An eye toward the future: Pressing questions for our discipline in today's academic and research climate.

This paper seeks to open a dialogue concerning the current trend in hiring non-nurse faculty (NNF) to tenure track positions in schools/colleges of nursing. The evolution of non-nurses as faculty, including a review of contemporary papers in affecting this trend, is offered. Three means of involving non-nurses in advancing our discipline are presented. The impact of the growing trend of NNF is discussed relative to the integrity of our discipline and effects on education. We conclude by suggesting a manner of proceeding and raise questions for furthering dialogue.

A Predictive Model for Identification of Children at Risk of Subsequent High-Frequency Utilization of the Emergency Department for Asthma.

BACKGROUND: Asthma is the most common chronic condition among children with high-frequency emergency department (ED) utilization. Previous research has shown in outpatients seen for asthma that acute care visits predict subsequent health care utilization. Among ED patients, however, the optimal method of predicting subsequent ED utilization remains to be described. The goal of this study was to create a predictive model to identify children in the ED who are at risk of subsequent high-frequency utilization of the ED for asthma. METHODS: We used 3 years of data, 2013-2015, drawn from the electronic health records at a tertiary care, urban, children's hospital that is a high-volume center for asthma care. Data were split into a derivation (50%) and validation/test (50%) set, and 3 models were created for testing: (1) all index patients; (2) removing patients with complex chronic conditions; and (3) subset of patients with in-network care on whom more clinical data were available. Each multivariable model was then tested in the validation set, and its performance evaluated by predicting error rate, calculation of a receiver operating characteristic (ROC) curve, and identification of the optimal cutpoint to maximize sensitivity and specificity. RESULTS: There were 5535 patients with index ED visits, of whom 2767 were in the derivation set and 2768 in the validation set. Of the 5535 patients, 125 patients (2.3%) had 4 or more visits for asthma in the outcome year. Significant predictors in models 1 and 2 were age and number of prior ED visits for asthma. For model 3 (additional clinical information available), the predictors were number of prior ED visits for asthma, number of primary care visits, and not having a controller medication. Areas under the ROC curve were 0.77 for model 1, 0.80 for model 2, and 0.77 for model 3. CONCLUSIONS: Administrative data available at the time of ED triage can predict subsequent high utilization of the ED, with areas under the ROC curve of 0.77 to 0.80. The addition of clinical variables did not improve the model performance. These models provide useful tools for researchers interested in examining intervention efficacy by predicted risk group.

Defining patterns of genital injury from sexual assault: a review.

The forensic examination following rape has two primary purposes: to provide health care and to collect evidence. Physical injuries need treatment so that they heal without adverse consequences. The pattern of injuries also has a forensic significance in that injuries are linked to the outcome of legal proceedings. This literature review investigates the variables related to genital injury prevalence and location that are reported in a series of retrospective reviews of medical records. The author builds the case that the prevalence and location of genital injury provide only a partial description of the nature of genital trauma associated with sexual assault and suggests a multidimensional definition of genital injury pattern. Several of the cited studies indicate that new avenues of investigation, such as refined measurement strategies for injury severity and skin color, may lead to advancements in health care, forensic, and criminal justice science.

Injury as a global phenomenon of concern in nursing science.

PURPOSE: To discuss injury research as a phenomenon of concern in nursing science. ORGANIZING CONSTRUCT: Injury is defined as the physical damage that results when the human body is briefly subjected to intolerable levels of energy. It is the leading cause of death in the first 4 decades of life in high-income nations and is second only to infectious diseases as a leading cause of death in low- and middle-income nations. METHODS: Review and discussion of relevant scientific and theoretical literature in both injury and nursing science. FINDINGS: Nurse scientists can apply unique perspectives to increase understanding of injury and its consequences. Fertile areas for nursing inquiry include identifying people at risk, developing models to explain the association between risk-taking and injury, testing interventions to prevent and limit injury, and creating and refining interventions that are culturally relevant to subpopulations most at risk for injury. CONCLUSIONS: The mandate to improve global heath should lead to nursing inquiry about this phenomenon, including developing and testing interventions to prevent and reduce injury.

The case for alcohol research as a focus of study by nurse researchers.

