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.

Determinants of functional health of older persons.

The study investigated relationships among demographics, self esteem, health locus of control, health promotion behaviors, perceived health and functional health ratings in 179 older men and women from 65 to 99 years. Canonical correlation and stepwise discriminant analyses demonstrated several meaningful and significant relationships suggesting that exercise and nutrition may be critical health promotion activities associated with better scores on five functional dimensions. The 85+ years age group differed from younger groups through having significantly higher reported exercise scores.

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.

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.

Determinants of health promotion in midlife women.

Health locus of control, self-esteem, and health status were analyzed for their impact on health-promoting life-style activities in 262 women between 35 and 65 years of age. Negative chance health locus of control, self-esteem, current health status, health worry/concerns, post-high-school education, and internal health locus of control explained 25% of the variance of likelihood to engage in health-promoting life-style activities. Two canonical variates explained 72.8% of the variance in the criterion set, the subscale scores of the Health-Promoting Lifestyle Profile (Walker, Sechrist, & Pender, 1987). Internal health locus of control, self-esteem, current health status, and future health status explained 36.3% of the variance of the self-actualization, interpersonal support, and exercise subscales; age, negative chance health locus of control, health worry/concern, and negative (poor) prior health status explained 36.5% of the variance of the health responsibility, nutrition, and stress management subscales. The canonical correlations for the two variates were .78 and .66, respectively. The study results support in part the relationships posited in the Pender health promotion model and previous research on women's health.

Health promotion in the family: current findings and directives for nursing research.

This paper reviews the current nursing research findings on health promotion within the family and provides directives for future research. The concept of health promotion-the overall enhancement of well being--is contrasted with primary or disease prevention, the specific protection from a health threat. The conceptual parameters of health promotion were used to search the nursing research journals for studies of health promotion in the family. The four major nursing research journals were reviewed and yielded five articles in 105 issues which addressed this phenomenon. The findings from these studies as well as other research literature are used to develop future directives. The directives are presented for both the internal environment of the family and its external environment. Areas for study related to the internal environment include definitions of health and health promotion, descriptions of current health promotion behaviours and those practised over time, decision making, fathering, and methods of intervention. Research of the external environment includes the societal norms, societal interventions, and the effects of societal institutions. This discussion of health promotion in the family describes an agenda for nursing research which is necessary to support nursing practice with families if 'health for all' is to be reached by the year 2000.

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.

Primary prevention behaviors: the female-headed, one-parent family.

The purpose of this study was to describe the primary prevention behaviors of 59 female-headed, one-parent families and the barriers which deter their practice. Two interviews, a health diary, and a card sort were used for data collection. Descriptive statistics and content analysis were used to analyze the qualitative data. Nutrition was the behavior the families felt was most important for maintaining health. Time was the major barrier to primary prevention practices. A relationship was found between the family's ability to change and grow and their practice of primary prevention behaviors. Families that consciously risked lifestyle changes also were willing to try to incorporate primary prevention behaviors. On the contrary, families with stagnant lifestyles expressed the desire to change their primary prevention behaviors but made no visible attempt to do so.

Designing nursing research: the qualitative-quantitative debate.

Nursing research has not evolved with immunity from the qualitative-quantitative debate which has surrounded the behavioural and social sciences. The outcome of this debate should be better nursing science since researchers are forced to face and address the controversial issues. Attaining this goal requires researchers to debate the issues with a knowledge of epistemology and methodology and not blind devotion to the tradition of the hard sciences. This paper addresses the issues of epistemology, methodology, and ethics for two prototypes of the qualitative-quantitative continuum. Grounded theory explains the issues of qualitative research: the search for meaning, the inclusion of environmental factors, the depth of data, and the treatment of participants as subjects. The true experiment, the epitomy of the quantitative approach, seeks to identify existing truths by isolating the significant variables and controlling for contaminating factors. Based on these arguments, recommendations are made for nursing research which rely on both approaches.

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.

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.

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.

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.

Determinants of health-promoting lifestyles in older persons.

The purpose of this study was to determine the degree to which selected components derived from Pender's Health Promotion Model (1982) explained engaging in health promotion practices in a sample of 477 persons 65 years and older. One directional hypothesis was tested using canonical correlation analysis. Three significant canonical variates were demonstrated, explaining 88.7 percent of variance. Older healthy persons with high self-esteem and internal locus of control reported practicing five of the six health promotion strategies. Men with higher income and self-esteem but poorer health less often exercised or ate well. Older married subjects with higher incomes who were internally controlled were more likely to engage in exercise, health responsibility and stress management but not in interpersonal support. Findings provide direct multivariate support for the additive nature of the relationships posited in the Health Promotion Model.