Comparison between Urine Protein: Creatinine Ratios of Samples Obtained from Dogs in Home and Hospital Settings.

BACKGROUND: The urine protein:creatinine ratio (UPC) is used to quantify urine protein excretion and guide recommendations for monitoring and treatment of proteinuria. HYPOTHESIS/OBJECTIVES: Home urine samples will have lower UPCs than hospital samples. The objectives were to compare UPCs of samples collected in each setting and to determine whether environment of sample collection might affect staging, monitoring or treatment recommendations. ANIMALS: Twenty-four client-owned dogs. METHODS: Prospective, nonmasked study. Clients collected a urine sample from their dog at home and a second sample was collected at the hospital. Dogs receiving corticosteroids or angiotensin-converting enzyme inhibitors were excluded, as were those with urine samples of inadequate volume, no protein on dipstick analysis, or active urine sediment. Samples were refrigerated after collection, dipstick and sediment evaluations were completed and each sample was frozen at -80°C within 12 hours. UPCs were performed on frozen samples within 2 months. RESULTS: From 81 paired samples, 57 were excluded. Of the remaining 24, 12/24 (50%) had higher hospital sample UPCs, 9/24 (38%) had identical UPCs, and 3/24 (12%) had lower hospital UPCs. The UPCs of hospital samples were higher than home samples for the total population (P = .005) and the subset with UPC > 0.5 (P = .001). CONCLUSIONS: Setting and related circumstances of urine collection in dogs is associated with UPC differences; results are usually higher in hospital than in home samples. This difference has the potential to affect clinical interpretation.

Vitamin B12, folate, homocysteine, and bone health in adults and elderly people: a systematic review with meta-analyses.

Elevated homocysteine levels and low vitamin B12 and folate levels have been associated with deteriorated bone health. This systematic literature review with dose-response meta-analyses summarizes the available scientific evidence on associations of vitamin B12, folate, and homocysteine status with fractures and bone mineral density (BMD). Twenty-seven eligible cross-sectional (n = 14) and prospective (n = 13) observational studies and one RCT were identified. Meta-analysis on four prospective studies including 7475 people showed a modest decrease in fracture risk of 4% per 50 pmol/L increase in vitamin B12 levels, which was borderline significant (RR = 0.96, 95% CI = 0.92 to 1.00). Meta-analysis of eight studies including 11511 people showed an increased fracture risk of 4% per µ mol/L increase in homocysteine concentration (RR = 1.04, 95% CI = 1.02 to 1.07). We could not draw a conclusion regarding folate levels and fracture risk, as too few studies investigated this association. Meta-analyses regarding vitamin B12, folate and homocysteine levels, and BMD were possible in female populations only and showed no associations. Results from studies regarding BMD that could not be included in the meta-analyses were not univocal.

International community health networking project: two year follow-up of graduates.

AIM: This paper presents the perceptions of graduates 2 years post-exchange in a USA-European Union funded programme. The primary goal of this 8-week exchange programme was to increase cultural knowledge and sensitivity by teaching a common module of community health assessment and planning to multi-national groups of undergraduate students in four countries. BACKGROUND: Cultural diversity and globalization are among the factors that encourage faculty in nursing to develop programmes of international exchange for students. The challenge is to combine the exchange with the teaching of other courses required by the home institution during the same semester. METHODS: Twenty-one graduates of participating USA schools responded to an open-ended interview by telephone or email 2 years after graduation. Bennett's continuum (1993) of intercultural sensitivity was used to assess cultural development. FINDINGS: Graduates overwhelmingly supported international education and described its continued impact personally and professionally. Gains in cultural sensitivity were perceived as the greatest benefit and influence on their practice. The majority of graduates were believed to be in Bennett's ethnorelative categories of acceptance and adaptation. The depth and breadth of previous cultural experiences, specific host and home schools, and previous travel were found to be related to development on the intercultural sensitivity continuum. DISCUSSION: Most important are the findings from this evaluation that provide insight into the factors enhancing growth of intercultural sensitivity. Previous travel, characteristics of the home and host institutions, and the opportunity and willingness to be a cultural outsider were important influences.

A critique of cultural education in nursing.

UNLABELLED: AIM(S) OF THE PAPER: This paper critiques cultural education in nursing. Current approaches to cultural education, embedded in traditional anthropology, are obsolete and fail to acknowledge the global environment that impacts even the most remote and isolated cultures. The argument is made that new, transformative approaches to cultural education are needed. BACKGROUND: Cultural awareness of the other is the foundation of existing strategies to teach cultural education. Students are encouraged to learn about each culture, often described as a monolith, by learning the unique characteristics of a group with a common race, ethnicity, or other distinguishing feature. Despite the increased emphasis on cultural education in nursing worldwide, culturally based problems persist. Nurse and health care researchers continue to report disparities in health, an unequal distribution of health care, and the lack of knowledge and sensitivity when caring for clients from another culture. DISCUSSION: Globalization contributes to differences within cultures that may equal or exceed differences between cultures. Evidence is presented that current nursing education emphasizes cultural distinctions that do not persist in the postmodern world. Problems adherent to the continued use of cultural monoliths as the foundation of cultural education are discussed and expanded perspectives on culture and cultural education are presented. CONCLUSION: The principles of transformative education are offered as an alternative to the current approaches to cultural education. Students are encouraged to be vulnerable to personal change when interacting with people from other cultures because transformative education is as much about personal growth as it is about enhanced care of others. This modernized approach to cultural education transcends the standard adaptation of care from the dominant culture of the health care delivery system to the culture of the client/patient.