Sixty percent of the U.S. population drinks alcohol. Although numerous investigators have shown that low-volume alcohol intake has positive influences on cardiovascular health, bone density, and cognition, there is a fine line between positive, neutral, and negative ramifications of alcohol consumption on health. Alcohol accounts for 7% of the global burden of disease and injury from all causes and for 10% to 11% of all illnesses and death each year worldwide. So alcohol use is a two-edged sword. Psychiatric nurses have a long history of involvement with alcoholic patients, and alcohol users, misusers, and abusers comprise a significant percentage of the patient load in every specialty and subspecialty of nursing. Yet nursing education has neglected this important area of content in general nursing curricula, staff development has not trained mainstream nurses to routinely assess for alcohol problems among hospital patients, and primary care providers have failed to do case finding. During the past 25 years, the federal government has funded curricular and faculty development programs to bring alcohol information into the core of health provider training. The process has been halting and minimally successful at best. One ramification of the inattention to alcohol-related education is the dearth of nurse-scientists engaged in programs of research in the field of alcohol abuse. A federally funded faculty development program in the 1990s focused attention on this issue, and a small cadre of nurses were trained to do related research. Several of the authors in this volume are members of that group. A brief overview of the focus of each of the remaining chapters in this volume is presented. A rationale is provided for the importance of this area of research for nursing knowledge and quality patient care in essentially all areas of nursing practice. Finally, several burning research questions are posed that would most appropriately be answered through nursing research.

Alcohol and risky behaviors.

The purpose of this chapter is to review and critique the literature on risky drinking, driving, and sexual behaviors. To complete this review, electronic searches using databases from the disciplines of nursing, medicine, and psychology were used with keywords alcohol and risky behavior, risky drinking, risky driving, risky sex, and sexual aggression, as well as other relevant terms. The basic tenets of contemporary theoretical models of risky behaviors are used as a framework for reviewing the literature. Most relevant to the discussion are the relationships among the behaviors, risk and protective factors, and major unresolved theoretical and methodological issues. In the literature, sensation seeking was differentially associated with risky drinking, driving, and sex, but causal assertions are premature. Important conceptual and physiological issues are clarified. First, unconventionality contributes to risky drinking, risky driving, and, among adolescents, risky sex. Second, the pharmacologic effects of alcohol on cognitive processing contribute to risky sex, but only among persons who feel conflicted about risky sex (e.g., condom use). This perception may be particularly true for men who have a belief that alcohol will enhance sex. Third, sexual aggression appears to stem from a variety of factors, including the pharmacologic effects of alcohol on aggression and stereotypes about drinking women. Exploration of risk and protective factors adds breadth and depth to the discussion of risk taking. Risk factors include (1) high tolerance for deviance, (2) unconventional attitudes and behaviors such as early alcohol use and precocious sex, (3) peer norms for deviance, (4) high sensation seeking, and, to a lesser extent, (5) disturbed risk perception and positive beliefs about alcohol. Protective factors appear to mitigate risk and include (1) conventional attitudes and behaviors and (2) having peers that model conventional attitudes and behaviors. Although empirical evidence suggests that risky behaviors tend to covary, most intervention trials to date have focused on single behaviors, and often are based on clinical information rather than existing theoretical and empirical knowledge.

Measurement of alcohol consumption: issues and challenges.

In both the clinical and research settings, nurses assess patterns of alcohol consumption to screen for risk of adverse events or to determine the health consequences of drinking. The purposes of this critical review are to explore issues and controversies surrounding the measurement of alcohol consumption and to critique the existing literature relevant to the research and clinical arenas. An electronic literature search was completed to identify research articles addressing human studies from 1995 through 2004 related to alcohol consumption. Key words included alcohol drinking (subheadings blood, metabolism, psychology, and urine), standard drink, problem drinking, heavy drinking, and ethanol analysis (subheadings blood, urine, and chemistry). The results were in two primary content areas: self-reported alcohol consumption and assessment of consumption by using biological markers. Self-reported alcohol consumption can be quantified in a variety of ways, such as ounces of ethanol per day, standard drinks per day, drinking occurrences per month, heavy drinking occasions per month, and frequency of perceived drunkenness. The choice of measure depends on setting (clinical vs. research), the role of the variable under study, the capabilities and demographics of the study population, the study design, and the resources available to collect alcohol consumption data. A variety of biologic instruments are used to assess alcohol consumption, each with sensitivities and specificities that vary by age, gender, and possibly by ethnicity/race. Previous work has focused on the white, male, alcohol-dependent population and non-alcohol-dependent male controls. Some urgency exists to expand the biometrics of alcohol use to minority and older populations as well as to women across the life span.

Using colposcopy in the rape exam: health care, forensic, and criminal justice issues.

In the setting of a forensic examination following rape, colposcopy allows practitioners to identify and photograph genital injury not readily visible to the unaided eye, thereby clarifying the location and extent of injury as well as providing evidence for court proceedings. Since the 1980s, the technique once reserved for victims of child abuse has been used across the lifespan and has been shown to identify genital injury in up to 87% of women who have been raped. The role of colposcopic findings as evidence in court testimony, however, remains controversial. This paper explores the history of colposcopy in the rape exam and describes the epidemiology of genital injury in consensual sex as well as rape.

