Journal of Nursing Scholarship

Published by Wiley
Online ISSN: 1547-5069
Publications
Article
To analyze scientific activity in Latin American nursing using bibliometric indicators. This is a quantitative, descriptive study of the universe of Latin American nursing journals (119) and scientific documents (13,208) published according to current library databases including: the Web of Science (WOS), Medline, LILACS, Periodica, Cuiden, and SciELO. A database was prepared using ProCite. The PAHO (Pan American Health Organization) Open-access Directory of Latin American Nursing Journals includes the greatest number of the 119 journal titles (60%). The average journal longevity is 11.3 years and Brazil produces the greatest percentage (31.9%) of journals. Of the current journals, 55% do not have international readership. The non-Latin American countries that contribute most to document diffusion are Spain, the United States, and England. The doubling time of scientific production of documents is 7.3 years and the annual growth rate is 10%; 2% of researchers form the most productive group of authors. Only in recent years has the number of contributions to the ISI nursing category begun to stabilize. Latin American scientific nursing production is still growing exponentially and Latin American nursing contributions to knowledge being disseminated through databases of recognized scientific quality seem to be increasing. The current scientific task is to organize and improve the publication processes. We describe the conditions in which Latin American nursing research has become institutionalized, the challenges that it has faced, and the gradual incorporation of such research into international science.
 
Article
To explore the international activities of American nursing scholars from 1985 to 1995, as indicated by their international teaching, scholarship, and consultation. All faculty (N = 2,254) teaching in nursing doctoral programs in the United States were surveyed using an investigator-designed questionnaire. The professional characteristics of American nursing scholars who worked abroad and the dates, nature, and types of international activities they undertook were ascertained. From a total of 928 usable returns, 247 described international activity. Data indicated a three-fold increase in international activity from 1985 to 1995 in the three major areas investigated. Universities in Western Europe and Asia were the most frequent recipients of nursing scholarly activity. The scholars or representatives of the host institutions made approximately half the initial contacts. The international hosts or U.S. universities were the predominant providers of funding. Nurses most likely to participate in international scholarly activity were senior faculty who were full professors in doctoral-granting institutions, published in international journals, presented educational topics, and were recognized by peers through membership in honorary organizations. A substantial increase in international nursing scholarship occurred during the decade studied, particularly related to teaching.
 
Article
This paper is a description of a study about articles published about nursing in Africa from 1986 to 2006. An exhaustive database search of articles written by nurses or articles related to nursing in Africa was done. Access to the database was mainly via EBSCO (http://www.ebsco.com), which allowed searching seven electronic databases. These are major databases useful for finding and accessing articles in academic journals, repositories, and archives. Data were recorded on computer spreadsheets and analyzed using frequencies and percentages. A total of 1,860 indexed research studies were categorized and analysed for themes, content, source of publication, location, subject, scientific or nonscientific methods, nursing or non-nursing research, clinical or nonclinical nursing. A progressive increase of publications was noted. Regional variations were observed in the number of publications over the years with most from Southern Africa (67.3%) compared to West Africa (5.2%) and East Africa (3.3%). Common themes were nursing education (11.9%) HIV/AIDS (11.9%), community health care (16.1%), and professional nursing issues (10.3%). Single authorship (90.7%) outnumbered multiple authorship (9.3%), though research-based (50.5%) and nonresearch-based articles (49.5%) were almost evenly distributed. More emphasis will be required for research concerning clinical studies; and collaborations--particularly multinational and across regions of Africa--should be developed. Efforts should be intensified to continue to build research capacity among nurses. Emphasis on African-based clinical studies which directly relate to patient care and culture can advance evidence-based practice in nursing with particular reference to African settings.
 
Article
Purpose: To assess author credentials of quantitative research in nursing, the composition of the research teams, and the disciplinary focus of the theories tested. Design: Nursing Research, Western Journal of Nursing Research, and Journal of Advanced Nursing were selected for this descriptive study; 1990, 1995, 2000, 2005, and 2010 were included. The final sample consisted of 484 quantitative research articles. Findings: From 1990 to 2010, there was an increase in first authors holding doctoral degrees, research from other countries, and funding. Solo authorship decreased; multi-authorship and multidisciplinary teams increased. Theories tested were mostly from psychology; the testing of nursing theory was modest. Multidisciplinary research far outdistanced interdisciplinary research. Conclusions: Quantitative nursing research can be characterized as multidisciplinary (distinct theories from different disciplines) rather than discipline-specific to nursing. Interdisciplinary (theories synthesized from different disciplines) research has been conducted minimally. Clinical relevance: This study provides information about the growth of the scientific knowledge base of nursing, which has implications for practice.
 
Article
To assess nurse overtime in acute care general hospitals and the factors that influence overtime among various hospitals and in the same hospitals from year to year. Staffing data from 1995 to 2000 from 193 acute general hospitals in New York State were used to examine hospital characteristics (size, location, RN unionization, hospital ownership, and teaching status) to determine whether they were associated with nurse overtime. The average weekly overtime RNs worked was 4.5% of total hours, varying from almost none to 16.6%. At mean overtime levels, nurses were working less overtime than the mean for manufacturing workers, but, at the extreme, nurses were working more than 6 hours overtime per week. Significant differences were observed in the use of overtime by hospital ownership and by union status. Nurses in government hospitals worked less overtime than did those in nongovernment hospitals. Nurses in unionized hospitals worked slightly more overtime than did nurses in nonunionized hospitals. Hospitals varied dramatically in their overtime use. That some categories of hospitals (e.g., government-owned) used little overtime indicates that hospital management can find substitutes for overtime to meet fluctuating staffing needs. The finding that hospitals with similar characteristics varied greatly in their number of overtime hours also supported this conclusion.
 
