The future of nursing education. Ten trends to watch.

The millennium has become the metaphor for the extraordinary challenges and opportunities available to the nursing profession and to those academic institutions responsible for preparing the next generation of nurses. Signal change is all around us, defining not only what we teach, but also how we teach our students. Transformations taking place in nursing and nursing education have been driven by major socioeconomic factors, as well as by developments in health care delivery and professional issues unique to nursing. Here are 10 trends to watch, described in terms of their impact on nursing education.

Functional bowel disorders in women with dysmenorrhea.

OBJECTIVES: The relationship between menstrual and bowel symptoms, the overlap between the diagnoses of dysmenorrhea (DYS) and functional bowel disorder (FBD), and markers that may be useful in discriminating functional bowel disorders from DYS were studied in 383 women (20-40 yr of age). METHODS: All women completed the NEO Personality Inventory at intake and completed the Moos' Menstrual Distress Questionnaire and a bowel symptom inventory every 3 months for 12 months. Prostaglandin levels were measured in vaginal dialysate on the first day of menses. RESULTS: DYS was diagnosed in 19.8% of the total sample. Functional bowel disorder, defined as abdominal pain with altered bowel function, was diagnosed in 61% of the DYS group compared with 20% of controls (p < 0.05). Neuroticism scores were significantly higher in subjects with functional bowel disorder with or without DYS. However, bowel symptoms were significantly correlated with menstrual symptoms even after statistically controlling for the effects of neuroticism. Painful menses and water retention distinguished the DYS group from the functional bowel disorder group. Prostaglandin levels were elevated in women with DYS, but did not consistently differentiate the diagnostic groups. CONCLUSIONS: The strong covariation of menstrual and bowel symptoms, along with the overlap in diagnoses of DYS and function bowel disorder, suggest a common physiological basis.

Modeling and reinforcement of the sick role during childhood predicts adult illness behavior.

Previous studies suggest that the ways in which parents respond to children's health complaints (reinforcement) and the ways in which they cope with their own illnesses (modeling) influence the frequency of symptoms, disability days, and health care visits made by these children when they grow up. However, previous studies have not controlled for the mediating influence of stress, neuroticism, and physical examination findings. This study investigated the influence of childhood social learning on adult illness behavior in 383 women aged 20 to 40 years. Illness behavior was measured prospectively for 12 months by the frequency of symptoms, disability days, and physician visits for menstrual, bowel, and cold (upper respiratory) symptoms. Childhood reinforcement and modeling was measured retrospectively by validated questionnaires. Other independent variables were stress, neuroticism, and selected demographic variables. Multiple regression analysis was used to assess the relative contribution of each independent variable to each category of illness behavior. The principal findings were as follows. First, childhood reinforcement of menstrual illness behavior significantly predicted adult menstrual symptoms and disability days, and childhood reinforcement of cold illness behavior significantly predicted adult cold symptoms and disability days. These effects were independent of stress and neuroticism. Second, childhood reinforcement scales were useful to predict which functional disorders (dysmenorrhea or irritable bowel syndrome) these subjects had even after we controlled for stress and neuroticism.

Effects of stressful life events on bowel symptoms: subjects with irritable bowel syndrome compared with subjects without bowel dysfunction.

A standardised inventory of stressful life events and a bowel symptom questionnaire were administered at three month intervals for one year to 383 women who were unselected with respect to bowel symptoms. A NEO Personality Inventory was given initially to assess neuroticism. Subjects who satisfied restrictive diagnostic criteria for irritable bowel syndrome were compared with those who complained of abdominal pain plus altered bowel habits but who did not meet restrictive diagnostic criteria (functional bowel disorder) and with controls without bowel dysfunction. The irritable bowel group showed significantly higher levels of stress than the other two groups even when the confounding effects of neuroticism were statistically controlled for. Time lagged correlations showed that stress in one three month interval was significantly correlated with bowel symptoms in the subsequent three month interval for all groups. The slope of the regression line relating stress to bowel symptoms was significantly steeper for the irritable bowel group than for the other two groups at three and six months, suggesting that subjects with irritable bowel syndrome show a greater reactivity to stress. Stress scores were also significantly correlated with the number of disability days and the number of medical clinic visits for bowel symptoms.

