Development of an academic consortium for nurse-managed primary care.

This article describes the development of an academic consortium comprised of four universities and their schools and colleges of nursing. The initial efforts at collaboration arose from the need to obtain funding and address policy issues related to advanced practice issues at the state level. The developmental stages of the Michigan Academic Consortium are described within a framework developed by Bailey and Koney (I).

Development and implementation of a semester program in Mexico for senior nursing students.

The College of Nursing (CON), Michigan State University (MSU), in collaboration with the School of Nursing and Obstetrics, University of Guanajuato, Celaya, Mexico, developed a semester-long study-abroad program for senior MSU nursing students offered for the first time in the fall of 1998. The program provides intensive Spanish language classes and allows students to take required nursing courses in Mexico with a substantial amount of course content provided by Mexican faculty without an MSU CON faculty member on site at all times. Students receive a broad perspective of nursing and health care in Mexico, and develop an appreciation for its language and culture as well. This program represents an innovative approach to the development and implementation of a study-abroad program in nursing.

Patient decision support intervention: increased consistency with decision analytic models.

BACKGROUND: Patient Decision Support (PDS) tools assist patients in using medical evidence to make choices consistent that are with their values and in using evidence about consequences of medical alternatives. OBJECTIVE: To evaluate a PDS intervention for perimenopausal hormone replacement therapy. We assessed the impact of the PDS on (1) consistency between the decision to take estrogen replacement therapy (ERT) or progesterone/estrogen replacement therapy (PERT) and the expected utility of treatment and (2) likelihood to take ERT and PERT pre- and postintervention. DESIGN: Content of the PDS was standardized. Randomized trial of three intensities of intervention: (1) brochure; (2) lecture/discussion; and (3) active decision support. SUBJECTS: Participants were perimenopausal community volunteers between the ages of 40 and 65 (n = 248). MEASURES: (1) Consistent with values (correlation between expected utility (EU) and likelihood of taking hormones); and (2) Likelihood to take hormone replacement therapy. RESULTS: (1) The brochure group was less consistent with the decision analytic model than the lecture/discussion and active decision support groups. (2) Influence on decisions: PDS tools increased the number of women certain about whether or not to take hormones. There were no differences among experimental groups. Of 99 women uncertain about ERT pre-PDS, 65% changed. Twenty-one (32%) decided against ERT and 44 (68%) decided for ERT. (3) More intensive interventions produced modest gains in a normative direction. CONCLUSIONS: PDSs using any of 3 formats reduce uncertainty and assist women to make informed decisions. Increased consistency with decision analytic models appears to be driven by better estimates of likelihood of outcomes.

An educational intervention as decision support for menopausal women.

The purpose of this study was to develop and test a decision support intervention (DSI) to assist women to make and act on informed decisions that are consistent with their values in the area of menopause and hormone replacement therapy (HRT). Mode and intensity of intervention were tested in midlife women (N = 248), randomly assigned to one of three intervention formats: written information only, guided discussion, or personalized decision exercise. Data were collected over 12 months. Knowledge, decisional conflict, satisfaction with health care provider, and self-efficacy improved following intervention and were maintained for 12 months for all groups. Women's adherence to their own plans over 12 months was 59% (exercise), 76% (calcium intake), and 89% (HRT). Carefully written information is effective in promoting knowledge, adherence, and satisfaction among well-educated, interested women. It was concluded that women can understand complex information, including tradeoffs regarding treatment options. Women will adhere to their own plans, suggesting that consumer rather than provider plans may be the more appropriate gold standard for measuring adherence.

African-American women's attitudes and expectations of menopause.

INTRODUCTION: In this study, low-income perimenopausal African-American women were surveyed to determine knowledge of menopause and hormone replacement therapy (HRT). METHODS: A 92-item survey assessed perceptions of menopause and health risks to identify preventive strategies in this population. The nonprobability sample of 197 African-American women typically had incomes of < $15,000, age 46-55, high school education or less. RESULTS: Major findings were that African-American women (1) experienced expected levels of occurrence of symptoms, but perceived them as not very bothersome, (2) had a knowledge deficit related to menopause and HRT, and (3) had expectations about menopause that underestimated their lifetime risk of heart disease. CONCLUSION: The lack of knowledge about menopause, HRT, and lifetime risks of heart disease suggests that low-income African-American women need better information for decision making about prevention. However, this sample knew the rank order of major health risks. Health information to the public and culturally relevant patient education are critical prerequisites to any preventive behavioral strategies in this population. Further research should identify culturally based expectations of disease risk and efficacy of prevention strategy to tailor messages to particular subpopulations.