Article
To evaluate the extent of an international perspective in publication in nursing journals. Characteristics of 2,581 articles, authors of articles, and journals (editorial purpose and editorial team) of 42 high-ranking nursing journals for the year 2000 were analyzed. The characteristics were assessed using seven operational definitions of "international." Major findings were: (a) 747 (28.9%) articles were identified as international, of which (b) 705 (94.3%) were placed in the scholarly or empirical categories; (c) more articles were categorized as empirical in the international articles; more articles were categorized as scholarly among the noninternational articles; (d) 763 (79.3%) articles met an international definition based on author characteristics; and (e) 20 (47.6%) journals had international editorial teams. Nearly 30% of articles had international content. Articles with international content were more frequently databased than were noninternational articles. The study provides a baseline indication of the extent of international perspectives in published articles in nursing journals. The extent to which these international articles make substantial contributions to knowledge has yet to be discovered.
 
Article
The purpose of this study is to describe the lived experience of U.S. military nurses who served in Iraq or Afghanistan during the war years 2003 to 2009, and life after returning from war. Colaizzi's phenomenological method guided discovery. This method includes elements of both descriptive and interpretive phenomenology. The sample consisted of 37 military nurses who served in the Army, Navy, or Air Force in the Iraq or Afghanistan wars. Four data-generating questions guided the interview process. Most interviews were face-to-face and conducted in naturalistic settings chosen by the participants. Several interviews were conducted telephonically due to geographic constraints. Data analysis followed Colaizzi's method of analysis. Seven themes emerged from the data, including "deploying to war;"remembrance of war: most chaotic scene;"nurses in harm's way: more than I bargained for;"kinship and bonding: my military family;"my war stress: I'm a different person now;"professional growth: expanding my skills;" and "listen to me: advice to deploying nurses." Analysis continued until data saturation was achieved. Results indicated that wartime deployment was a difficult challenge, lessons learned should be shared with nurses deploying in future years, homecoming was more difficult than most nurses anticipated, and reintegration after coming home takes time and effort. Nursing in war is a unique experience regardless of education, preparation and training. There are a myriad of variables that enter into the experience and effect outcomes, both personal and professional. Wartime nursing is a reality in the current clinical practice arena. War takes its toll on everyone involved, including the caregivers. Nurses returning from war can provide valuable insights to those that follow.
 
Article
PURPOSe: To compare the characteristics of nursing research being done in different countries, using data from studies published in nonspecialty, English-language nursing journals. Data for this cross-sectional analysis were retrieved from a consecutive sample of 1,072 studies published in eight leading English-language research journals in 2005 and 2006. For each study, data were extracted on the characteristics of the study participants and authors, study focus-specialty area, funding, and methodologic attributes. Studies from 15 countries or regional groupings were compared. International differences in authors, participants, and study characteristics were typically large and statistically significant. Studies that were focused on nurses were especially prevalent in Europe, Australia, and Canada, whereas patient-centered studies were most common in Asian countries and the US. Qualitative studies were predominant in Norway, Sweden, and the UK. Asian nurse researchers, by contrast, undertook mostly quantitative studies, and were especially likely to conduct intervention research. Significant country differences existed in the omission of demographic (age and sex) information about participants, with omissions most prevalent in the UK and Ireland and least prevalent in Asian countries. Research funding was reported for 62% of all studies, ranging from 13% in Turkey to over 75% in Canada and the US. Although this study had several limitations, especially with regard to potential biases in the sample of studies from non-English-speaking countries, this analysis of over 1,000 nursing studies indicates many important inter-country differences in the focus, methods, and authorship patterns of nursing research published in leading journals. Because research "informs" practice, international differences that exist in the focus and methods of nursing research have implications for nursing practice in the respective countries.
 
Article
To analyze the social meaning of the American system of education for nursing practice. Historiographical analysis to compare and contrast the relative educational level of different self-reported groups of American women with that of nurses in the later decades of the 20th century. Early 20th century social support for efforts to improve the overall educational level of some nurses planning careers in education, administration, or public health nursing lent credence to the belief in nursing as a vehicle for upward social mobility. This promise of mobility was particularly apparent in the educational backgrounds of African American, Hispanic, and Asian American nurses. However, the late 20th century decreased average educational level of U.S. nurses relative to that of all U.S. women jeopardizes the clinical and social roles of the profession. The language of class and community status is needed in addition to that of science, knowledge development, and clinical excellence to increase social and political support for educational initiatives.
 
Article
Keywords:world health;future of nursing
 
Article
Keywords:future of nursing;community health;U.K. National Health Services
 
Article
Keywords:research priorities;international
 
Article
To compare IRB processes in 68 U.S. hospitals for the same multicenter study. Survey of IRB processes in 68 U.S. hospitals during 2001-2002. Requirements of IRB submission including type and duration of review and qualifications of principal investigator were compared by hospital bed size, region, and academic affiliation. The majority of hospitals (63.2%) were on the East coast, and mean bed size was 465 (range: 77-2,112). About one-third (33.8%) required that the principal investigator listed on the application be from within the institution, 26.5% required evidence of human subjects research training, 10.3% required a conflict of interest statement. Mean number of pages for the application was 5.24 (1-31) and up to eight copies were requested. Time from submission of the IRB application to approval averaged 45.4 days (range, 1-303 days), and the majority of reviews were "expedited" (61.8%). Expedited reviews required more time (mean, 54.8 days) than did either exempt (mean, 10.8 days) or full (mean, 47.1 days) reviews. Current IRB review processes are cumbersome and nonstandardized, and review time varies widely. The absence of efficient and streamlined review might unnecessarily impede national clinical research projects without improving participant safety.
 
