Neonatal Abstinence Syndrome: An Uncontrollable Epidemic.

There is an uncontrollable epidemic of drug abuse, with the misuse of opioids the most alarming. Along with the increase in opioid abuse, there exists a concomitant upsurge in the number of neonates experiencing neonatal abstinence syndrome (NAS) due to the effects of the mother's withdrawal from the drug. Neonates experiencing NAS exhibit various nervous system, gastrointestinal, and respiratory untoward symptoms. Diagnosis is determined by taking an accurate maternal history and assessment of clinical signs and symptoms. Clinical management strategies include pharmacologic and nonpharmacologic therapies. Nursing care is evidence based, includes nonpharmacologic therapies, and focuses on prevention and support.

Educational challenges in neonatal nursing practice and advanced practice.

Education for advanced practice has been debated since the development of the position on the doctor of nursing practice for advanced clinical practice. This article explores the issues that have emerged with an emphasis on the advanced practice roles in neonatal nursing. Licensure, certification, and scope of practice are addressed.

Racial/ethnic disparities in the utilization of high-technology hospitals.

INTRODUCTION: Hospitals with high-technology services may have better outcomes. However, access to high-technology hospitals might not be uniform across racial/ethnic groups. This study examined if racial/ethnic minorities, compared to whites, are less likely to utilize hospitals that have the availability of technology services and infrastructure items such as computed tomography, positron emission tomography, magnetic resonance imaging, diagnostics radiation facility, and a level 1 trauma unit. METHODS: Data were obtained from the 2003 Healthcare Cost & Utilization Project's Nationwide Inpatient Sample and the 2003 American Hospital Association's annual survey data. The sample consisted of 3381 324 patients admitted to and discharged from 368 hospitals in 18 states in the United States. RESULTS: Logistic regression results suggest that Hispanic patients are less likely than whites to utilize high-technology hospitals when controlling for other factors (odds ratio[OR], 0.47; 95% confidence interval [CI], 0.28-0.79). CONCLUSIONS: Our study adds empirical evidence that significant gaps persist in access to care between minorities and whites. Particularly, access to high-technology hospitals for Hispanics appears to be a major problem.

Does caregiver knowledge matter for hospice enrollment and beyond? Pilot study of minority hospice patients.

We examined the level of hospice knowledge of caregivers of minority elderly hospice patients and determined how it influences the hospice enrollment decision and the decision on the use of hospice services after enrollment. Based on qualitative analysis of medical records and interviews with caregivers of minority elderly hospice patients who received personal care from paid caregivers (eg, other than family caregivers), we found that hospice knowledge increased access to hospice among minority patients who otherwise would not opt for hospice or enroll too late for comprehensive hospice care services. Furthermore, the highest level of knowledge-acquired through caregivers' health care occupations-appears to influence hospice care after hospice enrollment. Caregivers with that level of knowledge made requests for changes in site of care and/or additional services that may enhance the quality of hospice care that their loved ones receive.

Ethnic variation in timing of hospice referral: does having no informal caregiver matter?

BACKGROUND: The length of hospice stay, as an indicator of timing of hospice referral, is an important outcome to examine in end-of-life care because it is relevant to the quality and cost efficiency of end-of-life care that patients receive. Although the majority receives nonmedical care from informal caregivers, many elderly hospice users rely on paid caregivers or staff of residential facilities. OBJECTIVE: This study examined whether availability of informal primary caregiver interact with ethnicity to affect length of hospice stay. DESIGN: A retrospective cross-sectional study. SETTING/SUBJECTS: Data on 3024 hospice patients aged 65 and older discharged between 1997 and 2000 was extracted from the National Center for Health Statistics' National Home and Hospice Care Survey (NHHCS). MEASUREMENTS: Length of hospice stay prior to death or discharge. RESULTS: Survival analysis revealed that among patients with formal caregivers, minority patients were likely to have significantly shorter hospice stays than non-Hispanic whites. There were no significant ethnic differences in length of stay among patients with informal caregivers. CONCLUSIONS: Our findings suggest that ethnic differences in length of stay should be discussed in terms of type of caregiver, not just type of setting, since patients in residential facilities can have informal primary caregivers who are vigilant advocates for their dying relatives. We discuss possible reasons for the influence of having formal caregivers on length of stay of minority elders.

Barriers of HIPAA regulation to implementation of health services research.

Although many perspectives on the impact of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) on health services research have been wide spread, little empirical evidence has been reported about HIPAA-related barriers during the implementation of research projects. Using three cases of health services research projects, this study examined practical barriers created by HIPAA regulation. During the stage of implementation of the three projects, we experienced some HIPAA-related concerns, previously raised in the field of health services research. We found that technically complicated consent forms and privacy protection forms as well as socially-sensitive clinical conditions make patients less willing to participate in research projects; concerns about safety of patient medical information makes health organizations more hesitant to let researchers have access to the patient's information, especially through electronic transfer; more restrictive IRB processes and challenging patient recruiting processes make health services researchers reluctant to go through the process; and as a result, they may compromise with the scientific soundness of the project. Overall, HIPAA complicates the research process and requires more resources and longer time to conduct research.

Perspectives on neonatal nursing: 1985-2005.

Neonatal nursing practice has been influenced by a number of external forces over the past 20 years. This article explores some of the influences that have altered practice in the 20-year history of the Journal of Perinatal & Neonatal Nursing. Attention is directed to several significant influences such as the development of the Internet and the World Wide Web and the role that information plays in care delivery. Changing practice roles with the continuing evolution of the neonatal nurse practitioner role and the emerging plans for the doctorate of nursing practice are described. The history of professional associations for neonatal nurses and the impact of evidence-based practice are considered. Finally, the legal environment surrounding practice is explored.

The experiences of international nursing students in a baccalaureate nursing program.

International students, especially those with English as a second language (ESL), can have difficulty adjusting to university life in the United States and successfully completing the demands of a nursing program. The purpose of this qualitative study was to explore the perceptions and experiences of international nursing students in a baccalaureate nursing program. Eight female Nigerian nursing students aged 25 to 48 who had been in the United States from 5 to 20 years were interviewed. Most (75 per cent) had some prior college experience, but only two had a baccalaureate degree. The data was analyzed by using a multifunctional computer software program and three themes emerged: social isolation, resolved attitudes, and persistence despite perceived obstacles. Factors contributing to each theme explained how these students progressed from their social isolation to their resolved attitudes. Their progression was marked by an acceptance of antagonistic attitudes found in the program and their development of persistence despite perceived obstacles. Their persistence was the impetus to achieve their overall goal of graduating from the program. Implications for nursing faculty include assisting these students through social and academic transitions and nursing administrators' provision of fiscal and support resources to facilitate effective integration of international students into the nursing program and the community.