Academy of Medicine-Ministry of Health clinical practice guidelines: attention deficit hyperactivity disorder.

The Academy of Medicine (AMS) and the Ministry of Health (MOH) have developed the clinical practice guidelines on Attention Deficit Hyperactivity Disorder (ADHD) to provide doctors and patients in Singapore with evidence-based treatment for ADHD. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on ADHD, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical.html.The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.

The self as role model in health promotion scale: development and testing.

Historically, nurses have been expected to be role models of health promotion, conceptualized and operationalized narrowly and indirectly as the practice of healthy behaviors. The purpose of the current study was to develop and test an instrument (The Self as Role Model for Health Promotion [the SARMHEP]) to measure nurses' perceptions of themselves as role models. Data were collected from nurses working in public health, nursing education, and general practice with a 56% return rate. A series of exploratory factor analyses elicited a five-factor solution that accounted for 44% of the variance and approximated the theoretical dimensions that guided the instrument's development. Cronbach's alpha for the total scale was .91. The new multidimensional SARMHEP was shown to have beginning validity and reliability.

Conceptualization and manifestation of depression in an asian context: formal construction and validation of a children's depression scale in Singapore.

Understanding that the conceptualization and manifestation of depression vary across cultures, in a preliminary study, Koh and colleagues (2002) identified a cultural model and a prototype measure of depression for Asian children. The present study sought to provide further examination of the initially identified conceptualization, manifestation, and measurement of depression in Asian children. Involving a community sample of 442 Singaporean Chinese children (6 to 12 years old), a culturally salient factor, Negative Social Self, was established to constitute part of depression, in addition to three universally recognized factors: Negative Affect and Cognitive Dysfunction, Loss of Interest, and Psychosomatic Manifestations. The Asian Children Depression Scale (ACDS) and Negative Social Self (NSS) were found to be positively related to hopelessness and negatively related to self-esteem, subjective well-being, and control-related beliefs, establishing support for convergent validity. Notably, NSS was found to account for significant incremental validity over that of the universally recognized factors in predicting most of the above-mentioned variables, supporting its added value as a factor of depression in Asian children. The results suggested that the ACDS and the culturally salient dimension reflect the phenomenological experiences and manifestations of depression in Asian children.

Living with chronic obstructive pulmonary disease: insiders' perspectives.

AIM: This paper reports a study of the experiences of older adults with severe chronic obstructive pulmonary disease, with the aim of gaining an understanding of how the disease had affected their lives. BACKGROUND: Chronic obstructive pulmonary disease is a major personal and public health burden and is the fifth cause of mortality worldwide. The brief encounters that healthcare professionals have with patients in hospitals, physicians' offices and other outpatient settings are insufficient to be able to truly understand the challenges that people face in the attempt to integrate a chronic illness into their lives. Previous qualitative studies on chronic obstructive pulmonary disease have tended to focus on specific problems associated with the disease, such as fatigue and social isolation. METHOD: A hermeneutic phenomenological study was carried out with 10 older adults who participated in a local hospital's case management or pulmonary rehabilitation programme. Data were collected by interviews in 2003. FINDINGS: Three major themes were identified: Knowing What Works, Hanging On...Barely, and Losing Control-Gaining Control. The changes associated with chronic obstructive pulmonary disease were described as increasingly challenging and even threatening to participants' current lifestyles. The impact of dyspnoea was great and invaded almost every aspect of their lives. Participants identified the most effective methods to resolve shortness of breath. CONCLUSION: People with severe chronic obstructive pulmonary disease have had extensive experience of managing their disease and are familiar with techniques that have helped them integrate the illness and symptoms into their lives. Nurses can synthesize patient knowledge with nursing knowledge to assist patients with severe chronic obstructive pulmonary disease to achieve their maximum quality of life.

Nursing structure, processes, and patient outcomes in army medical centers.

The purpose of this study was to describe patient outcomes in Army Medical Centers, identify differences in outcomes between mixed medical-surgical bed and specialty intensive care units (ICUs), and explore predictive models for outcomes attributable to nursing structure and processes. Data were collected from 138 patients and 103 nurses in four medical-surgical and four ICUs in two Army Medical Centers. Significant differences for unit type were found for length of stay and patient satisfaction with nursing care. Outcome predictive models were modest (adjusted R2 = .16 to .24) and significant for length of stay, satisfaction with nursing care, satisfaction with pain management, and health status following discharge. Exploring differences and commonalities between military and civilian hospitals will ultimately provide insight into ways of improving patient outcomes and bettering the work environment of nurses.

Nurses' beliefs about family presence during resuscitation.

The purpose of this descriptive qualitative study was to explore the beliefs and experiences of RNs about family presence (FP) during cardiopulmonary resuscitation. Ten RNs with a minimum of 4 years of clinical experience working in diverse acute care units provided data for the study. Data were analyzed using the constant comparative method. Four themes emerged: (a) the conditions under which FP is an option; (b) using FP to force decision making; (c) staff's feelings of "being watched"; and (d) the impact of FP on a family. Because FP is not traditionally practiced, it may not be a consideration unless brought to the attention of administration by nursing staff committed to changing their policy.

Nurses as imperfect role models for health promotion.

The purpose of this qualitative study was to discover ways in which nurses describe themselves as health-promoting role models. Focus groups and individual interviews were conducted with nurses working in a variety of settings. Transcribed interviews were analyzed thematically. Nurses defined themselves as role models of health promotion according to the meaning they gave the term, their perceptions of societal expectations, and their self-constructed personal and professional domains. The term role model evoked diverse interpretations ranging from negative perceptions of the idealized image to a humanized, authentic representation. Nurses perceived that society expected them as role models to be informational resources and to practice what they preached. Nurses defined themselves independently of societal expectations according to personal and professional domains. Valuing health, accepting imperfections, and self-reflecting were aspects of the personal domain, whereas gaining trust, caring, and partnering were facets of the professional domain.