Article
In this study we explored women's experiences with abortion complications in the postwar context of South Sudan. Abortion complications are the leading cause of admissions to gynecology units in major hospitals of South Sudan. Payment of bridewealth by the husband to the woman's relatives is critical and a symbolic binding of the commitment between families and clans. Failure by a husband to meet the bridewealth obligation is believed to result in a family curse that may cause abortion or death of children in a marriage. Qualitative descriptive design was used to collect data from 26 women treated for abortion complications at a county hospital in South Sudan. In-depth interviews were conducted from March through April 2008. The majority of women in this study, whose husbands had not followed the cultural rules of bridewealth payment, believed that a family curse caused the abortion. The women thought that they would continue to experience spontaneous abortion with subsequent pregnancies until the bridewealth issue was resolved. Cultural beliefs and the status of women in society can hinder access to information on abortion prevention, treatment, and other reproductive health care. Listening to women's perspectives and providing culturally relevant and gender-sensitive reproductive health interventions is important for effective programming by nurses among diverse cultures globally.
 
Article
To examine the effectiveness of guided imagery for immediate smoking cessation and long-term abstinence in adult smokers. A repeated measures design was used with 71 smokers recruited from a hospital outpatient clinic, 38 in the intervention group, and 33 in the control group. Both study groups received educational and counseling sessions in their homes. The intervention group was provided with additional instruction in the use of guided imagery and was encouraged to practice this imagery at least once per day with a 20-minute audio-taped exercise for reinforcement. The repeated measures included smoking rates (cigarettes per day) that were measured and confirmed through corroborating friends and family. At 24-months after the intervention, smoking abstinence rates were significantly higher for the guided health imagery intervention group (26% abstinence rate versus 12% abstinence rate for the placebo-control group). Guided imagery was an effective intervention for long-term smoking cessation and abstinence in adult smokers.
 
Article
To describe sexual abstinence from the perspective of abstinent African American female adolescents. Descriptive qualitative. Data were collected from 14 sexually abstinent, African American adolescent girls during two semi-structured interviews. Data were collected using the life history method and were analyzed in the style of narrative analysis. This analysis indicated four themes in descriptions of abstinence: limited information, categorization of sexual behaviors, activities that lead to intercourse, and abstinence as a self-determined choice. For most participants, "having sex" referred to heterosexual vaginal intercourse and being abstinent meant that one chose to refrain from intercourse. The participants' limited definition of abstinence might lead them to unknowingly put themselves at risk by engaging in other forms of genital sexual activities. They may think that they are protected because they believe that they are practicing abstinence.
 
Article
(a) To examine the relations among processes of change, decisional balance, self-efficacy, perceptions of personal power, and relationship power to stage of change (SOC) for sexual abstinence behavior, and (b) to identify the important explanatory factors of SOC for sexual abstinence among adolescent virgins who were dating steady boyfriends. A cross-sectional survey. Female adolescents (N=500) who were dating steady boyfriends and had not had sexual experience in the past were selected. An anonymous, self-administered questionnaire was used with parts concerning: age, processes of change for sexual abstinence, decisional balance for sexual abstinence, self-efficacy for sexual abstinence, perceptions of personal power, perceptions of relationship power, and SOC for sexual abstinence. Processes of change, decisional balance, self-efficacy, perceptions of personal power, and relationship power differed across the SOC for sexual abstinence. Stepwise logistic regression showed higher self-efficacy for sexual abstinence, higher decisional balance for sexual abstinence, and lower age increased the probability of being in the definite group (preparation and action stage). In the final regression model 77.3 % of the participants were correctly classified. This information about SOC for sexual abstinence can be used by health professionals for intervention strategies for adolescent girls who were dating steady boyfriends.
 
Article
The purpose of this study was to describe the factors that influence disclosure of abuse by women of Mexican descent. Few published studies describe the experiences of women of Mexican descent with a history of intimate partner abuse, specifically in terms of their process of disclosure of abuse. A qualitative research design was used to conduct this study in south Texas adjacent to the United States-Mexico border. Twenty-six key informants were recruited from two different sites. An open-ended approach with a semistructured interview guide was used to collect the narrative information from the 26 participants. The findings illuminated that many factors hindered disclosure. Some of these factors included protecting their partners, avoidance of worrying their mothers, and fear of losing their children. The study may help healthcare providers to understand the complexity of disclosure by women with a history of intimate partner abuse and may help explain why women do not readily disclose their abusive situations. This study on the disclosure decision process of abuse by women of Mexican descent provides some understanding on the cultural or situational factors that hindered or encouraged disclosure; ultimately this knowledge can help healthcare providers and others to provide for the woman's health, welfare, and safety.
 
Article
Purpose: This study examined relationships between verbal abuse from nurse colleagues and demographic characteristics, work attributes, and work attitudes of early career registered nurses (RNs). Design and methods: Data are from the fourth wave of a national panel survey of early career RNs begun in 2006. The final analytic sample included 1,407 RNs. Descriptive statistics were used to describe the sample, analysis of variance to compare means, and chi square to compare categorical variables. Findings: RNs reporting higher levels of verbal abuse from nurse colleagues were more likely to be unmarried, work in a hospital setting, or work in a non-magnet hospital. They also had lower job satisfaction, and less organizational commitment, autonomy, and intent to stay. Lastly, they perceived their work environments unfavorably. Conclusions: Data support the hypothesis that early career RNs are vulnerable to the effects of verbal abuse from nurse colleagues. Although more verbal abuse is seen in environments with unfavorable working conditions, and RNs working in such environments tend to have less favorable work attitudes, one cannot assume causality. It is unclear if poor working conditions create an environment where verbal abuse is tolerated or if verbal abuse creates an unfavorable work environment. Clinical relevance: There is a need to develop and test evidence-based interventions to deal with the problems inherent with verbal abuse from nurse colleagues.
 