Injury in women who are raped: what every critical care nurse needs to know.

Sexual assault is considered the silent, violent epidemic. However, many critical care nurses are unaware of the injury patterns that may indicate that their patient has been sexually assaulted. In addition, critical care nurses are often uncertain how to proceed when caring for someone with a suspected sexual assault. This article provides both background information about sexual assault and guidance to critical care nurses on how to manage this difficult situation.

Assessing acute and critically ill patients for problem drinking.

More critically ill patients have acute drinking problems than chronic problems with alcohol dependence. A hospitalization offers an opportunity for nurses to perform a brief assessment and initiate a simple intervention to advise patients to reduce their drinking. A few minutes of advice may make a long-term difference in a patient's health.

The cellular basis of septic shock.

Severe sepsis and septic shock are among the most complex and challenging conditions treated by critical care practitioners. Although the pathophysiology of severe sepsis and septic shock is not fully understood, bacteria and immune responses are known to trigger the release of cytokines. These cytokines initiate a cascade of events that lead to illness behaviors such as fever, anorexia, and sleepiness, as well as a host of physiologic events such as activation of the coagulation cascade, vasodilation, hypotension, and increased vessel permeability. As research advances the understanding of severe sepsis and septic shock, practitioners must become aware of the cellular basis of events so that treatments can be implemented knowledgeably and evaluated.

Laboratory measures of alcohol (ethanol) consumption: strategies to assess drinking patterns with biochemical measures.

Alcohol (ethanol) use is a global, health-related problem that spans a continuum ranging from low-risk, at-risk, and problem drinking to alcohol dependence and chronic abuse. Clinicians and researchers alike have the need to quantify drinking patterns to determine the risk for adverse, health-related events such as injury, liver damage, and cancer Biochemical measures of ethanol consumption are affected by temporal patterns of drinking as well as individual characteristics such as gender and age. The choice of a laboratory analysis to determine ethanol consumption is complex; no single laboratory test will predict drinking accurately across all drinking patterns, across the life span, and across gender. In conjunction with interviews and physical assessment, however, biochemical laboratory tests are sensitive tools used to measure both recent and long-term patterns of alcohol consumption.

"Nurse, I only had a couple of beers": validity of self-reported drinking before serious vehicular injury.

BACKGROUND: Of the more than 40000 Americans killed each year in vehicular crashes, 40% are involved in alcohol-related collisions. Although self-reported alcohol use has become an anchor for alcohol intervention after traffic crashes, clinicians are often skeptical about the truthfulness of self-reporting. OBJECTIVE: To determine the validity of self-reported alcohol consumption of vehicular occupants hospitalized for a serious, alcohol-related injury. METHODS: Non-alcohol-dependent subjects 18 years and older who were injured in motor vehicle crashes were interviewed. The self-reported number of standard drinks, time that drinking commenced, sex, and weight were used to calculate estimated blood alcohol concentration. This value was compared with the blood alcohol concentration measured at admission. RESULTS: Of the 181 subjects, 60% provided sufficient data to calculate the estimated concentration. Seven men with admission concentrations of 10 mg/dL or more denied drinking. Among the 113 subjects with estimated concentrations who acknowledged drinking (excluding the 7 who denied drinking), the mean concentration at admission was 158.67 mg/dL, and mean estimated concentration was 83.81 mg/dL. According to multiple regression analyses, weight and number of drinks accounted for 3% of the variance in alcohol concentration at admission for women (R=0.174, F2,40=0.623, P=.54) and for 29% of the variance in men (R=0.543, F2,128=26.71, P< .001). CONCLUSIONS: Most persons who drink before vehicular injury acknowledge drinking. Self-reported data from men generally reflect the overall trend of alcohol consumption but with systematic underreporting. Reports from women are less predictable.

Focused life stories of women with cardiac pacemakers.

Biotechnical devices such as cardiac pacemakers are implanted into people to manage a range of disorders, yet comparatively little is known about the emotional impact of this experience. Women may have a unique response to implanted devices due to cultural messages about the masculinity of technology. In this qualitative study using Hall's focused life stories design, 11 women from teenagers to elders with permanent cardiac pacemakers were asked to describe their experiences using semistructured interviews. The themes that emerged are relinquishing care, owning the device, experiencing fears and/or resistance, imaging the body, normalizing, positioning as caretaker, finding resilience, and sensing omnipotence. Understanding what it means for women to live with an implanted biotechnical device may facilitate planning interventions to support their psychological and physiological health. Effective pacemaker function may depend, in part, on recipients' successful emotional attachment to the device.