Development and validation of a depression scale for Asian adolescents.

Items covering both core and culture-specific facets of depression were generated based on literature review and clinical experience. They were modified following focus group discussions with depressed adolescents and adolescents in the community. The newly constructed Asian Adolescent Depression Scale (AADS) was administered to a clinical and a community sample of adolescents together with other rating scales. The AADS comprised 4 factors (negative self-evaluation, negative affect, cognitive inefficiency and lack of motivation) and demonstrated sound psychometric properties. Negative socially oriented self-evaluation and cognitive inefficiency were important in Singaporean adolescents' conceptualization of depression and are likely to be Asian culture-specific dimensions.

Evaluating the effects of an educational symposium on knowledge, impact, and self-management of older african americans living with osteoarthritis.

The purpose of the study1 was to determine the effects of a 1-day educational symposium on knowledge, impact, and self-management of older African Americans living with osteoarthritis (OA). A 1-group pre- and posttest design was employed. The educational symposium was the intervention variable. Speakers were experts in the field of arthritis care. Participants were recruited from a community senior center. Participants completed the Short Form of the Arthritis Impact Management Scales (AIMS2-SF), the Summary of Arthritis Management Methods (SAMMS), and a 6-question Knowledge Test about OA before the symposium. The knowledge test was administered again at the completion of the program. Posttesting of the AIMS2-SF and SAMMS occurred 3 months later to assess changes in arthritis impact and self-management strategies. Knowledge scores increased significantly immediately following the symposium. The AIMS2-SF subscales of Affect, Symptom, and Physical Function decreased significantly 3 months after the symposium indicating that arthritis had less impact on participants after the conference. Participants also reported using more self-management methods 3 months after the event. The results of this pilot study indicate that this symposium was effective in increasing participants' knowledge of OA, improving self-management, and decreasing the impact of OA on daily function. The small sample size and preexperimental design limit generalizability.

Older adults with osteoarthritis. Psychological status and physical function.

The purpose of this study was to identify how sociodemographic characteristics such as age, race, and socioeconomic status; psychosocial factors of hardiness, health promotion practices, and social support; health status; and pain are related to the ability of older, community-residing individuals with osteoarthritis (OA) to maintain psychological equilibrium and physical function. A total of 81 older adults with OA completed a survey that included a sociodemographic data form, a hardiness scale, a measure of health promoting practices, and five subscales from the Arthritis Impact Measure Scale 2 on social support, general health status, pain, and psychological status and physical function. Analyses using multiple regression showed that hardiness, pain, and social support were significant contributors to psychological status and physical function and, respectively, accounted for 53% and 54% of the variance. By knowing about OA and being aware of factors that contribute to maintaining independence in individuals with OA, nurses can provide expert help to aging individuals.

The effect of communication on nursing student outcomes in a Web-based course.

This study compared the effectiveness of different instructional communication methods in a Web-based course on students' cognitive learning, satisfaction, and motivation to complete the course. A total of 174 undergraduate nursing students were selected randomly and assigned to experimental or control groups. Instruments included a demographic data form, two examinations on course material, a course satisfaction scale, and calculation of completion rates. All students received identical didactic Web-based instructional materials. However, type of communication varied among groups. No significant group differences were found for cognitive learning or motivation to complete the course. A significant group difference was found for student satisfaction with the course, indicating carefully planned communication strategies can improve satisfaction. A need for technical support also was evident. More research is needed to determine the best strategies to enhance student learning outcomes and decrease student attrition in Web-based courses.

How nurses learn advocacy.

PURPOSE: To describe how nurses develop the skill of advocating for patients. DESIGN & METHODS: Hermeneutic phenomenological research methods. Both reserve and active U.S. Army nurses who cared for patients associated with the military operation in Bosnia were individually interviewed to gain an understanding of their experiences of advocating for patients and how they developed their advocating practices. FINDINGS: The constitutive pattern identified was Developing Advocating Practices. The themes comprising this constitutive pattern were Who I Am, Watching Other Nurses Interact with Patients, and Gaining Confidence. CONCLUSIONS: For the nurses in this study, developing advocating practices was more haphazard and situationally dependent than methodically taught in their nursing education programs. Nurses would have a stronger foundation in advocacy in nurse educators consciously teach advocacy and if nurse administrators support new graduates' advocacy in the work environment.

Characteristics of nurses and hospital work environments that foster satisfaction and clinical expertise.

OBJECTIVE: The purpose of this aspect of a larger study was to describe characteristics of nurses and their work environment at two military hospitals. BACKGROUND: Few studies have explored characteristics among nurses who practice in military hospitals. There is reason to believe that differences exist between nurses who work in military and civilian hospitals, some of which are required educational level, leadership experience, officer status, and career development opportunities. METHODS: A descriptive design was used to address how military and civilian nurses who work in military hospitals describe their autonomy, control over practice, nurse-physician collaboration, and clinical expertise and what relationships exist among these variables. RESULTS: Scores on autonomy, control over practice, and nurse-physician relationships all were above midpoint for all respondents as a group, indicating positive work environments in both of the military hospitals studied. Scores from the clinical expertise instrument were well above midpoint, indicating a desirable level of clinical expertise. These findings all reflect favorably on the military hospital work environment. CONCLUSIONS/IMPLICATIONS: This information will help to make a case for instituting or preserving those nursing processes that are effective and for identifying and working to change nursing processes that are not effective. Nurses will benefit by having a more collaborative work environment.