those nurses. This article describes the development and implementation of a psychosocial support program, based on Caplan's (1973) model of mental health consultation, for nursing staff impacted by the HIV epidemic. The program, established through a cooperative alliance between psychiatric/mental health clinical nurse specialists and nursing staff, has proved to be effective and efficient. It is recommended that other psychiatric/mental health nurses, including faculty, use the consultation model to improve the psychosocial support available to health-care professionals affected by the HIV epidemic.

Models of psychiatric consultation liaison nursing

Recent developments in healthcare legislation have caused nurses to examine new and innovative styles of practice. Psychiatric consultation liaison nursing promotes collaboration among healthcare practitioners, raises standards of patient care and strengthens rather than negates the traditional role of the mental health nurse.

Preparing clinical preceptors to teach master's-level students in oncology nursing

This article reports the development of a structured program for clinical nurse specialists who served as clinical preceptors for graduate students in an oncology nursing program. A needs assessment of clinical preceptors was completed, and a program for the preceptors was developed based on the learning needs identified. In addition to the program, a Manual for Clinical Preceptors was developed. The benefits of this program include networking; positive working relationships among the preceptors, faculty, and students; potential job opportunities for students; potential applicants from the clinical agencies; and, ultimately, improved care for patients with cancer and their families. The authors conclude that administrators should support efforts to nurture and recognize the personnel in the clinical agencies.

Psychosocial responses among individuals with human immunodeficiency virus infection

The purpose of this research was to identify and describe psychosocial responses to being infected with human immunodeficiency virus (HIV). Ten adults infected with HIV were interviewed and audiotaped as they described their feelings and experiences as HIV-infected people. The interviews were analyzed using a grounded theory methodology. The core category that emerged from the data was Fighting to Survive with HIV Infection. Supporting concepts were Taking Care and Restructuring One's Life. The concept of Taking Care included processes of everyday work and illness work. The processes involved in Restructuring One's Life were living with uncertainty, accepting homosexuality, experiencing changing feelings, protecting confidentiality, dealing with the medical profession, handling multiple losses, and living with a terminal illness.

Home health nurses' assessments of cognition

Assessments of mental status in elderly persons admitted to home health agencies are the basis for decision-making related to resources provided. A home health nurse's perceptions of an elderly client's capacity for self-care determines whether community services will be prescribed. In institutional settings, evaluation of cognition by professional nurses is often incomplete or inaccurate. It was the purpose of this study to compare the judgements of cognition made by nine home health nurses who were admitting elderly clients to a visiting nurse association with scores from an objective measure of mental status. Findings suggest that these nurses relied primarily on orientation as an indicator of cognitive abilities.

Perceived risk of infection and attitudes toward risk groups: determinants of nurses' behavioral intentions regarding AIDS patients

The relationship of perceived occupational risk of AIDS and attitudes toward AIDS risk groups to behavioral intentions regarding the care of AIDS patients was examined among nurses (N = 496) residing in a selected area of New Jersey, a state with a relatively high number of reported AIDS cases. Hierarchical multiple regression analyses on anonymous mail survey responses revealed that, controlling for AIDS knowledge and years of education, nurses who perceived that caring for AIDS patients increased their risk of HIV infection scored higher on an index of intentions to avoid AIDS patient care. In addition, nurses who expressed more negative attitudes toward intravenous drug users or homosexuals were more likely to report similar intentions to avoid AIDS patient care. The implications of these findings for efforts to increase nurses' ability and willingness to provide quality care to persons with AIDS are discussed.

A pediatric rehabilitation experience for undergraduate nursing students

Pediatric rehabilitation is a specialty that will need more nurses in the future. A clinical rotation in this specialty was incorporated into the pediatric experience of junior-year baccalaureate nursing students at the University of Maryland School of Nursing. The experience helped students to learn more about the nursing care involved in pediatric rehabilitation, to appreciate the different disciplines within the specialty, and to view pediatric nursing from a holistic long-range perspective. The experience also strengthened ties between nursing education and practice.