Patient satisfaction with health care decisions: the satisfaction with decision scale.

Patient satisfaction measures have previously addressed satisfaction with medical care, satisfaction with providers, and satisfaction with outcomes, but not satisfaction with the health care decision itself. As patients become more involved in health care decisions, it is important to understand specific dynamics of the decision itself. The Satisfaction with Decision (SWD) scale measures satisfaction with health care decisions. It was developed in the context of postmenopausal hormone-replacement therapy decisions. The six-item scale has excellent reliability (Cronbach's alpha = 0.86). Discriminant validity, tested by performing principal-components analysis of items pooled from the SWD scale and two conceptually related measures, was good. Correlation of the SWD scale with measures of satisfaction with other aspects of the decision-making process showed the SWD scale was correlated most highly (0.64) with "decisional confidence," and least with "desire to participate in health care decisions" and "satisfaction with provider." The SWD scale predicts decision certainty in this study. Use in an independent study showed that the SWD scale was correlated with the likelihood of patients' intentions to get a flu shot. Further investigation in relation to other health decisions will establish the utility of the SWD scale as an outcome measure.

Menopausal women as decision makers in health care.

The findings of a preliminary analysis of data from a study now being conducted to design and evaluate an educational intervention to aid women in becoming more effective decision-makers regarding menopause, self-care strategies, and hormone replacement therapy (HRT), indicate that the lack of attention to the symptoms and health effects of menopause has resulted in frustration and dissatisfaction among women health care consumers. Women in the menopausal years are not informed adequately nor empowered to participate in decision making around issues related to their own health. They do not have the information they want and they do not know where to get it.

Women's use of information regarding hormone replacement therapy.

For perimenopausal women, an important decision is whether or not to use hormone replacement therapy (HRT). The decision is complex because HRT involves judgment in weighing gains and losses related to physiological risk. Gains involve relief of hot flashes and prevention of osteoporosis; losses include cancer mortality and side effects of medication. A policy-capturing study of 283 perimenopausal women showed that the factor of most frequent concern was relief of hot flashes. Cluster analyses identified four major groups. Group 4 had an n of 9 and the lowest R2, making interpretation of data questionable. The largest group responded to hot flashes alone; the second to hot flashes and osteoporosis; and the third to hot flashes, somewhat to osteoporosis, but also to side effects of estrogen/progestin therapy. Results indicate nursing interventions should anticipate differences in women's concerns and tailor counseling appropriately.

Aptitude, previous achievement, and cognitive style: relation to academic achievement in nursing courses of differing content.

The questions studied were whether a) cognitive style might predict differential success in nursing courses having a different specialty content focus and b) whether after the inclusion of aptitude measures and previous achievement measures FDI cognitive style would significantly increase the prediction of academic achievement in nursing courses of differing specialty content. Senior baccalaureate nursing students completed the Group Embedded Figures Test as a measure of field-dependence-independence (FDI) cognitive style. Aptitude and achievement scores were obtained from students' files and instructors' grade sheets. The findings were that FDI cognitive style is not a predictor of differential academic success. The junior nursing grade point average was the best predictor of achievement in senior level nursing courses. The prediction of academic achievement of nursing students has received researchers' attention over the years in an attempt to identify data that might aid in the establishment of selection criteria, in program and curriculum planning, and in the establishment of remediation or supportive programs for enrolled students who have been identified as high risk. In most studies, affective factors alone, such as personality characteristics and vocational interests, have not been found to be predictors of academic achievement. Most researchers have found that previous achievement or aptitude measures are the best predictors of nursing course achievement (Schwirian, 1976; Grant, 1986). While previous achievement and aptitude measures may be used in the selection process, they are not helpful in giving direction for planning teaching-learning experiences. Cognitive style might serve this purpose if it was found to be predictive of academic achievement.(ABSTRACT TRUNCATED AT 250 WORDS)