Article
To present a comparison of three measures for assessing elder abuse. Three measures for assessing elder abuse were identified through a literature review. The characteristics and uses of each measure were reviewed and evaluated. The Indicators of Abuse (IOA) is a 22-item tool for discriminating abuse and nonabuse cases; it is completed by a health care professional after a home assessment is conducted. The Elder Abuse and Neglect Assessment (EAI) is a 44-item scale comprised of seven sections to review signs, symptoms, and subjective complaints of elder abuse, neglect, exploitation, and abandonment; it can be used by health care providers in all clinical settings. The Elder Abuse Screening Test (EAST) is a 15-item tool to be completed by a health care provider based on the patient's responses. This screening tool is limited because of the small unrepresentative samples used to test it, the low internal consistency, and a relatively high false-negative rate. An instrument to accurately assess elder abuse in long-term care is needed. Proper identification of elder abuse is the first step in assisting victims in dealing with abusive situations.
 
Article
To determine the frequency and sources of verbal abuse against nurses working in clinical settings in different hospitals in the last 12 months, to identify nurses' perceptions about verbal abuse, and to determine types of emotions experienced by nurses who had encountered verbal abuse. This descriptive study was conducted in May 2001 in Turkey. Data were collected from 467 nurses working in various clinical settings in three hospitals. The instrument was a 23-item questionnaire on verbal abuse. Data were evaluated using frequency and descriptive statistics. The findings revealed that the majority of nurses had experienced verbal abuse in the last 12 months (86.7%, n = 405). Most nurses (92%) reported that verbal abuse negatively affected their morale. The most common sources of verbal abuse were patients' relatives and patients themselves. Workplace verbal abuse events cannot always be anticipated. Contingency plans to handle potential situations should be developed.
 
Article
To describe the process by which childhood adversity influences the life course of survivors of childhood sexual abuse. A community-based, qualitative, grounded-theory design. In this grounded theory study, data were drawn from open-ended interviews conducted as part of a larger study of women's and men's responses to sexual violence. The current study indicates the experiences of 48 female and 40 male survivors of childhood sexual abuse and family adversity. Data were analyzed using the constant comparison method. Participants described a sense of inheriting a life of abuse and adversity. The process by which childhood adversity influences the life course of adult survivors of childhood sexual abuse is labeled Living the Family Legacy. The theory representing the process of Living the Family Legacy includes three major life patterns: (a) being stuck in the family legacy, (b) being plagued by the family legacy, and (c) rejecting the family legacy/creating a new one. Associated with these life patterns are three processes by which participants passed on a legacy to others, often their children: (a) passing on the family legacy, (b) taking a stab at passing on a new legacy, and (c) passing on a new legacy. The legacy of abuse and adversity has a profound effect on the lives of survivors of childhood sexual abuse. There are several trajectories by which the influence of childhood adversity unfolds in the lives of adult survivors and by which the legacy is passed on to others. The model representing the theoretical process of Living the Family Legacy can be used by clinicians who work with survivors of childhood sexual abuse and childhood adversity, especially those who have parenting concerns.
 
Article
To investigate early risk factors that led to substance-related disorders and to predict group differences between substance-impaired (SI) and nonimpaired (NI) registered nurses. Donovan's multifactorial model of impairment, and Rogers' Science of Unitary Human Beings. Data were gathered from 100 previously SI and 100 NI nurses located through use of the Internet. Three questionnaires were used: the Zuckerman Sensation Seeking Scale (ZSSS), the Efinger Alcohol Risk Survey (EARS), and the Children of Alcoholics Screening Test (CAST). Independent t-test scores showed the two groups differed significantly on all three instruments' total scores. Discriminate analysis indicated a correct prediction of 87% for SI and 95% for NI nurses, with an overall rate of 91%. EARS scores were the best predictor of nurses with substance-related disorders (.99), followed by ZSSS (.44) and CAST (.42) scores. The three variables indicate early risk factors for substance-abuse impairment. Identification of nurses at risk for impairment will allow for earlier intervention and possible prevention. Methods to reduce the number of modifiable risk factors are recommended.
 
Stepwise Regression Model for Predicting Women's Perception of Own Psychological Health Symptoms
Article
To examine the effects of physical, sexual, and emotional abuse on physical and psychological health among Icelandic women visiting an emergency department (ED) or high-risk prenatal care clinic (HRPCC). We hypothesized that the women's previous experience of abuse by a close family member and current experiences of abuse by an intimate partner, would predict their physical and psychological health. A cross-sectional study design was used. Data were collected using questionnaires (e.g., Women Abuse Screening Tool (WAST) and semistructured interviews, from a sample of 208 women (101 visiting the ED and 107 visiting the HRPCC). For the women seen in the ED, their experience of previous sexual abuse by a close family member, emotional abuse within the preceding year, and current abuse predicted the women's psychological health. For the women seen at the HRPCC, their previous experience of physical abuse, sexual abuse by a close family member, and being currently in an abusive relationship significantly predicted the women's psychological health. Women in Iceland, who are survivors of abuse, seek healthcare services from EDs and high-risk prenatal clinics. The complex effects of both former and current abuse on women's health indicates the importance of regular screening for abuse against women. Offering appropriate interventions within emergency departments and high-risk prenatal clinics to women who are victims of abuse is vital.
 