Refusal to care for patients with human immunodeficiency virus/acquired immunodeficiency syndrome: issues and responses

Nurses historically have accepted the risk of contagion while caring for patients with infectious diseases. The duty to care for patients is directly related to the care the patient requires, the nurse's knowledge, and the extraordinary risk to the nurse. The current infection with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) highlights other factors, such as fear, ignorance, and homophobia, that influence a nurse's decision to refuse to provide care. Professional associations, nurse administrators, and educators must assist nurses to gain the knowledge and skill necessary to provide care as well as explore feelings about different life-styles.

The imposter phenomenon in the clinical nurse specialist role

The imposter phenomenon describes individuals who at times feel as if they are imposters in their chosen profession. Individuals experiencing the phenomenon have a deep feeling that they are fooling everyone. The title of clinical nurse specialist (CNS) in itself may foster misinterpretations and false beliefs in oneself or others. The term "specialist" implies expertise in the five subroles of the CNS (educator, consultant, research, clinician and manager). Feelings of imposture within the CNS role can precipitate or exacerbate low self-esteem and lead to ineffective role implementation. The phenomenon must be recognized in the CNS and management strategies instituted. Management strategies include peer support, CNS mentoring and self-provided positive reinforcement. Further research is essential to document the existence of the phenomenon within the CNS role and the creation of effective management strategies to prevent or alleviate it.

Overcoming stigmatization: social and personal implications of the human immunodeficiency virus diagnosis

All diseases have attached metaphors. Social and personal reactions to people with human immunodeficiency virus are influenced by the metaphor, "fear of polluting people," and have in common with sexually transmitted diseases, the irrational fear of easy contagion. These issues negatively affect clients' response to their diagnosis and their treatment and care. Many clients have suffered as a result of receiving care from professionals who are condemning of the person with the disease. Others, though have found supportive care givers and have experienced positive reactions to the diagnosis through achieving emotional and spiritual development. The response of nursing to this stigmatized disease is explicated.

Clinical research with community-based older women

Subjects for research with community-based elderly women are best obtained by first establishing rapport with the manager of the retirement home or apartment complex for the elderly. The site for group research should be comfortable, private, and free of distractions; it should also be centrally located and easily accessible for subjects with impaired mobility. Verbal instructions and printed questionnaires must be appropriate for the elderly subject's hearing, visual acuity, and reading level. It is important to ensure that subjects are using functional hearing aids and glasses, to allow extra time to repeat or explain questions, and to plan sessions that are not lengthy or tiring.

Development of a measure of attitudes toward persons with AIDS

This paper describes the development of a brief scale to measure attitudes toward persons with AIDS. Results from content validation, factor analysis, classical reliability estimation and generalizability analysis show the measure to have strong psychometric properties.

Nurses' Willingness to Perform AIDS Patient Care

We evaluated nurses from hospitals with different prevalences of AIDS patients and with different levels of nursing education to measure their willingness to provide care to AIDS patients. Nurses who were most experienced in AIDS patient care, employed in high-prevalence hospitals, and who considered themselves most knowledgeable about infectious disease consistently were less willing to provide nursing care for AIDS patients. Nurses with BSN or MSN education employed in hospitals with low and moderate prevalence of AIDS were the most willing to provide AIDS patient care. The results are discussed in light of recent research on universal precautions adherence and factors that may contribute to increasingly negative attitudes for nurses who provide sustained AIDS patient care.