Doctoral specialization in nursing informatics.

A prototype program of doctoral study has been developed at the University of Maryland School of Nursing to prepare students with nursing expertise in the conceptualization and research of computer based information systems in hospitals, industry and other health care organizations. The graduate will be prepared to design effective nursing information systems; create innovative information technology; conduct research regarding integration of technology with nursing practice, administration, and education; and develop theoretical, practice, and evaluation models for nursing informatics.

Evidence for exacerbation of irritable bowel syndrome during menses.

Many women report that bowel symptoms are associated with menstruation, but neither the prevalence of these complaints nor their physiological basis is known. This study aimed to estimate prevalence, to determine whether patients with irritable bowel syndrome are more likely to make such complaints, and to determine whether bowel complaints during menstruation are attributable to psychological traits such as increased somatization. To estimate prevalence, 369 clients of Planned Parenthood of Maryland were asked whether gas, diarrhea, or constipation occurred during menstruation. These subjects were compared with women referred to a gastroenterology clinic and found to have irritable bowel syndrome or functional bowel disorder (abdominal pain plus altered bowel habits but not satisfying restrictive criteria for irritable bowel syndrome). Thirty-four percent of 233 Planned Parenthood clients who denied symptoms of irritable bowel syndrome or functional bowel disorder reported that menstruation was associated with one or more bowel symptoms. Gastroenterology clinic patients with irritable bowel syndrome were significantly more likely to experience exacerbations of each of these bowel symptoms, but especially increased bowel gas. Self-reports of bowel symptoms during menstruation were not associated with psychological traits or with menses-related changes in affect.

Nursing informatics: a model curriculum for an emerging role.

The authors delineate the emerging role of the nurse as Information Systems Specialist and describe a prototype educational program in Nursing Informatics which is designed to prepare nurses for this role. Major duties, knowledge required, and resulting interactions related to the role are discussed in relation to the curriculum design and course content. The projected impact of this model program is also addressed.

Existence of irritable bowel syndrome supported by factor analysis of symptoms in two community samples.

To determine whether bowel symptoms covary in a pattern consistent with the existence of irritable bowel as a distinct syndrome, bowel symptom questionnaires from 2 independent samples were factor analyzed. Samples consisted of 351 18-40-yr-old women who visited Planned Parenthood clinics for contraception and 149 18-89-yr-old women recruited through church women's societies. Factor analysis of 23 bowel symptoms identified 4 factors (clusters of symptoms that were correlated with each other) in both samples. The factor accounting for the most variance in both samples included relief of pain with defecation, looser stools with pain onset, more frequent stools with pain, and gastrointestinal reactions to eating. This irritable bowel factor was not correlated with an objective measure of lactose intolerance. An independent constipation factor was found in both samples to include self-reported constipation, straining with bowel movements, feeling of incomplete evacuation, and rectal bleeding. Thus factor analysis of bowel symptoms supports the existence of a specific irritable bowel syndrome and suggests symptoms that may be used to diagnose this syndrome.

Constipation in the elderly living at home. Definition, prevalence, and relationship to lifestyle and health status.

The prevalence of self-reported constipation and the factors which contribute to it were investigated in a door-to-door survey of 209 people aged 65 to 93. Thirty percent of men and 29% of women described themselves as constipated at least once a month. However, elderly people define constipation differently than do their physicians: only 3% of men and 2% of women in the community sample reported that their average stool frequency was less than three per week, the customary medical criterion for constipation. The primary symptom which elderly people used to define constipation was having to strain in order to defecate. Multiple factors were found to influence self-reports of constipation. The amount of liquids consumed was significantly related to longest period without a bowel movement in men, but fiber and liquids were not related to self-reported constipation in either sex. The number of chronic illnesses and the number of nonlaxative medications were significantly related to constipation in women but not men, and the number of psychological symptoms correlated significantly with self-reports of constipation in both men and women. Age was not significantly related to self-reported constipation in men or women over the age of 65.

Incontinence.

