Nursing Clinics of North America

Gene therapy represents a fundamentally new way to treat disease. Originally conceived as an approach to hereditary disease, it is now being applied to a broad range of acquired conditions such as infections, cancers, and degenerative disorders. A current overview of gene therapy is presented in this article, including descriptions of two clinical protocols and perspectives for new directions.

Health care in the United States is changing rapidly under pressure from both political and professional stakeholders, and one area on the front line of required change is the discipline of case management. Historically, case management has worked to defragment the health care delivery system for clients and increase access to health care. Case management will have an expanded role resulting from Affordable Care Act initiatives to improve health care. This article includes definitions of case management, current issues related to case management, case management standards of practice, and a case study of the management of pediatric chronic disease. Copyright © 2015 Elsevier Inc. All rights reserved.

Nurse home visiting with pregnant women and new mothers in the early decades of the twentieth century was designed to improve birth and newborn outcomes, hasten Americanization of immigrant mothers, and improve their parenting skills. Today the Nurse Family Partnership home visitation program improves newborn and child outcomes by positively influencing maternal role attainment and significantly decreasing maternal smoking and other substance abuse, child abuse and neglect, and children's emergency room visits. It also improves life possibilities for vulnerable young women by decreasing the interval and frequency of subsequent pregnancies and reduces dependence on welfare by increasing workforce participation. This article reviews the history of home visits by nurses to pregnant women and demonstrates the benefits achieved by these programs today.

This article reviews the retrievable unpublished research pertaining to pressure ulcers for the years 1976 through 1986.

Multidisciplinary teams, therapeutic research, and large successful clinical trials have led to the exciting improved survival outlook in pediatric oncology. The development of sophisticated supportive care measures and the identification of significant prognostic variables within disease categories have dramatically altered the management and outcome for many children with cancer. Prolonged survival has focused attention on the quality of life and strategies to enable these children and their families to cope effectively with chronic, life-threatening illness. Research is ongoing on several fronts: to find innovative treatment approaches for children who currently have a poorer prognosis, to minimize or prevent acute and late toxicities by modifying treatment plans so less intensive treatment can be given to patients with a low risk of disease recurrence, and to increase our understanding of the epidemiology and etiology of childhood cancer. With the continued efforts of researchers in the laboratory and at the bedside, prevention of these catastrophic diseases may some day become a reality.

Quality management is the vehicle for integrating the critical aspects of patient care into nursing service delivery approaches. Predetermined standards for quality, productivity, risk, and cost are correlated in this quality management approach. Information systems facilitate this integration. Nurses must now structure their quality management data elements to accurately reflect nursing practice and relationships of nursing care to the whole.

The Omnibus Reconciliation Act of 1987 set forth new provisions for Medicare and Medicaid sections related to new standards for care in the nursing home setting. One major provision was for nurse aide training. Within that provision there are four specified requirements: (1) nurse aide training for 75 hours, (2) competency evaluation of newly trained nurse aides, (3) competency evaluation of nurse aides already providing care, and (4) a registry for nurse aides. The primary implications of the these requirements center on the responsibility of the individual nurse or nurse community in ensuring appropriate implementation of the new requirement. Without appropriate implementation, some of the provisions increase the liability of the nurse and the risk to the public. The reality of OBRA 1987 and its intent of bringing a measure of quality assurance to the nursing home industry should only serve as an impetus for the nursing community to better translate the nurse role and its contribution in the nursing home setting to policy makers at local, state, and federal levels.

Beginning in 1984, the long-term decline in tuberculosis (TB) cases stopped, and since 1985 the number of cases has actually increased by 18%, from 22,201 new cases in 1985 to 26,283 in 1991. The change in the morbidity trend appears to be primarily due to three factors: HIV coinfection, TB occurring in persons from countries where this disease is prevalent, and deterioration of the health care infrastructure with resultant outbreaks of TB. This article presents six interventions that address major areas where action is needed. These efforts will require coordinated action by health care providers, public health departments, and other public and private organizations. Protection of all workers and patients in health care settings is one important goal of these efforts.

In the preface to the Core Curriculum, editor Terri Goodman, RN, MA, CPSN, CNOR, eloquently describes plastic surgical nursing as "a dynamic specialty that is expanding rapidly in response to technology, creativity, and the increasing autonomy of both nurse and patient." She goes on to say that today's "plastic surgical nurse [is] a sensitive, skilled communicator [possessing] a broad knowledge base and the ability to apply principle." These are exciting times in which to be a nurse. Yes, the winds of change are blowing. Some see them as threatening the core of medical practice, that is, caring for patients. Others see them bringing opportunity, empowerment for nurse specialists, and freedom to reach new levels of professionalism. The specialty of plastic surgical nursing is proud to be a part of this exciting future.

The events of September 11, 2001, set in motion the broadest emergency response ever conducted by the US Department of Health and Human Services. In this article, some of the nurses who deployed to New York City in the aftermath of that horrific attack on the United States offer their recollections of the events. Although Public Health Service Commissioned Corps (PHS CC) officers participated in deployments before 9/11, this particular deployment accelerated the transformation of the PHS CC, because people came to realize the tremendous potential of a uniformed service of 6,000 health care professionals. When not responding to emergencies, PHS CC nurses daily serve the mission of the PHS to protect, promote, and advance the health and safety of the nation. In times of crisis, the PHS CC nurses stand ready to deploy in support of those in need of medical assistance.

