Heart failure outcomes based on race and gender of patients in a medically undeserved area.

The purpose of this descriptive study was to investigate changes in quality of life (QoL), disease severity and exercise tolerance of heart failure (HF) patients in a medically underserved clinic based on race and gender. Despite advances in the treatment of HF over the past decade, incidence, morbidity and mortality for patients continue to rise while QoL declines. HF is common in African-Americans and women; however, there is limited research focusing on race and gender variables. Health related QoL, disease severity measured by B-type natriuretic peptide blood test (BNP) and ejection fraction (EF), and exercise tolerance measured by six minute walk test (6MWT) were assessed at admission and at 6 months in a convenience sample of 53 patients. Variables were compared by race and gender. The sample was 67.9% African American and 62.3% male. Men had greater improvements than women in QoL, BNP, and EF, while women had greater improvements in the 6MWT. African Americans had greater improvements than Whites in all four variables. Even in the presence of disease severity in patients with New York Heart Association (NYHA) Class III and IV HF, there were significant improvements in QoL, BNP, HF outcomes demonstrating the importance of developing culturally sensitive and gender-specific treatment plans.

Learner-centered characteristics of nurse educators.

The purpose of this study was to describe the learner-centered teaching characteristics of nurse faculty who report using contemporary pedagogy. A secondary analysis of data collected by an international survey of nurse educators regarding pedagogical teaching approaches and strategies was used to answer the research questions. The study sought to: 1) describe characteristics emerging from faculty response, 2) make inferences from faculty responses regarding meaning, and 3) make inferences regarding the importance of the meaning to nursing. A qualitative research design was used to address the research question. Themes that emerged were placed under the concepts of power, role of teacher, responsibility of learner, and philosophy of evaluation guided by Weimer's (2002) conceptual framework of a learner-centered philosophy of teaching. Themes and meaning units derived from the study helped to generate textual and structure statements that represent the characterizations of learner-centered nurse educators.

Reusable learning units: an innovative teaching strategy for online nursing education.

Constructivist and adult learning theory provided the theoretical framework for reusable learning units (RLUs) developed for a Southeastern University's family nurse-practitioner and nurse-midwifery distance educational programs. Reusable learning units are an organized series of learning events that satisfy one or more interrelated learning objectives that cannot be broken down to component parts without losing semantic and pragmatic meaning. This paper describes the conceptual framework, background and history of RLUs, and collaborative efforts for development and implementation.

The quality of life of hospice patients: patient and provider perceptions.

The purposes of this study were to describe the quality of life (QOL) of terminally ill patients in a home-based hospice program and to examine the relationship between QOL data and patients' symptom distress, ability to function, interpersonal communication (support from family and friends), well-being (their affairs in order), and transcendence (religious comfort/support) as recorded in their charts. QOL was measured by the Missoula-Vitas Quality of Life Index (MVQOLI), an instrument designed specifically for use with terminally ill patients. The study was conducted over a three-year period with 129 terminally ill patients enrolled in a home-based hospice program of care. The MVQOLI was administered to patients within 20 days of their admission to hospice. A retrospective chart review was conducted to determine patients' levels of symptom distress, ability to function, social support, whether or not their affairs were in order, and religious comfort/support. The mean age of participants in this study was 67, with 54.3 percent male and 45.7 percent female. Cancer was the primary diagnosis for 92.2 percent of the sample, and 35 percent of these patients had a diagnosis of lung cancer. Of the 7.8 percent non-cancer diagnoses, five were diagnosed with AIDS, four with chronic obstructive pulmonary disease, and one with chronic heart failure. The results of this study revealed positive scores on the five dimensions of the MVQOLI QOL scale, indicating that within 20 days of admission to hospice, patients rated their QOL as good to very good. Data obtained from the chart review also indicated that patients did not experience a great deal of symptom distress (e.g., pain, nausea, shortness of breath, and restlessness). A significant correlation existed between age and QOL; number of interventions and pain levels; and marital status, well-being, interpersonal relationships, and transcendence. Shortness of breath and well-being were significantly correlated with QOL. There was no significant correlation between gender, race, or closeness to death and the five dimensions of the MVQOLI and chart review assessments.

Patient and caregiver satisfaction with end-of-life care: does high satisfaction mean high quality of care?

The purpose of this study was to determine patient and caregiver satisfaction with a hospice program of care. The setting for the study was a home-care hospice in the southeastern United States that provides a full range of services for patients with life-limiting illness and supportive services for family caregivers. Two Likert-type instruments were used to determine satisfaction with staff, communication, education, information provided, symptom management, promptness with service, and overall satisfaction. Some 321 patients and 443 caregivers completed surveys over a two-year period of time. Data indicates the majority of patients and their caregivers were very satisfied with hospice services and the care they received. Providing quality care at the end of life is the goal of hospice. Satisfaction with delivery of care, management of symptoms, and communication with staff are all components of quality care and contribute to quality of life.