Attitudes toward certification. A pilot study

The CNOR certification is a voluntary commitment that individual perioperative nurses make after considering financial, professional, and personal issues. The results of this survey indicate that CNOR certification is sought to fulfill personal and professional goals. A vital component in the delivery of quality perioperative patient care is the individual nurse. This is true whether or not the perioperative nurse is certified. One question is the value of the CNOR process in the validation of nurses for the delivery of perioperative patient care. It is easy to assume that if knowledge is present, the knowledge will be applied. Assumptions, however, can be misleading. These findings suggest that several nursing traits interact to promote quality perioperative patient care delivery, and CNOR certification is only one of those traits. Claims of CNOR outcomes should be based on documented support rather than assumption and speculation. Further investigation on a much larger and more inclusive scale is needed before suggesting specific changes to the present certification process. This project substantiates the process and the feasibility of conducting future studies. Using a modification of this survey tool in future studies would provide support to the reliability of these findings. This investigation shows that CNOR certification is an important topic to perioperative nursing. With current NCB:PNI proposals and other national considerations, CNOR certification will continue to be an important issue.

Nurses' Knowledge About and Attitudes Toward Patients With AIDS

With the increasing incidence of AIDS, it is probably inevitable that most nurses working in acute care settings will at some time come in contact with a patient who has AIDS. Nurses must be prepared to give safe, competent, and compassionate care to patients with AIDS. This article reports the results of a survey of registered nurses' knowledge and attitudes related to AIDS and AIDS patients. The respondents displayed moderate scores on the knowledge questions, high scores on transmission and treatment, but low scores on epidemiology and pathophysiology. On the attitude subscales, scores were above three on a five-point scale, indicating a lack of negative attitudes. Recommendations for educational programming are included.

[A descriptive study of the defining characteristics of nursing diagnosis: sexual dysfunction]

The defining characteristics of the nursing diagnosis "Sexual Dysfunction" were gathered from NAAM assessment records. From this population 96 records with the defining characteristics of Sexual Dysfunction were selected. The 9 defining characteristics proposed by The North American Nursing Diagnosis Association were used as a framework for the data collection tool. The 3 most frequently defining characteristics were absence of sexual desire (71.9%), vaginal discharge (64.5%), and pain (44.8%). The authors concluded that 6 defining characteristics have not appeared; absence of sexual desire and vaginal discharge can be considered as minor characteristics. The authors recommend the implementation of other studies to clarify the subjective defining characteristics.

Conceptual models and nursing practice: the reciprocal relationship

There is a reciprocal relationship between conceptual models of nursing and nursing practice. Conceptual models influence clinical nursing practice by specifying standards for and purposes of practice; identifying relevant clinical problems, settings for practice, legitimate recipients of nursing care, and the content for the nursing process; suggesting methods for delivery of nursing services; and by providing frameworks for clinical information systems, patient classifications systems and quality assurance programmes. Nursing practice, in turn, provides data that can be used to determine the credibility of the conceptual models. Sources of data from clinical practice for credibility determination include evaluations of nursing interventions, the recipient's perspective of nursing care and quality assurance reviews.

Caring for people with AIDS: nurses' attitudes and feelings

A qualitative, non-experimental study was conducted to identify the feelings and attitudes that nurses associate with caring for people with AIDS. Data collection and analysis were guided by the phenomenological method. Cognitive dissonance theory served as the theoretical framework to view the experience of caring for someone with AIDS. Data analysis of audiotaped, semi-structured interviews resulted in the identification of six mutually inclusive as well as exclusive themes which represent the attitudes and feelings of nurses: fear, anger, sympathy, self-enhancement, fatigue and helplessness. Particularly evident were differences in the way respondents perceived and treated AIDS patients who are intravenous drug users and those who are homosexuals.

A Psychoeducational Model for Changing Nurses' AIDS Knowledge, Attitudes, and Practices

A review of the research literature over the last five years reveals that nurses' knowledge of the human immunodeficiency virus (HIV) has improved dramatically. However, attitudes and fears about HIV and acquired immunodeficiency syndrome (AIDS) have not changed commensurately with nurses' knowledge. Also, there is evidence that nurses' clinical practice is not always safe. This paper summarizes the research literature and proposes a three-tiered psychoeducational model for changing knowledge and clinical skills, knowledge and attitudes, and attitudes alone. These approaches include information and demonstration, expression of attitudes and fears, role-playing, group discussions, practice in designing policies, and exposure to various sociocultural groups, to persons with HIV, and to religious, legal, and ethical spokespersons.

