A study of the relationship of nursing interventions and cognitions to the physiologic outcomes of care in a simulated task environment.

This study, based on the Expert Performance Approach, examined the clinical nursing performance of participants who were introduced into a simulated task environment requiring them to administer care to a client experiencing an exacerbation of Congestive Heart Failure. This was undertaken to identify cognitive and physiologic variables that differentiate performance levels among participants. Data on participant actions and verbal reports were coded to characterize their relationship with physiologic responses of the Human Patient Simulator. The results demonstrated that physiologic responses to nursing interventions reflect a reliable pattern that can be used to differentiate performance levels.

A faith-based screening/education program for diabetes, CVD, and stroke in rural African Americans.

The purpose of this study was to examine the effectiveness of a faith-based health screening/education program to ultimately reduce risk factors for diabetes (DM), cardiovascular disease (CVD), and stroke (CVA) in a southern, rural, African-American population. Over 120 parishioners from four rural African-American churches attended health education/screening programs offered as a part of their Bible Study. The majority of participants were female, married, with a mean age of 45 years. The program included education about prevention of cardiovascular disease (CVD), diabetes (DM), and stroke (CVA) followed by health screening, individual counseling, and healthy snacks. Pre/post test surveys for health knowledge were given. While the pre/post health knowledge scores showed some improvement, they were not statistically significant indicating the need for more than one program. Participants under age 30 and over age 60 years had the least knowledge on the pretest about these illnesses compared to the middle-age group. Almost 50% were found to have high blood pressure, and 14% had high blood sugar levels of which they were unaware. Participant and pastor feedback was positive and supported the feasibility of ongoing faith-based screening/ education programs as one way to meet the health needs of a rural African-American population.

Transitioning Florida NPs to opioid prescribing.

Prior to statutory changes in prescriptive authority for controlled substances, this study examined the knowledge gaps and prescribing limitations of Florida advanced registered nurse practitioners regarding opioids. Study results revealed statistically significant knowledge gaps in the areas of federal and state guidelines; opioid classes and proper doses; risk assessment skills; monitoring of treatment; and confidence in dealing with challenges of opioid prescribing.

Predicting depressive symptoms and self-care in patients with heart failure.

OBJECTIVE: To examine relationships among heart failure (HF) physical symptoms, social support, social problem-solving, depressive symptoms, and self-care behaviors in outpatients with HF. METHODS: Cross-sectional data were collected from 201 outpatients. Structural equation modeling was used in this preliminary analysis to examine the relationships among the study variables. RESULTS: HF physical symptoms and social support were predictors of depressive symptoms and self-care behaviors. Social problem-solving also predicted self-care behaviors. Social support mediated the relationship between HF physical symptoms and depressive symptoms. CONCLUSIONS: Social support may influence depressive symptoms and self-care behaviors, whereas social problem-solving may impact self-care behaviors. Future research should examine causality and sub-components of social problem-solving on these outcome variables.

Colon cancer screening in African American women.

African American women are more likely to die of colorectal cancer than are women of any other racial or ethic group. Early diagnosis depends on routine examination and screening. However, studies have shown that African American women are not utilizing available screening tools. African American women age fifty or older were questioned about their risk factors and frequency of CRC screening. The conceptual framework used was the Health Belief Model. Women who perceived fewer barriers, more benefits, higher perceived susceptibility, and increased confidence in the accuracy of screening, were likely to undergo screening. Implications for nursing practice are discussed especially focused on the role of advanced practice nurses as primary care providers. Utilization of a faith-based approach to reaching this population was also suggested.

Basal-bolus insulin therapy and glycemic control in adult patients with type 2 diabetes mellitus: a review of the literature.

PURPOSE: To present an integrative review related to basal-bolus insulin therapy and glycemic control in adult patients with type 2 diabetes mellitus. DATA SOURCES: A search of the Cochrane, Medline (first search and PubMed), and CINAHL electronic databases was conducted from 2004 through 2011 using the search terms "basal-bolus insulin therapy, sliding scale insulin, glycemic control, and adult." CONCLUSIONS: Comparisons were made of glycemic control, safety, adverse events, body weight, and insulin dose showing basal-bolus insulin therapy to be at least equal, if not superior to sliding scale insulin for the patient with type 2 diabetes mellitus. Overall patients using basal-bolus insulin therapy experienced better glycemic control, fewer hypoglycemic events, and had less weight gain. IMPLICATIONS FOR PRACTICE: Basal-bolus insulin therapy is recommended over sliding scale insulin for achieving glycemic control in both the inpatient and outpatient setting because of a reduced number of occurrences of hyper- or hypoglycemic events. This could translate to decreased hospitalizations, decreased length of stay, decreased healthcare costs, and improved patient outcomes.