Article
To determine the predictive ability of self-report questions, physical measures, and biomarkers to detect alcohol misuse and abuse among older women. Healthy women volunteers age 60 and older who fit selection criteria were enrolled. The 135 participants were divided into nondrinkers (ND; n = 63) and drinkers (D; n = 72) based on self-reports of quantity and frequency of standard drinks consumed per month. The mean ages for the groups were 69.2 (ND) and 69.6 (D). The best predictor was a score >0 on the T-ACE, a four-item instrument to detect alcohol abuse. Other significant predictors were: (a) behaviors: smoking, mixing over-the-counter (OTC) drugs with alcohol, heavy coffee drinking, using alcohol to sleep, and less sleep latency; and (b) biomarkers: higher mean corpuscular volume (MCV), hemoglobin (Hgb), hematocrit (Hct), and high-density lipoprotein cholesterol (HDL). The heaviest drinker subgroup had more physical stigmata, including broken blood vessels in nose and larger liver spans. The "best predictor model" showed that older women who were at risk for alcohol misuse or abuse had T-ACE scores of 1 or higher, used two or more OTC drugs regularly, drank large amounts of coffee, used alcohol to fall asleep, and had less sleep latency. Because positive T-ACE scores have high sensitivity and specificity for alcohol abuse, scores of 1 or greater should be addressed in clinical settings, e.g., referrals for more definitive diagnoses and relevant treatment.
 
Article
To compare the effects of recent intimate partner abuse on maternal and infant health in publicly versus privately insured pregnant women. Exploratory descriptive analysis in 13 Massachusetts prenatal care sites from records of 2,052 women who had been screened during pregnancy for domestic violence. Clinicians screened pregnant women for domestic violence using the Abuse Assessment Screen. After delivery, prenatal and birth outcome data and abuse screening results were extracted from medical records by project staff. Odds ratios were used to compare maternal and infant health indicators in abused and nonabused women. Data from women with public and private health insurance then were examined separately, using logistic regression to control for low education and single marital status while examining the odds of adverse maternal and infant outcomes in abused and nonabused women. In the sample as a whole, recently abused women were more likely to be publicly insured and unmarried, to have less than 12 years of formal education, and to have medical and obstetrical complications. Parity, ethnic background, and infant birth outcomes did not differ in relation to abuse. In separate analyses for women with public and private health insurance, after controlling for marital status and education, abuse increased the odds of low infant Apgar scores, poor nutrition, hyperemesis, hypertension, and substance abuse in publicly insured women, and abuse increased the odds of poor nutrition and bleeding during pregnancy for privately insured women. The different correlates of abuse in publicly and privately insured women might be important for clinicians caring for these different populations. Screening for abuse and providing abuse-related services are indicated for pregnant women.
 
Article
The purpose of this study was to explore why Jordanian women stay with an abusive husband. The study used a qualitative approach to collect data from 28 abused women who were recruited through their community during the summer and fall of 2007. Data were collected using an open-ended question through one-on-one in-depth interviews. Results from analysis of the qualitative data revealed that abused Jordanian women identified five main reasons for staying with an abusive husband: the inherited social background, financial dependency, lack of family support, sacrificing self for the sake of the children, and the adverse social consequences of divorce. The results indicate that Jordanian women are strongly bound by traditions and cultural rules and lack all means of empowerment. Results of the study have implications for healthcare providers, social workers, policy makers, and educators to enhance the health and social well-being of Arab Muslim women in Jordan. The findings may also apply to Arab families immigrating to the United States, Canada, and Europe who tend to bring their cultural beliefs, values, and norms, and may help healthcare professionals dealing with violence against women in these countries. Healthcare professionals worldwide need to play an instrumental role in providing culture-specific and evidence-based care to empower women staying in abusive relationships, taking into consideration the influence of Arab Muslim culture.
 
Article
The purpose of this study was to determine the common meanings a history of violence has for women out of abusive and violent relationships with an intimate male partner for 5 or more years. To describe the common meanings and shared practices of women who left violent and abusive heterosexual intimate relationships 5 or more years ago, the challenges they face in their current lives, and the resources they use to meet those challenges. An additional aim is to elucidate practical advice they have for others who want to be supportive of the efforts of women recovering from intimate partner violence. An interpretive phenomenological approach using Heideggerian hermeneutics was utilized. Approval of the University Social Sciences Institutional Review Board was obtained. Participants were recruited by means of fliers distributed through a domestic violence listserv and through postings in health clinics in western New York. Interviews were recorded and transcribed. A hermeneutic team approach was used for analysis and interpretation of texts. Twenty-one women of various ages, ethnicities, and backgrounds, who self-identified as being out of abusive relationships for 5 or more years, were interviewed. Six themes were identified: developing and maintaining self reliance; negotiating relationships; creating a safe and supportive environment; challenging societal roles and expectations; nurturing the self; and protecting the children. Engendering independence while living with purpose was the constitutive pattern that unified the themes. Women can successfully establish productive, meaningful lives after violence and will fiercely protect and maintain their independence as they negotiate relationships and developmental challenges throughout their lives. A need for control of their lives and difficulty trusting others remain a lasting legacy of living with a history of violence. This is the first study that examines women's lives 5 or more years after leaving violent and abusive relationships. Findings indicate that women can successfully leave violent and abusive relationships, and challenge the widely accepted notion that women do not leave.
 