Examination of nursing diagnoses for adults hospitalized with acquired immunodeficiency syndrome, 1982-1990

The literature on nursing care of the hospitalized adult with acquired immunodeficiency syndrome (AIDS) from 1982 to the present was examined, and 16 formal care plans were extracted. The nursing care plans were examined for commonalities of identified nursing diagnoses, which were then tabulated according to frequency. Analysis of the types of problems addressed shows that five of the nine highest-frequency problems were physiologic (altered nutrition: less than body requirements, respiratory problems, impaired skin integrity, diarrhea, potential for infection). The other four problems were cognitive (altered thought processes), safety (potential for injury), social (social isolation), and a combination of physiologic and cognitive (pain). Validation of nursing diagnoses is needed as a solid foundation for nursing intervention research in the care of patients with AIDS.

Knowledge and Attitudes About AIDS Among Canadian Nursing Students: Educational Implications

Research was conducted to examine the level of knowledge and attitudes about acquired immunodeficiency syndrome (AIDS) among Canadian nursing students and faculty and the relationships among knowledge, attitudes, and willingness to care for AIDS patients. The study was an extension of earlier research by Lawrence and Lawrence (1989). A descriptive-correlational design was used in which four levels of nursing students and faculty (N = 166) completed the AIDS Assess Test. Knowledge scores increased as students progressed through the program; faculty had the highest scores. Attitude scores were relatively low, indicating areas in which further education and values clarification are essential. Pearson's r revealed significant positive relationships between subjects' knowledge of AIDS and attitude scores for the sample as a whole and two levels of students in the nursing program. Other variables relating to subjects' attitudes toward AIDS patients and willingness to care for and have contact with them were identified in the research. Findings suggest additional learning experiences for assisting students in developing the knowledge needed for care of the patient with AIDS and clarifying values and beliefs which might influence that care.

Management style and staff nurse job satisfaction

The purpose of this study was to determine nurses' perceptions of the current and desired management styles of hospital units and to investigate the relationship of management style with job satisfaction. Full-time staff nurses (N = 505) in two private and two public acute care general hospitals in a southeastern metropolitan area were surveyed using instruments with established psychometric properties. The staff nurses were currently experiencing a benevolent-authoritative management style, but preferred a participative style. Management style and job satisfaction were significantly correlated (r = .6050). Management style perception scores predicted 36.6 per cent of the variance in job satisfaction scores. Implications for nursing administration are presented.

Stigma, AIDS and quality of nursing care: state of the science

Reports of fear and psychological distress on the part of nurses when caring for AIDS patients have drawn attention to the real possibility that care for this very sick group of patients may be less than adequate. This paper reviews what is currently known about the attitudes of nurses and the care provided to HIV-infected individuals. The authors reveal the paucity of empirical data concerning quality of care and how the concept of stigma might serve to aid our understanding. The need for more research documenting the quality of care provided to HIV-infected patients is discussed.

Taking care of the caretakers: a partial explanation of clinical nurse specialist practice

The purpose of this study was to describe the clinical practice of clinical nurse specialists (CNSs). Data were collected from three recorded case studies and interviews from a theoretical sample of 17 masters-prepared CNSs who had functioned in the CNS role for a minimum of 1 year. Using the constant comparative method, transcribed interviews were line-coded and clustered to form groups of data that could be labelled as constructs. Caring was validated as the basic psychological process. Scientific caring included investigating and teaching; humanistic caring included creating the new, showing the way, working with others, and taking care of the environment. It was found that CNSs took care of the caretakers as well as the patients and their families.