Microscope objectives

The objective is the most crucial image-forming component of a microscope. A knowledge of the many types of objectives available and their characteristics is critical to the selection of appropriate objectives for image cytometry. This unit discusses aberrations in image formation and their correction, construction and types of objectives, and objectives for other microscopy applications, explaining the advantages and limitations of each one.

The impact of the Needlestick Safety and Prevention Act on home care and hospice organizations

Administrators, managers, and clinicians need to be up-to-date on all aspects of the new Needlestick Safety and Prevention Act recently passed into law. This article gives the background and foundation needed to implement policies, procedures, and actions that will assure compliance with the law and increased worker safety.

2001-2002 Joint Commission Home Care Manual: what's new? Part 1

The changes in the format of the 2001-2002 CAMHC are tremendously helpful for organizations that provide multiple types of home care programs. At last, reviewing the common and service-specific standards can identify the applicable standards. The most significant change is the change in the aggregation methodology that places home care and hospice organizations at higher risk for type 1 recommendation(s). The next Accreditation Strategies column will review the changes in the standards in the 2001-2002 CAMHC from the chapter entitled "Improving Organizational Performance" through the chapter entitled "Surveillance, Prevention and Control of Infection".

Microscope alignment

In order to obtain good images using any microscopic imaging modalities, it is necessary to understand the microscope thoroughly and set up properly. This unit should be required reading for all students and staff using a light microscope. It clearly defines the types of illumination used in microscopes and details the correct set up and operation.

Relationship of physical symptoms and physical functioning to depression in patients with heart failure

OBJECTIVE

The purpose of this study was to determine the relative contribution of physical symptoms and physical functioning to depression in adult patients with heart failure during hospitalization and the early postdischarge period.

DESIGN

An exploratory, correlational longitudinal design was used.

PATIENTS

The sample included 170 subjects with heart failure.

RESULTS

Subjects' mean scores on the depression scale indicated that subjects were not depressed on average; however, 30% of the sample (n = 52) had scores indicative of clinical depression. Both physical symptoms (r = 0.48) and physical functioning (r = -0.32) were moderately correlated with depression. Physical symptoms contributed 13% uniquely to the variance in depression while physical functioning contributed only 2% uniquely to the variance in depression. Multiple regression analyses indicated that physical symptomatology is more closely related to depression than is physical functioning in adults with heart failure.

CONCLUSIONS

This study showed the patients with heart failure who had increased physical symptoms and poorer physical functioning reported increased symptoms of depression. Physical symptoms explained a greater portion of the variance in depression than did physical functioning. Thus, it appears that patients with heart failure are affected emotionally by both their physical symptoms and their limitations in their physical functioning, but depression is more strongly related to having more physical symptoms than having greater limitations in physical functioning.

Changes in the 2001 Joint Commission home care survey process

These are just a few of the forthcoming changes facing accredited home care and hospice organizations. The next "Accreditation Strategies" column will review the changes in the standards from the 2001-2002 Comprehensive Accreditation Manual for Home Care, discuss the new aggregation rules, and explain what the changes mean for accredited home care and hospice organizations.

The Joint Commission's "improving organizational performance" standards for home infusion therapy providers

In today's homecare environment, optimizing operational efficiency and making data-driven decisions is essential. Home infusion therapy organizations that are accredited by the Joint Commission on Accreditation of Healthcare Organizations (Joint Commission) will find a heavy emphasis on the standards for improving organizational performance during the homecare survey process. The standards from the "Improving Organizational Performance" chapter are reviewed, and the Joint Commission's requirements for meeting the intent of the standards are discussed.

Improving infection control in home care: from ritual to science-based practice

While many home care policies and procedures are developed with the best of intentions, they frequently lack a scientific basis and have been perpetuated over the years. This article discusses infection control rituals in home care and hospice and the importance of making patient care practice decisions based on sound scientific principles.

Preventing and controlling the transmission of antibiotic-resistant microorganisms in the home care setting

Antibiotic-resistant microorganisms can spread to other home care patients by an infected or colonized patient receiving home care services and the home care staff member unknowingly carrying it to another home care patient's home. Controlling the transmission of antibiotic-resistant microorganisms is the primary responsibility of those providing direct patient care. The ultimate goal for home care is to prevent staff colonization and cross-contamination to other home care patients.

Social comparisons and temporal comparisons after coronary artery surgery

OBJECTIVE

To examine the use and efficacy of social and temporal comparisons used before and after coronary artery surgery.

DESIGN

Secondary analysis of data from a prospective study designed to examine social support.

PATIENTS

141 subjects undergoing surgery.

RESULTS

One third of subjects made spontaneous social comparisons. Most who made a social comparison before and 1 month after surgery viewed themselves as similar to others. Social comparisons were related to mood states only before surgery. The majority of subjects made temporal comparisons 1 year after surgery. Subjects generally saw themselves as the same or better than they were before surgery. Temporal comparisons were related to both emotional and functional outcomes.

CONCLUSIONS

Social comparisons were not consistently related to emotional and functional status; thus whether they can be used to formulate interventions needs further exploration. On the other hand, use of temporal comparisons was related to better mood state and functional status. Enhancing an individual's ability to view self as stable or improved compared with before surgery may be beneficial. Results are discussed in terms of how social comparison theory fits within the overall context of coping with physical illness.

Putting infection control principles into practice in home care

Implementing sound, rational infection control practices in home care has been challenging since guidelines, standards, and most references have been developed for the acute care setting. This article provides guidance for adapting appropriate infection control interventions for patient care practices to the home care setting. Such practices include handwashing, home infusion therapy, respiratory care, wound care, urinary tract care, and isolation precautions. Assessment of the home care environment, cleaning and reprocessing of equipment, surveillance, implications for occupational health, and program design are also discussed.