1. Urinary incontinence is a significant cause of disability and dependency among the elderly, and is frequently cited as the major precipitant in long-term institutionalization. 2. Incontinent elderly view their condition as a significant symbol of loss of control as well as self-esteem, and is discussed by them in terms of infantilization. 3. Potential advantages of research and intervention and urinary incontinence include improved well-being of patients, relief of family burden, and cost benefit to society. 4. Evaluating behavioral treatment for incontinence remains an important nursing challenge due to the diversity of the incontinent elderly population in terms of their urinary tract pathophysiology; neurologic, cognitive, and functional status; and their environmental setting.

Graduate specialization in nursing informatics.

This article describes the need and rationale for developing nursing informatics as a new area of graduate level specialization. Included are the results of a comprehensive needs assessment study that was conducted to determine the employment opportunities for graduates of such a program of study as well as the potential student applicant pool. The findings clearly indicate the immediate and future demand for master's prepared nurses in this field and the importance of a timely academic response.

Levels of computer education for professional nursing. Development of a prototype graduate course.

Leveling computer education for professional nurses at the undergraduate and graduate levels is presented via a four-tiered model. Foundational course content at level 2 for all graduate nursing students preparing for advanced nursing roles is described. A quasi-experimental study (N = 80) demonstrated the effectiveness of the course in terms of the attitude changes toward computerization and perceived knowledge about computer applications in nursing.

Severe perimenstrual symptoms: prevalence and effects on absenteeism and health care seeking in a non-clinical sample.

Three hundred eight nursing students were classified into three perimenstrual severity groups based on their responses to the Moos Menstrual Distress Questionnaire, disregarding the number of symptoms reported. The prevalence of severe perimenstrual symptoms was 44% for strong symptoms and 18% for acute symptoms. Severity was significantly related to perimenstrual absence and to health care seeking for menstrual disorders, dysmenorrhea, and for gynecological disorders unrelated to menstruation. Severity was not significantly related to non-gynecological absence or health care seeking for non-gynecological disorders. Severe menstrual symptoms, particularly dysmenorrhea, had more of an effect on absenteeism and health care seeking than severe premenstrual symptoms.

Neurotrophic effects of hippocampal target cells on developing septal cholinergic neurons in culture.

The influence of hippocampal target cells on the development of cholinergic septal neurons was studied in rotation-mediated reaggregating cell cultures. Brain cells from 15-day-old mouse embryos were obtained from: septum, containing cholinergic cells which project to the hippocampus; hippocampus which contains target cells for the septal cholinergic neurons; and cerebellum, containing cells which are not targets for the septal cholinergic cells. The cells were then cultured for 3 weeks in a rotary incubator in the following combinations: septal cells alone; hippocampal cells alone; cerebellar cells alone; septal-hippocampal cells together; and septal-cerebellar cells together. After harvesting, fixation, and embedding, 50 micron sections were cut and processed for visualization of acetylcholinesterase activity. Sections from reaggregates containing either hippocampal or cerebellar cells alone contained only a few acetylcholinesterase-positive cells, but no positive fibers. Sections from septal-hippocampal coaggregates revealed a pattern of well-defined, fine-caliber acetylcholinesterase-positive fibers with extensive arborizations and varicosities suggesting axonal proliferation. In septal-cerebellar coaggregates, acetylcholinesterase-positive fibers appeared to be degenerating and distinct areas were observed which were essentially devoid of acetylcholinesterase fibers. In some experiments, either cerebellar or hippocampal cells were labeled with wheatgerm agglutinin-rhodamine prior to culture in order to identify these cells in the resulting reaggregates. Analysis of sections from these studies showed that acetylcholinesterase fibers were excluded from regions of coaggregates containing cerebellar cells, but were present in regions of coaggregates containing hippocampal cells. Finally, cell counts of acetylcholinesterase-positive cells in the various combinations revealed that these putative cholinergic neurons were significantly more numerous in septal-hippocampal coaggregates (271 +/- 19 per 10(6) septal cells added) than in septal reaggregates (38 +/- 6 per 10(6) septal cells added) or septal-cerebellar coaggregates (85 +/- 29 per 10(6) septal cells added). These results, taken together, suggest that hippocampal target cells influence the development and survival of cholinergic neurons.