The development and psychometric evaluation of the Ethical Issues Scale.

PURPOSE: To describe the Ethical Issues Scale (EIS), its conceptual development and psychometric evaluation, and its uses in determining how frequently nurses experience ethical issues in practice. DESIGN: The EIS was validated with a sample (N = 2,090) of New England registered nurses (RNs) currently in practice. The sample was randomly split into two approximately equal samples. The calibration sample was used to derive the underlying components; the validation sample was used to confirm the component structure. METHODS: Psychometric analysis of the 35-item EIS included: (a) item analysis, (b) confirmatory principal components analysis (PCA), and (c) internal consistency reliability using Cronbach's alpha. RESULTS: Three components (end-of-life-treatment issues, patient care issues, and human rights issues) were demonstrated, confirming the original conceptually-derived structure. The calibration sample accounted for 42.4% of initially extracted common variance; the validation sample accounted for 41.5% of initially extracted common variance. CONCLUSIONS: The three EIS subscales had satisfactory internal consistency reliability and factorial validity for use as independent scales in future studies.

Designing a health outcomes research study in infusion nursing practice. How to get from a great idea to research results.

In infusion nursing practice, outcomes research involves identifying and measuring outcomes sensitive to, and most consistent with, current infusion nursing practice and theory. This article discusses what outcomes should be measured in infusion nursing; how to frame the study problem, develop a working research question, and define study variables; and how to design the method for sampling, variable measurement, data collection, and proposed data analysis. The article concludes with a discussion of how to apply research components using retrospective descriptive-comparative and prospective experimental approaches, and details how to write up the final research report.

Conceptual analysis of compliance.

Compliance has been studied from a wide range of scientific perspectives including medicine, nursing, psychology and health economics. There is no agreement regarding a commonly accepted definition. Lack of consistency in the definition and measurement of compliance is a major problem in research which becomes more complicated in an international study. The response to the confusion over the term compliance has been to suggest and use alternative terms such as adherence, co-operation, mutuality and therapeutic alliance. These terms are ill-defined and often are used as synonyms. The purpose of this paper is to analyse definitions of the concept of compliance. Abstracts from MEDLINE have been analysed in order to identify the types of compliance research that have been carried out.

The development of an instrument to measure the compliance of adolescents with a chronic disease.

The purpose of this paper was to describe the process of developing an instrument for measuring the compliance of adolescents with a chronic disease. The aim was to develop an instrument that could be used in a clinical setting to evaluate the compliance of young people with a chronic disease and to test a theoretical model of compliance, which had been developed along with the instrument. The instrument was originally developed to measure the compliance of adolescents with diabetes and later adjusted to measure the compliance of adolescents with asthma, rheumatoid arthritis and epilepsy. To test and develop the instrument, face and criterion validity, factor analyses, linear structural relations (LISREL) analyses, correlation coefficients and Cronbach's alpha were used. The instrument has 13 background questions and 41 items to measure compliance and factors connected to it.

An innovative model for international undergraduate education.

Educational exchange programs have a long academic history. Through such programs, students expand their knowledge of cultures in their home country and the larger world. Typically, students learn about a particular substantive area, such as politics, economics, health care, or language. There is also a loftier goal: to encourage understanding and respect for the people of other countries and share experiences with family and friends at home. In a biography of William J. Fulbright, the developer of the preeminent exchange program that bears his name, the senator is described as hoping that in a democratic country like the United States, "the knowledge and understanding of other cultures would inevitably trickle down through the educational system to those who were not privileged to travel abroad" (1, p. 131).

Family nursing practice in public health: Finland and Utah.

This exploratory study of family nursing practice in public health care was conducted in Finland and Utah. Staff nurses were interviewed in focus groups and asked to describe their practice of family nursing, the factors promoting and restraining practice, and the impact of the changes in health care delivery on practice. Thirty-six Finnish and 30 Utah nurses participated. Pressure to do more activities with fewer nurses and resources, changes in family problems, and skill level of the nurses were common themes. However, differences were evident. Finnish public health nurses used emotional support and information to help families empower themselves to use resources and to strengthen their family unit. Utah nurses focused first on individual level goals and then family cohesion and health. Nurse-initiated referrals and direct physical care were the primary intervention strategies of Utah nurses. Unlike the U.S. health care system, access for all in maternal and child health care and school health allowed Finnish nurses to develop long-term relationships with families, thus advancing family nursing practice. This study identifies several potential variables for further study particularly related to the organization of health care and nurse-family relationships.