Accuracy and reproducibility of estimating the adequacy of the squamous component of cervicovaginal smears

In the Bethesda System for reporting cervicovaginal cytology results, 1 criterion for smear adequacy is an adequate squamous component. The accuracy of a cytologist's estimate that 10% of the slide is covered by squamous cells, the adequacy threshold, has not been determined. The percentage of the surface of a glass slide covered by squamous cells was independently estimated by 4 cytologists on 2 occasions by microscopic examination of 83 buccal smears prepared to display estimated coverage of 1% to 20% of the slide surface. The accuracy of visual estimates was compared with measurements by the TracCell System. Each observer made a third set of estimates after receiving 5 slides with known coverage. Median coverage by visual estimation ranged from 4% to 25%, but as measured by the TracCell system was 2%. Median estimated coverage was significantly different for 2 of 4 observers between first and second viewings and between all but 1 pair of observers. For all observers, it was significantly higher than the true coverage. A visual estimate of 10% coverage corresponded to a true median coverage of 3%. When provided with a physical standard, the median estimated coverage by 3 of 4 observers was not statistically different from the true coverage, and interobserver kappa values improved. Unaided visual estimation of the adequacy of squamous cell coverage is neither reproducible nor accurate. What most cytologists consider "adequate" coverage represents only 3% coverage. The availability of a physical standard dramatically increases reproducibility and accuracy.

Social support sources among older women with heart failure: continuity versus loss over time

The extent to which older women with heart failure experienced continuity or loss of their support sources and the relationship between support source loss, perceived enacted support, and psychological well-being were examined in this study. In-home interviews were conducted with 57 older women who completed two interview 18 months apart following a hospital admission for heart failure. Both the emotional and tangible support sources were quite stable, indicating that the predominant pattern is continuity for older women with heart failure. Loss of tangible support sources was related to a perception of receiving less tangible support and less positive affect. Implications for future research and nursing practice are discussed.

Risk management strategies for home transfusion therapy

Transfusion therapy has been performed safely in the home setting for the past 15 years; however, it is not free of risks. Legal liability and risks can be reduced when transfusions are performed according to the accepted standards of care. Strategies to reduce transfusion risks through administrative, patient care, and quality control activities will be discussed. Methods to assure high-quality home care services also are provided.

Older adults' symptoms and their duration before hospitalization for heart failure

OBJECTIVE

To describe the older adult heart failure patients' symptoms and their duration before a hospital admission and to explore related factors.

DESIGN

The study was an archival study of inpatient hospital records at one acute care facility in western New York.

SAMPLE

One hundred eighty-one patients with a mean age of 76 years.

RESULT

Ninety-one percent of the patients reported having dyspnea an average of 3 days before hospital admission, and 37% reported having acute dyspnea an average of 12 hours before admission. Thirty-five percent of the patients reported having edema, and 33% reported a cough for an average of 7 days before their hospital admission. Age, heart failure history, and a symptom pattern of simultaneous development of preadmission symptoms were each related to the length of time patients experienced symptoms before admission.

CONCLUSION

This study, at one acute care institution, showed that older adult patients with heart failure experience symptoms for a relatively long time before hospital admission. Education about symptom monitoring, symptom interpretation, and prompt health care-seeking are warranted for all patients with heart failure.

1997 Joint Commission on Health Care Organizations home care standards: what's new?

Even though there are no new home care standards for 1997, there are some changes in the standards' interpretations and documentation expectations. Not all of the new interpretations are stricter interpretations. In fact, most of the new 1997 standards interpretations are more flexible. New interpretations for other problematic home care standards will be addressed in future columns.

Correlates of fatigue in older women with heart failure

OBJECTIVE

To examine the relative contribution of psychologic factors and physical symptoms to the variance in fatigue in older women with heart failure.

METHODS

Eighty women who had been hospitalized in the previous 12 months for heart failure were interviewed. Fifty-seven women completed second interviews 18 months after the first interview.

RESULTS

Fatigue was the most frequently occurring physical symptom at both measurement times, and it significantly increased with time. Other physical symptoms contributed uniquely to the variance in fatigue at both measurement times, but psychologic factors did not. At time 1, sleep difficulties, chest pain, and weakness each explained unique variance in fatigue. At time 2, dyspnea was the only variable that explained unique variance in fatigue (9%). Dyspnea also explained a significant portion of the variance (7%) in time 2 fatigue, when time 1 fatigue was controlled.

CONCLUSIONS

Fatigue in older women with heart failure is related more to other physical symptoms than psychologic factors.

The relationship of emotional and tangible support to psychological well-being among older women with heart failure

The purpose of this study was to determine the relationship between social support, symptom severity, and psychological well-being in older women with heart failure. In-home interviews were conducted with 80 older women following a hospital admission for heart failure. Subjects were asked their perceptions of emotional and tangible support received, symptom severity, and psychological well-being. Greater emotional support was related to greater positive affect and satisfaction with life. Greater tangible support was related to less negative affect. Neither emotional nor tangible support buffered symptom severity. The results indicate that emotional and tangible support may each affect different aspects of psychological well-being in older women with heart failure.

Social support sources and psychological well-being in older women with heart disease

A test of the compensatory hierarchical model of social support sources was conducted in a sample of 80 older women with heart disease. Relationships of support sources to measures of psychological well-being also were investigated. Emotional and tangible support sources fit the model with the exception that unmarried women without children named friends more often than extended family as emotional support sources. Receipt of emotional support from nonfamily members rather than from sources including family members was related to lower positive affect. Similarly, receipt of tangible support from nonfamily members rather than from sources including family members was related to less satisfaction with life. Factors that disrupt the family relationships of older women with illness are worthy of further exploration.