Research agenda: emerging issues in the management of health and illness.

Today, in our capitalistic society, demographics, economics, and quality assessments are major systemwide drivers of research in the management of health and illness. Future trends promise a continued emphasis on outcomes, with a likely focus on rationing of care. Changes in quality definitions and changing acceptance of the levels and locations of care, with continued cost shifting into a broadened form of tax-supported health care, are anticipated. Concomitant and reflexive with these macroscopic trends are more microscopic organizational and professional trends and research agendas.

Discharge teaching. Work strategies of patients and families for care in the home.

PURPOSE: To better understand how care givers, and their care receivers who have experienced mobility limitations over a period of time, enhance the work of care in the home. DESIGN: The qualitative method of grounded theory was used to identify work strategies enacted by care dyads consisting of informal (family) care givers and their care receivers. SAMPLE: The sample consisted of 60 care dyads. METHOD: Data was collected via semi-structured interviews conducted in the care receiver's home. After leaving the home, interviewers completed end notes describing the care situation. MAIN RESEARCH CLASSIFICATION: Nursing Research, Orthopaedic Nursing, Home Health Nursing. FINDINGS: Content analysis revealed five interpersonal and informational work strategies, used by both care givers and care receivers, to facilitate the work of care: Sharing Ideas and Feelings, Delegating, Achieving a Common Goal, Identifying Sources of New Information, and Creative Problem Solving. End note data substantiated the benefits of using these strategies. CONCLUSION: Although providing care to a family member in the home is frequently thought of as "work," few analysts have described the nature of this work or considered the care receiver as a worker. This study identified the important role of the care receiver in the work of care in the home and delineated five specific Work Strategies used by informal care givers and their care receivers to facilitate such care. IMPLICATIONS FOR NURSING RESEARCH: Ongoing research is needed for further clarification of these strategies and for development of innovative ways to teach the strategies to informal care givers and their care receivers as they prepare to live with mobility limitations in the home setting.

Personnel resource distribution for nursing programs in Carnegie-classified Research I and II and Doctoral I institutions.

Increasingly, nursing education programs, like other major institutions in the United States, are being charged to "do more with less." How to acquire sufficient human and material resources is a continuing challenge in an era of economic constraint. Benchmark data on the distribution of personnel resources within nursing programs is nearly nonexistent. To assess the personnel resources of nursing programs of major size and stature within the United States, a Personnel Resource Survey was mailed to the universe of all nursing programs located in Carnegie-designated Doctoral I, Research II, and Research I universities and/or colleges in the United States (n = 96). The return rate was 58 per cent, with a useable survey rate of 51 per cent (n = 49). Comparative numbers and ratios of administrators, faculty, students, and various levels and types of support staff by Carnegie-type institutions are presented. Findings indicate that, overall, nursing programs in Research I universities had 1.5 to 2 times as many personnel resources per student than programs in Doctoral I and Research II institutions. Doctoral I and Research II programs closely resembled each other. The details of the data, as well as its standardization into full-time equivalents, are useful to both university and nursing administrators, faculty, and staff in their comparisons and procurement of needed resources.

Advantages and disadvantages of collaborative research: a university and behavioral health care provider's experience.

This article describes the issues involved in a collaborative research effort between a university and a behavioral health care provider. We describe the collaborative process and highlight advantages and disadvantages of such collaboration. Specific examples are used to show how the collaborative process between a university team and clinical team can integrate theory, research, and clinical practice.

Boyer's model of scholarship applied to a career ladder for nontenured nursing faculty.

This article presents a career ladder for the reappointment and promotion of nontenured clinical faculty, based on Boyer's model of the scholarship of teaching, application, discovery, and integration and on his four principles and six standards. Titles, lengths of appointments, criteria, obligations, and professional development are defined for four levels of clinical faculty. Guide questions modeled on Boyer's dimensions of scholarship, principles, and standards that were used to guide the development of the career ladder are included.

Power in practice: a study of nursing authority and autonomy.

Power and politics need to be translated into practice through development of authority and autonomy within the staff nurse role. The purpose of the research described was to identify and compare aspects of agreement or disagreement between nurse leaders and staff about staff nurses' authority and autonomy to deliver patient care. Findings indicated that significant differences exist between staff nurses' and nurse leaders' sense of staff nurse autonomy, and importance of authority and autonomy, differences that can lead to serious misunderstandings and power struggles. These differences, especially concerning management support, can seriously hinder both nurse leaders and staff nurses' success in restructuring cost-effective quality care.

Nurses' retirement preparation.