The concept of adaptation: examining alternatives for the study of nursing phenomena.

Clients' adaptation is frequently studied in nursing and used to guide nursing practice. Many nurse authors have suggested that adaptation may be a unique conceptual framework for nursing. Other nurse authors have suggested, however, that in focusing on adaptation, nursing limits its focus to changing clients to fit the environment and neglects to change the social system or environment to meet clients' needs. The purpose of this article is to argue that adaptation theory limits the range of clients' acceptable responses to change. Adaptation theory assumes clients are responsible for adjusting to the norms or standards established by a relatively immutable environment. An alternate set of assumptions broadens the range of acceptable responses by clients and targets the environment for change. On the basis of these assumptions, directives are given for nursing research aimed at studying clients' responses to change.

Determinants of reported health promotion behaviors in employed Mexican American women.

This study based on the revised Pender Health Promotion Model (HPM) was conducted to determine the extent to which selected demographic modifying factors, health locus of control, self-efficacy, and current health status explained engaging in six health promotion practices in a sample of 397 employed Mexican American women aged 19 to 70 years who lived and worked in the Rio Grande Valley of Texas. Self-administered test packets contained measures of demographic characteristics, health locus of control, self-efficacy, health status, and the six health promotion practices. Canonical correlational analysis demonstrated two significant canonical variate pairs explaining 88% of variance in the dependent set, the subscale mean scores of the Health-Promoting Lifestyle Profile. Age; education; self-efficacy; internal and powerful others health locus of control; and prior, current, and future health status made statistically significant contributions. However, the demographic variables made only a minimal contribution, confirming the recent conclusions of researchers that the HPM as currently configured provides an inadequate explanation of the modifying factors' role in health promotion activity. Study results make an important addition to the understanding of how lifestyle factors contribute to Mexican American women's health and well-being.

Correlates of health-promotion activities in employed Mexican American women.

The purposes of this study were to describe the health-promoting lifestyle behaviors of 397 employed Mexican American women and to compare them with women in other published reports that used the Health-Promoting Lifestyle Profile (HPLP). Mexican American women had the highest HPLP total scores of all minority groups, but lower scores than all predominantly White groups. HPLP self-actualization and interpersonal support were the highest subscale scores. The exercise subscale was the lowest score for all groups, including minorities. Canonical analysis revealed two significant canonical variate pairs explaining 88% of variance. Age, education, self-efficacy, health locus of control (internal and powerful others), and current health status made statistically significant contributions to all HPLP subscale scores. Study results support previous research findings and make an important contribution to understanding the factors that influence Mexican American women's health-promoting lifestyle behaviors.

Testing the Theory of Transcending Options: health behaviors of single parents.

The Theory of Transcending Options was developed in a grounded theory study of the health behaviors of female single parents. The 2-year study reported in this article is the first statistical test of the associations between the independent variables identified in the theory and the number of health behaviors practiced by divorced women with children. Data on demographics, psychological variables, and social support were collected from 148 women at three points in time over 2 years. These data were entered into three stepwise multiple regression analyses, with health behaviors as the dependent variable. Each analysis was statistically significant. The independent variables that made statistically significant contributions to health behavior practices in one or more of the regression analyses were education, number of years single, depression level, self-esteem, and total social support. The results of this study indicate that further clarification and testing of the theory are warranted.

Developing a nursing doctorate for the 21st century.

Nursing in the next century will reflect changes in the health care system, and although the profession has made great strides in preparing nurse researchers, the current system has a serious gap that must be addressed; that of preparing clinical leaders. The article describes the need for a practice-focused doctoral curriculum that will produce a new type of senior clinician or expert practitioner to fill this gap. The envisioned graduates will be skilled in clinical decision making and information processing and will effect changes at both the micro- and macro-levels of the system. There is a clear future need to expand the number of primary care providers. The faculty required for their education must be doctorally prepared nurses who are themselves clinically proficient. The research and practice doctorates should be differentiated by faculty, the program of studies, resources, and placement/expectation of graduates. The article includes a model curriculum plan.

Social networks and social support of recently divorced women.

A study of the support networks and social support of recently divorced women with children was conducted over two years. Its purpose was to assess changes in the women's social support and identify their unmet needs. Data were collected from 148 women by mailed questionnaire and telephone interview soon after the final divorce decree, and again at two years. The women did experience a significant decrease in network size and social support over two years; however, the primary members of their networks--family and friends--remained stable. Women with preschool-age children had more family support than those with older children. Nine categories of unmet needs were identified. Most frequently cited, in descending order, were emotional support, financial assistance, need for a boyfriend/partner/spouse, time for herself, and child care. The average number of needs per woman was less than two. The findings of this study confirm the losses in overall network size and support that women experience after divorce. The identification of unmet needs helps nurses to target areas in which women may require assistance to find social support.