The use of therapeutic massage as a nursing intervention to modify anxiety and the perception of cancer pain.

The purpose of this exploratory study was to examine the effects of therapeutic massage (consisting of effleurage, petrissage, and myofascial trigger point therapy) on pain perception, anxiety, and relaxation levels in hospitalized patients experiencing significant cancer pain. Thirty minutes of therapeutic massage was administered on two consecutive evenings to nine hospitalized males diagnosed with cancer and experiencing cancer pain. The subjects' self-reports of pain and relaxation (measured by Visual Analogue Scales) as well as anxiety (measured by the Spielberger State Anxiety Inventory) were recorded before and immediately after the intervention. The objective physiologic measures of heart rate, respiratory rate, and blood pressure were obtained before, immediately after, and, finally, 10 min after the massage intervention. Massage therapy significantly reduced the subjects' level of pain perception (average = 60%) and anxiety (average = 24%) while enhancing their feelings of relaxation by an average of 58%. In addition to these subjective measures, all physiological measures (heart rate, respiratory rate, and blood pressure) tended to decrease from baseline, providing further indication of relaxation. In conclusion, although the exact mechanism is not known, therapeutic massage is a beneficial nursing intervention that promotes relaxation and alleviates the perception of pain and anxiety in hospitalized cancer patients.

A statewide study of academic variables affecting performance of baccalaureate nursing graduates on licensure examination.

The purpose of this study was to validate, using a statewide sample, findings from two previous smaller studies investigating the relationships between admission selection variables and subsequent achievement in baccalaureate nursing programs and performance on the National Council Licensure Examination for Registered Nurses (NCLEX-RN). Subjects for this study were 1,069 graduates of nine Iowa basic baccalaureate nursing programs. The analyses included three major components. The first addressed the relationship between admission selection variables and subsequent achievement in the nursing programs and performance on a standardized nursing achievement test (AssessTest) and the NCLEX-RN. The second component investigated the extent to which achievement in nursing courses predicted performance on the NCLEX-RN. In the third component a path analysis was used to formulate a causal model describing the relationships among the variables in the study. The results of the study suggest that students' prenursing grade point average and American College Testing scores predict their performance on the NCLEX-RN. Knowledge of performance predictors can both facilitate admission selection and the use of educational resources to develop nursing competence and promote success in obtaining licensure to practice.

The willingness of family members of critically ill adults to learn the coping technique of imagery.

Critical care nurses face the challenge of helping anxious families cope with the critical illness of one of their members. The purposes of this exploratory descriptive pilot study were to identify whether adult family members of surgical intensive care unit (SICU) patients were willing and able to learn imagery during the time of their family member's critical illness, and which factors facilitate the learning. Of the 139 persons invited, 26 (18.7%) indicated willingness to participate, but only 10 participants completed both learning sessions. All 10 subjects achieved increased relaxation with the imaging. Facilitators of their learning were the quiet environment, the investigator's voice, and the breathing aspect of the technique. Those who participated found imagery beneficial, but further study is needed regarding the basis of both willingness and reluctance to learn relaxation techniques such as imagery to assist with coping during the SICU vigil.

Normal thought processes. An overview.

The complexity of the neurologic mechanisms operating in normal thought processes is obvious as is their impact on the quality of human life. The efficient performance of intellectual activity, that is, thinking and reasoning, assumes an awake, alert state and encompasses the interplay of fundamental mental operations such as attention, memory, spatial orientation, language, and higher order functions of insight, calculation, and abstract reasoning. Systematic assessment of the full range of operations is required to accurately diagnose alterations in thought processes, because the identification of specific impairments may facilitate the localization of brain injury as well as focus nursing intervention.

Interventions related to activity and movement.

Ten nursing interventions related to human activity phenomena with definitions and a combined total of 246 defining activities were developed from literature reviews and concept synthesis. A two-round Delphi survey of highly experienced master's-prepared rehabilitation nurses confirmed the content validity of the interventions. Round 1 responses resulted in major revisions of several interventions that were questioned and viewed as being outside the domain of nursing practice. Respondents also indicated that some of the activities listed were "idealistic" and that factors such as limited staffing, institutional policy, and physical characteristics of the unit would limit implementation. None of the activities rated in round 2 were deleted for means less than 0.50. The interventions with the highest ICV scores were Swallowing Therapy (0.86), Exercise Therapy: Ambulation (0.85), and Exercise Therapy: Mobility (0.84). Although all of the interventions were conceptualized for nursing across settings, these are modest levels of agreement and may reflect the practice of nursing in more structured institutional settings where exercise and activity therapies are performed by specialty rehabilitation professionals. On the other hand, the 72% round 2 response rate and the volume of written feedback received attests to the level of commitment and attention given to the task by the nurse experts. This affirms the value of seeking systematically to identify, verify, and build nursing science.

Reliability and validity of a new preadmission acuity tool for long-term care.

The purpose of this project was to develop a new tool designed to assess the acuity of applicants to long-term facilities. Using a known groups method, residents of long-term care facilities were categorized as independent (n = 68), assist (n = 71), and dependent (n = 65) and assessed using the Preadmission Acuity Inquiry Tool (PAI) to generate the data base for examining its psychometric properties. The progression of the mean scores from independent to assist to dependent demonstrates the ability of the tool to differentiate across varying levels of functional independence. Using discriminant analysis, the degree of accuracy in predicting group membership for the independent group was 88%, for the dependent group 75%, and for the assist group 17% with the overall agreement between PAI scores and a priori classifications at 60%. Kappa coefficients for interrater reliability ranged from .54 to 1.0 with a mean of .90. The Cronbach's alpha coefficient was .81. The PAI has demonstrated sufficient reliability and validity to warrant further refinement and testing. This new instrument may enable health care professionals to provide the appropriate level of care in a cost-effective manner.

Motor performance correlates of functional dependence in long-term care residents.

The purpose of this study was to examine the validity and reliability of the Motor Performance Inventory (MPI), a series of upper and lower extremity movements for predicting functional dependence and independence. A random sample of 197 persons, aged 65 and above, who resided in one of eight extended care facilities, were stratified as independent, assist (intermediate), or dependent using modified 1990 Health Care Financing Administration (HCFA) operational criteria. A stepwise procedure yielded a five-task combination that accounted for 90% of the variance in functional level. The final model accurately predicted group membership 72% of the time.

Inductive methodology and a research team.

Large teams of researchers using inductive methodologies are relatively rare and present unique challenges to team members. A team from the University of Iowa reports on what it experienced during a project to develop a taxonomy of nursing interventions.

Classification of nursing interventions for care of the integument.

The Classification of Nursing Interventions research team at The University of Iowa, College of Nursing is building a taxonomy of nursing interventions that will include all of the direct care treatment activities that nurses perform on behalf of patients. This report describes the study in which 12 nursing interventions and their associated activities for care of the integument were extracted from a large database and validated through a two-round Delphi survey. Using an adaptation of Fehring's model for determining diagnostic content validity of nursing diagnoses, a definition, critical activities, and supporting activities were developed for each of the following interventions: Bathing, Bedrest Care, Hair Care, Nail Care, Oral Health Maintenance, Oral Health Promotion, Oral Health Restoration, Positioning, Pressure Management, Skin Care--Topical Treatments, Skin Surveillance, and Wound Care. Further research is needed to validate supporting activities and to continue classifying interventions and activities that nurses use in treating impaired skin integrity (potential and actual) and altered oral mucous membrane integrity (potential and actual).