Article
To describe the benefits and barriers associated with practice-academe partnerships and introduce Sigma Theta Tau International's (STTI's) Practice-Academe Innovative Collaboration Award and the 2009 award recipients. In 2008, STTI created the CNO-Dean Advisory Council and charged it with reviewing the state of practice-academe collaborations and developing strategies for optimizing how chief nursing officers (CNOs) and deans work together to advance the profession and discipline of nursing. The Council, in turn, developed the Practice-Academe Innovative Collaboration Award to encourage collaboration across sectors, recognize innovative collaborative efforts, and spotlight best practices. A call for award submissions resulted in 24 applications from around the globe. An award winner and seven initiatives receiving honorable mentions were selected. The winning initiatives reflect innovative academe-service partnerships that advance evidence-based practice, nursing education, nursing research, and patient care. The proposals were distinguished by their collaborators' shared vision and unity of purpose, ability to leverage strengths and resources, and willingness to recognize opportunities and take risks. By partnering with one another, nurses in academe and in service settings can directly impact nursing education and practice, often effecting changes and achieving outcomes that are more extensive and powerful than could be achieved by working alone. The award-winning initiatives represent best practices for bridging the practice-academe divide and can serve as guides for nurse leaders in both settings.
 
Article
To describe the development of an academic-health services partnership undertaken to improve use of evidence in clinical practice. Academic health science schools and health service settings share common elements of their missions: to educate, participate in research, and excel in healthcare delivery, but differences in the business models, incentives, and approaches to problem solving can lead to differences in priorities. Thus, academic and health service settings do not naturally align their leadership structures or work processes. We established a common commitment to accelerate the appropriate use of evidence in clinical practice and created an organizational structure to optimize opportunities for partnering that would leverage shared resources to achieve our goal. A jointly governed and funded institute integrated existing activities from the academic and service sectors. Additional resources included clinical staff and student training and mentoring, a pilot research grant-funding program, and support to access existing data. Emergent developments include an appreciation for a wider range of investigative methodologies and cross-disciplinary teams with skills to integrate research in daily practice and improve patient outcomes. By developing an integrated leadership structure and commitment to shared goals, we developed a framework for integrating academic and health service resources, leveraging additional resources, and forming a mutually beneficial partnership to improve clinical outcomes for patients. Structurally integrated academic-health service partnerships result in improved evidence-based patient care delivery and in a stronger foundation for generating new clinical knowledge, thus improving patient outcomes.
 
Program for All-Inclusive Care of the Elderly (PACE): National Overview
Collaboration and Outcomes of the LIFE Academic Nursing Practice at the University of Pennsylvania School of Nursing
Article
Academic service partnerships are critical for schools of nursing to maintain credibility regarding their missions of education, research, service, and practice. In this paper, we describe a case study of a ten year program, the Living Independently For Elders (LIFE) Program at the University of Pennsylvania School of Nursing that has provided community-based long-term care to high-risk older adults. Quality of care and financial outcomes were met with nurse faculty engagement, administrative commitment, and integration of business practices. As a result, high risk older adults receive care in their communities rather than nursing homes, and the school- owned and -operated program is a nationally recognized innovative nursing model of care. Strategies are described that can be used globally as more schools of nursing embrace and strengthen service partnerships.
 
Article
To investigate attitudes of acceptance toward male registered nurses by female registered nurses. Randomized descriptive design using 105 female registered nurses from a large midwestern state in the US. Data were collected using an attitude inventory and analyzed using t test, chi square, Spearman rho, Pearson correlation, Mann-Whitney U and multiple regression tests. Acceptance was normally distributed. No difference in acceptance was found between rural and urban participants. The length of time working with a male nurse explained significant variance in acceptance scores. City or town of socialization was not related to acceptance scores. Rural participants were less likely than were urban participants to believe that female nurses are ready to accept large numbers of men into the profession. The relationship of the distribution of acceptance of male registered nurses found in this study to the perceptions of acceptance by male registered nurses is unclear and requires further investigation.
 
Article
Need for long-term care (LTC) is increasing globally, and nurses have a professional imperative to address the growing need for long-term care (LTC). The author reviews the effect of globalization and the epidemiologic transition upon the growing need for LTC. I also summarize the lessons learned in the developing world, as well as in the industrialized world, based on the existing research evidence. The purpose of this paper is to explain the need for nursing as a profession to accept responsibility for LTC as part of nursing's raison d'etre, despite the global nursing shortage. This includes responsibility for innovative policy, health service, practice, research, nursing education development, and health promotion, because prevention is key to slowing the steep increase in LTC needs. Clinical relevance: Nurses must develop strategies for clinical practice, management, education, and research in order to increase our ability to meet future needs for LTC.
 
Article
To determine whether a state funding policy influenced access to health care for the uninsured in one county of the American Midwest. The Aday, Andersen, and Fleming (1980) Access Framework guided this descriptive study. The Framework indicates that health policy may directly affect the characteristics of the health care system, which in turn may affect utilization patterns and satisfaction of consumers. A descriptive cross-sectional survey in 1996 was used to explore client satisfaction with care at Health Care Access (HCA), the only organization in the county that received funding under a new state policy. HCA's purpose was to provide primary health care to the medically underserved. Satisfaction was measured using an adapted version of the Patient Satisfaction with Health Care Provider Scale (Marsh, 1996). To measure utilization patterns according to insurance status, data were collected to determine visits to the Emergency Department (ED) at the only hospital (LMH) in the county before and after implementation of the state policy. ED data were collected for 1988, 1990, 1993, and 1995; initial funding to HCA began in April 1992. Within 3 years after state funding was initiated, uninsured visits to the ED decreased by almost 40%, while insured visits continued to increase. The survey results showed that HCA clients had a high level of satisfaction. This descriptive study showed that the change in state policy increased access to health care for the medically underserved.
 