Factors associated with depressive symptoms in patients with heart failure.

Home healthcare clinicians commonly provide care for individuals with heart failure (HF). Certain factors may influence the development of depressive symptoms in those with HF. This cross-sectional, descriptive, correlational pilot study (N = 50) examined interrelationships among HF symptoms, social support (actual and perceived), social problem-solving, and depressive symptoms. Findings indicated that increased HF symptoms were related to more depressive symptoms, whereas higher levels of social support were related to fewer depressive symptoms. The use of more maladaptive problem-solving strategies was also associated with more depressive symptoms. Study results have implications for home healthcare clinicians providing care for individuals with HF, indicating a need for programs that strengthen coping skills and resources (i.e., social support and problem solving) in an effort to decrease the risk of developing depressive symptomatology.

Comparative analysis of body mass index, consumption of fruits and vegetables, smoking, and physical activity among Florida residents.

The purpose of this study was to compare body mass index (BMI), consumption of fruits and vegetables, smoking, and physical activity in residents of the 7 Florida counties with the highest reported BMI to residents of the 7 Florida counties with the lowest reported BMI utilizing 2002 data from the Florida Department of Health Behavioral Risk Factor Surveillance System. Results showed that survey respondents in counties with the lowest mean BMI consumed significantly more fruits and vegetables, compared to respondents in counties with the highest BMI. A positive relation between mean BMI and consumption of fruits and vegetables remained when controlled for physical activity, but not for smoking. Education about the importance of increased fruit and vegetable consumption, as well as physical activity, are important factors in the campaign against obesity.

Self-perception in children with attention deficit/hyperactivity disorder.

The purpose of this study was to compare self-perceptions of children diagnosed with attention deficit/hyperactivity disorder (ADHD) with those of children not diagnosed with ADHD. Seventy-seven children aged 8-12 years composed the two groups-38 participants with ADHD and 39 control participants without ADHD. The children completed the Self-Perception Profile for Children Questionnaire designed to measure self-perceptions in school-aged children. t Tests compared differences in mean scores between the groups. The ADHD group had a significantly lower overall score and a lower score on the behavioral conduct subscale compared with children without ADHD. Findings suggest a difference in the way school-aged children with ADHD perceive themselves as compared with their peers. The cumulative effect of years of low self-esteem and negative self-perception may have significant life consequences. Attention should be focused on fostering self-esteem and positive self-perception in children with ADHD through support groups and behavioral training.

The relationship of perceived benefits and barriers to reported exercise behaviors in college undergraduates.

This study examines current exercise habits and perceived benefits and barriers to exercise in a sample of 147 undergraduate university students. It found a significant relationship between perceived benefits and barriers to exercise and current exercise habits. Benefits most often associated with regular exercise habits relate to physical performance and appearance. Barriers most often associated with sporadic or nonexistent exercise habits relate to physical exertion and time constraints. A greater understanding of perceived benefits and barriers to exercise may assist health care providers and educators to establish methods for promoting exercise for the improved physical and mental health of a college-age population.

The extent, nature, and precipitating factors of nurse assault among three groups of registered nurses in a regional medical center.

INTRODUCTION: This study investigated nurse perceptions of the incidence and nature of verbal and physical assault or abuse by patients and their family members or visitors. METHODS: A survey was given to ED, ICU, and general floor nurses in a 770-bed acute care north Florida medical center. RESULTS: The response rate was 68.8% (86 out of 125). Large percentages of nurses reported being victims of verbal assault or abuse and physical assault by patients and family members or visitors; 88% reported being verbally assaulted and 74% reported being physically assaulted while at work in the past year. ED nurses reported the highest rates of these incidences, with 100% reporting verbal assault and 82.1% reporting physical assault within the past year. Assaults were most commonly perpetrated by patients with cognitive dysfunction (79.1%), patients with substance abuse (60.5%), and persons who were angry because of the patient's condition (55.8%). Surprising information: the most common causes of assault by family members and visitors were anger related to enforcement of hospital policies (58.1%), anger related to the patient's condition/situation (57%), anger related to long wait times (47.7%), and anger related to the health care system in general (46.5%). DISCUSSION: Nurses were confused about what legally constitutes "assault" and "abuse"; nurse rights versus patient rights; and policies and procedures for reporting assault or abuse incidences. Our results indicate that nurses are experiencing abusive and assaultive behavior from family members and visitors just as often as they are from patients, and ED nurses are at higher risk. Nurses perceive a lack of institutional support and an institutional emphasis on patient rights and satisfaction and do not feel safe in the workplace.