Nurses expect that professional achievement and dedication to society will reward them with economic security in their later years. Such rewards may not be theirs without deliberate and careful attention to early preparation. This study showed that although nurses expect an adequate income during retirement, their current pension, benefit, and savings status suggests otherwise. Nurses who do not actively manage personal finances or attend to details of employment benefit packages place themselves at distinct risk for economic crisis during their decades of retirement.

Breast cancer and the older woman: information and images.

Breast cancer is the most prevalent form of cancer in elderly women. Information on breast cancer explicitly relevant to elderly women was examined in 113 articles in the professional nursing literature and popular magazines. Content analysis on the nature or extent of information about breast cancer indicated that authors in the professional nursing literature and the popular media have inadequately addressed the degree of risk and the special needs of the elderly woman. Few authors in either the lay or professional literature have explicitly discussed the needs of elderly women, nursing research on breast cancer typically did not include elderly women, and popular articles and accompanying photographs tended to feature younger women.

Negotiating nurse-patient authority in pediatric home health care.

In this qualitative study, pediatric home health nurses described the solitary, ambiguous, and unprogrammed nature of home health nursing. As employees of the family, the nurses in this study found it necessary to negotiate their work tasks and working conditions with family members. In describing the meaning of their work, the nurses emphasized differences between hospital and home health nursing with regard to their authority for care decisions, methods of child discipline, parental control of care, and innovations of nursing routines and interventions. Characteristics of pediatric home nursing are identified in order for these to be communicated to prospective home care nurses, to pediatric nurse educators, and to home health managers. With knowledge of these characteristics, a new home health nurse will be better prepared to negotiate shared patient care responsibilities with the client's family.

Managing HIV-positive and AIDS risks: educational and psychosocial resource assessment.

A needs assessment survey reveals many staff nurses incorrectly estimate the HIV contagion risk, inadequately follow universal precaution mandates, and are often unaware of available information and counseling resources. Nurses want current, reliable HIV-AIDS related information and counseling from credible, accessible, and readily available sources. Colleagues, families, and friends' attitudes decidedly influence nurses' capacity to cope emotionally.

Coronary artery disease in women: assessment, diagnosis, intervention, and strategies for life style change.

Coronary heart disease is reaching epidemic proportions in women. With increased longevity, more women are living many years beyond menopause, the time when heart disease peaks in women. For midlife women, it is important to determine a personal profile of unmodifiable (family history, age, and race) and modifiable risk factors. The goal for every woman must be to control coronary risk factors such as smoking, hyperlipidemia, diabetes, sedentary life style/weight control and stress, which have been proven to be amenable to modification strategies. Many women also may consider hormonal replacement but must be counseled to make informed choices concerning the benefits and risks. Finally, as nurses and as leaders in the health care of women, we must model heart healthy behaviors to encourage each other and to increase our effectiveness with the clients we serve.

The handwriting on the wall. Warning signs of impending job loss.

Can nurse executives read the handwriting on the wall when they or another nurse executive are facing a forced resignation or termination? What are the warning signs of an eroding job position, including the relationship between the chief nurse executive and the chief executive officer? How much time does a nurse executive typically have in the job once the warning signs begin to show? The authors discuss these questions and specific tactics and strategies suggested by warning signs.

Female nurse executives. Finally, at an advantage?

Discrimination, subtle and overt, from socialization and institutional forces, continues to keep nurse executives, most of whom are women, out of chief executive officer (CEO) positions. However, because of the women's movement, changing organizational forces, and shifting demographics, more nurse executives are likely to move into the ranks of CEOs. The authors explore the issues of managerial discrimination and indicate strategies that are beginning to open doors to female nurse executives who desire CEO positions.

Nursing care costs for a DRG sub-group.

This study determined the average cost of nursing care for two DRGs and evaluated how a specific nursing intervention, Phase I Cardiac Rehabilitation, impacts on these costs. A unit-based methodology to determine the cost of providing nursing care to patients who stay on more than one nursing care unit during their hospital stay will facilitate decision making by nurse administrators and clinicians to contain rising health care costs.

A smoke-free environment: psychiatric nurses respond.

1. After only 1 month of establishing a smoke-free environment, 75% of the staff on Ward "A" and 70% of the staff on Ward "B" reported that the nonsmoking policy was a success. 2. Levine's Four Conservation Principles of Nursing provide a conceptual framework for developing nursing interventions that address the patient with an urge to smoke. 3. Administrative implications for nurses who manage a smoke-free unit have been presented as guidelines that can foster a successful transition to a smoke-free environment.