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To describe the availability of tobacco to youth in two urban communities, as a basis for designing a community-based intervention program. Two Midwestern U.S. urban communities were the setting for unannounced tobacco compliance checks. The population of retailers for this study included all convenience stores, grocery stores, pharmacies, and discount stores licensed by the state to sell tobacco products in the two communities. Establishments where entry is restricted to adults were not included. The total population of retailers was used as the sample, and two purchases were attempted at each retail outlet. Cigarette purchases by female teens and the location of cigarettes in stores were documented. Compliance-check procedures were planned with needed protections for retailers and youth. Adolescent tobacco purchase rates were near the federal recommendations for the two urban communities. Retailer use of self-service displays was higher than expected. Availability of the designated brand for self-service was significantly associated with the purchase rate of tobacco by underage youth. Self-service displays provide increased availability of tobacco to teens. Teen smoking and youth access to tobacco could be limited by legislation and policies to restrict retailer use of self-service displays.
 
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To determine the (a) levels of acculturation and job satisfaction, (b) relationship between acculturation and job satisfaction, and (c) effects of select sociodemographic variables in predicting job satisfaction among Filipino RNs educated in the Philippines who are working in the US. Descriptive correlational. A convenience sample of Filipino RNs (N=96) present during the PNAA Eastern Regional Conference in Baltimore, MD was conducted. A survey was conducted using A Short Acculturation Scale for Filipino Americans (ASASFA) to measure acculturation, Part B of the Index of Work Satisfaction Scale (IWS) to assess job satisfaction, and a participant demographic questionnaire. Data were analyzed using A Pearson correlation coefficient and multiple regression analysis. Participants had a moderate level of job satisfaction that was positively correlated to a level of acculturation that was closer to American than to Filipino culture. Furthermore, age, length of U.S. residency, and acculturation significantly predicted perception of job satisfaction among this group of Filipino RNs. Job satisfaction among Filipino nurses is related to acculturation and select sociodemographic variables. Further research to determine how best to improve acculturation may lead to improved retention rates of Filipino nurses in countries to which they have migrated.
 
Conceptual model of acculturation, mutuality, and expectations of family loyalty of children toward elderly relatives among Mexican American family caregivers.
Weights of Factor Scores (N = 192)
Analytic model of expectations of family loyalty toward elderly relatives among Mexican American family caregivers (N= 192).
Article
Informal family care for elders is conventional in Mexican American communities despite increasing intergenerational gaps in filial values. In our study, we explored whether acculturation and dyadic mutuality, as perceived by Mexican American family caregivers, explain the caregivers' expectations of family loyalty toward elderly relatives. A nonexperimental, correlational design with convenience sampling was used in El Paso, Texas, from October 2007 to January 2008. Three bilingual promotoras collected data from 193 Mexican American adult caregivers of community-dwelling elders using three scales designed for Mexican Americans: the Acculturation Rating Scale for Mexican Americans II-Short Form, the Mutuality Scale, and the Expectations of Family Loyalty of Children Toward Elderly Relatives Scale. Confirmatory factor analysis was used to analyze the data. Acculturation had a marginal effect (r = .21, p < .05), but mutuality presented a strong correlation (r = .45, p < .001) with the expectations of family loyalty toward elderly relatives. There was no significant correlation between acculturation and mutuality (r = .05). Although Mexican American caregivers with strong Mexican orientation may have high expectations of family loyalty toward elderly relatives, mutuality exhibits more significant effects on expectations. Among Mexican Americans, mutuality between the caregiving dyad, as perceived by caregivers, may be a better predictor of filial values than caregivers' acculturation alone. It may be useful to incorporate the dual paradigm of acculturation and mutuality into immigrant family care for elderly relatives.
 
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To determine if using personal digital assistants (PDAs) increased accuracy and efficiency of clinical decisions made by novice nurse practitioners (NPs). Experimental with a repeated measures design. The study sample included 40 novice NPs. Data were collected from December 2003 to March 2004 following a stratified random assignment of the subjects to a textbook or PDA group. Participants identified appropriate laboratory value assessments, diagnosis, and medication decisions using the assigned resources when given two randomly administered clinical scenarios. Accuracy was determined by the correct response score to each clinical question. The completion of the scenario was timed by the investigator. Length of time necessary to answer each part of the scenario determined efficiency. Data analysis included mixed design repeated measures analysis of variance. There was a significant interaction and difference in accuracy in the laboratory analysis section of the case scenarios (F(1,38) = 21.256, p ≤ .001) in the PDA group when compared with the textbook group. There were no differences in accuracy by section. In three of six efficiency variables measured, the PDA users were significantly more efficient. In both laboratory values and one of the treatment sections, the PDA users were more efficient in determining an answer to the clinical questions. Accuracy of PDA users was equal to textbook users. Clinical Relevance: The findings lend support to benefits for novice practitioners using PDAs when evaluating clinical situations, both in accessing certain correct information and doing this in a timely manner.
 
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To investigate indicators of fatigue, including depression, sense of powerlessness, and body aches, and to examine differences between symptomatic and asymptomatic women. Descriptive, comparative analysis. Investigators evaluated fatigue, depression, sense of powerlessness, and body aches for two groups of women in a small, rural community. Participants in one group (n = 20) reported subjective experiences of fatigue and the other group (n = 20) did not. No participant had a recognizable disease or physiologic alteration that would account for her fatigue. Symptoms in groups were compared using t tests with Bonferroni adjustment. Although the asymptomatic group members were younger, the groups did not differ in ethnicity, mean weight, number of medications taken, or normality of laboratory values. Women who reported feeling fatigued also had significantly higher scores on the depression and fatigue subscales of the fatigue instrument and significantly lower scores on the power instrument. For participants reporting fatigue, fatigue correlated with depression and depression negatively correlated with sense of power. Data did not indicate how fatigue and depression, or depression and sense of power, are interrelated. Findings provide support for the importance of acknowledging fatigued women's often readily dismissed complaints not only of fatigue, but of depression and sense of powerlessness, and for conducting further research regarding these complaints in women with no objective indicators of fatigue.
 
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Nonventilator hospital-acquired pneumonia (NV-HAP) is an underreported and unstudied disease, with potential for measurable outcomes, fiscal savings, and improvement in quality of life. The purpose of our study was to (a) identify the incidence of NV-HAP in a convenience sample of U.S. hospitals and (b) determine the effectiveness of reliably delivered basic oral nursing care in reducing NV-HAP. A descriptive, quasi-experimental study using retrospective comparative outcomes to determine (a) the incidence of NV-HAP and (b) the effectiveness of enhanced basic oral nursing care versus usual care to prevent NV-HAP after introduction of a basic oral nursing care initiative. We used the International Statistical Classification of Diseases and Related Problems (ICD-9) codes for pneumonia not present on admission and verified NV-HAP diagnosis using the U.S. Centers for Disease Control and Prevention diagnostic criteria. We completed an evidence-based gap analysis and designed a site-specific oral care initiative designed to reduce NV-HAP. The intervention process was guided by the Influencer Model™ (see Figure ) and participatory action research. We found a substantial amount of unreported NV-HAP. After we initiated our oral care protocols, the rate of NV-HAP per 100 patient days decreased from 0.49 to 0.3 (38.8%). The overall number of cases of NV-HAP was reduced by 37% during the 12-month intervention period. The avoidance of NV-HAP cases resulted in an estimated 8 lives saved, $1.72 million cost avoided, and 500 extra hospital days averted. The extra cost for therapeutic oral care equipment was $117,600 during the 12-month intervention period. Cost savings resulting from avoided NV-HAP was $1.72 million. Return on investment for the organization was $1.6 million in avoided costs. NV-HAP should be elevated to the same level of concern, attention, and effort as prevention of ventilator-associated pneumonia in hospitals. Nursing needs to lead the way in the design and implementation of policies that allow for adequate time, proper oral care supplies, ease of access to supplies, clear procedures, and outcome monitoring ensuring that patients are protected from NV-HAP.
 
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The primary purpose of this study was to examine the nursing practice environment and burnout of nursing personnel assigned to a deployed combat support hospital (CSH). A secondary aim was to compare differences in the level of burnout between the deployed Army nursing personnel and Army nursing personnel assigned to an Army hospital in the United States that served as the U.S. military's primary referral center for American combat casualties evacuated from Iraq. A nonexperimental cross-sectional design was used for this study. The Maslach Burnout Inventory and the Practice Environment Scale were administered to 105 personnel who deployed with a CSH to Iraq. Data from this study were linked to data obtained from 152 nursing personnel who participated in an earlier burnout study at a large Army hospital in the United States. The linked datasets yielded a final sample of 257 Army nursing personnel. Analysis of variance and linear regression analysis were used to analyze these data. Emotional exhaustion was common across groups. For the deployed nursing personnel, emotional exhaustion was related to a perceived lack of support from management, foundations for quality of care, collegial relationships, and extended work schedules. The U.S.-based Army hospital group scored significantly higher emotional exhaustion, but it was related to the additional responsibilities associated with being an Army nurse, working extended schedules, and working with combat casualties for extended periods of time. The U.S.-based group perceived more personal accomplishment from the work they do. Burnout was common across Army hospital settings. Emotional exhaustion was most problematic in the U.S.-based Army hospital; however, there was less cynicism toward patients and a greater perception of personal accomplishment associated with work. This study supports the importance of a professional practice environment for Army nursing personnel both during deployment and in U.S.-based Army hospitals.
 
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Journal of Nursing Scholarship, 2008; 40:2, 184–186. ©2008Sigma Theta Tau International.
 
Article
To examine South Asian immigrant women's health promotion issues and to facilitate the creation of emancipatory knowledge and self-understanding regarding health-promoting practices; to promote health education and mobilization for culturally relevant action. The study was based on critical social theory; the research model was participatory action research (PAR). Two groups of South Asian women (women from India and of Indian origin) who had immigrated to Canada participated in the project. The qualitative data were generated through focus groups. Reflexive and dialectical critique were used as methods of analyzing qualitative data. The data were interpreted through reiterative process, and dominant themes were identified. Three themes that were extracted from the data were: (a) the importance of maintaining culture and tradition, (b) placing family needs before self, and (c) surviving by being strong. An issue for action was the risk of intergenerational conflicts leading to alienation of family members. Over a period of 3 years, the following action plans were carried out: (a) workshops for parents and children, (b) sharing of project findings with the community, and (c) a presentation at an annual public health conference. The project activities empowered participants to create and share knowledge, which was then applied toward action for change. Health and health promotion were viewed as functions of the women's relationships to the world around them.
 
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Afaf Meleis
  • University of Pennsylvania
Nancy S Redeker
  • University of Connecticut School of Nursing
Ruth Mccorkle
  • Yale University
Peter J Gergen
  • National Institutes of Health
Robin Whittemore
  • Yale University