The level of emergency preparedness in US hospitals is a concern in light of the steady threat of natural disasters, transportation and industrial accidents, and the possibility of terror attack resulting in mass casualties. The science of hospital emergency preparedness is in an early stage of development. For research to logically expand knowledge, an accurate assessment--or examination of the state of the science--is conducted to determine the current state of knowledge, gaps in knowledge, and opportunities for future research. Milsten reviewed the literature on hospital response to acute-onset disasters from 1977 to 1999. His review of 107 articles contains research studies, case studies,and lessons learned pieces largely published in the medical literature.Milsten's analysis provides a substantial starting point. This article examines Milsten's review, identifies articles that have been published that add to this knowledge base, and identifies additional phenomena of interest.

This article is about nursing leadership, workforce diversity, and underrepresentation in nursing. It is about long-term care, specifically the nursing home, the nurses, and the certified nursing assistants. The nursing shortage, the shortage of nurse educators, and curricular changes in the colleges and universities are not the focus of this work. The questions asked here are, who will care for the residents in nursing homes, and how will they recruit the much-needed leadership at a time of unprecedented need?

A health care program based on Healthy People 2010 objectives provides screening and treatment to homeless children residing in a homeless shelter through a nursing center located on site. In addition to treatment for minor acute illnesses, children receive physical assessment and screening for health problems for which they are at increased risk. Interventions address these problems within the context of the complex psychosocial issues they face. Outcomes of interventions are monitored to support the value of case management and health education with these families.

Transition into the workforce for the new graduate nurse is affected by many factors. New graduate nurses can benefit from support provided through participation in the UHC/AACN Residency Program. The retention of even one graduate nurse saves the employing institution up to an estimated $80,000 annually. St Joseph's Hospital has improved the retention of new graduate nurses from approximately 40% to 100% with the addition of the UHC/AACN Residency Program alongside other system changes. Data are being monitored at St Joseph's and on a national level through this multisite collaborative aimed at improving patient care and increasing nurse retention.

In a developing country such as Pakistan, where illiteracy, poverty, gender differences, and health issues are prevalent, violence against women is a commonly observed phenomenon. The rising incidences of abuse among women indicate a need to introduce evidence-based community-derived interventions for meeting Millennium Developmental Goals by 2015. This article discusses the application of counseling, economic skills building, and microcredit programs as practical and effective interventions to improve the health outcomes of abused women and, therefore, improving maternal and child health in the Pakistani society.

Men's health is a holistic, comprehensive approach that addresses the physical, mental, emotional, social, and spiritual life experiences and health needs of men throughout their lifespan. The men's health movement consists of various movements that are melding into a central focus on men's health and well being. Current health policy is attempting to establish an Office of Men's Health. A men's health nurse practitioner role is proposed for development.

Advanced practice nurses have the capability of providing a variety of services in women's health care. The role and functions of certified nurse midwives, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists are discussed. Current issues and barriers to advanced practice nursing are presented and include role definitions and regulations, second licensure, educational level, prescriptive authority, third party reimbursement, admitting privileges, and malpractice reform. Future directions and recommendations are provided.

Changes in health care policy must be made to pave the way for the appropriate treatment and prevention of child and adolescent mental health problems. Nurses can provide the leadership needed to make the changes. Organizations such as the Association for Child and Adolescent Psychiatric Nurses and the Society for Education and Research in Psychiatric/Mental Health Nursing are already making important contributions. Challenges in the arenas of treatment, education, and research are before us in child psychiatric nursing. We are facing these demands, however, and are moving forward into the twenty-first century.

The need for the early detection of ovarian cancer continues to be one of the most important issues in women's health care. The overall 5-year survival rate for epithelial ovarian cancer remains approximately 30% and has not improved over the last three decades. The failure to improve the prognosis for women with ovarian cancer is directly attributable to the lack of an effective screening test for early-stage disease. It is hoped that with the study of those women at high risk, an appropriate screening method will be discovered. Nurses should become knowledgeable about the nature of ovarian cancer, should be able to identify the woman at familial risk, and should look at a symptomatic woman with a high degree of suspicion. As health educators, nurses can provide up-to-date information about Ca 125 serum tests and vaginal ultrasonography used to screen high-risk populations. Nurses must educate women about the importance of the pelvic examination. Historically, nurses are trained to view the patient holistically. Such a viewpoint will help to put together all of the pieces of a difficult puzzle.

There are many unique physical assessment findings that are associated with specific gastrointestinal disorders. The detection of these findings enables the nurse to manage gastrointestinal emergencies on the patient unit in a timely fashion, preventing deterioration and maintaining the safety of the patient. These skills build well on the traditional, detailed, and comprehensive assessments the nurse makes when using the nursing process. Specific abdominal assessments include detection of signs associated with appendicitis such as rebound tenderness and McBurney's, Rosvig's, and Aaron's signs. The nurse must always be alert to the possibility of peritonitis and the urgency of early detection and treatment. The patient with cirrhosis of the liver presents a distinct clinical picture. There is a need for subtle evaluation of mental status to detect early signs of hepatic coma. Another extra-abdominal assessment of this complication is asterixis. Finally, the assessment of the patient is enhanced when the nurse is able to help identify the location of bleeding. Improving abdominal and gastrointestinal system assessment leads to early detection of nursing problems and appropriate interventions.

Injuries to the chest usually require immediate intervention to maintain life. The procedures are simple and effective. The major life-threatening injuries are flail chest, tension and open pneumothorax, and cardiac tamponade. Blunt injuries of the abdomen are difficult diagnostic problems and the patient must be observed carefully.

Blunt abdominal trauma is a possible sequel of many accidents and can result in death from hemorrhage or sepsis if it is not detected early and managed aggressively. A thorough history of the causative accident, a systematic abdominal examination, selected laboratory studies, and x-ray films are helpful in establishing the diagnosis. Peritoneal lavage is, however, the most reliable assessment tool (besides an exploratory laparotomy) for confirming significant viscus injury and intra-abdominal hemorrhage. Nurses who are assisting in the evaluation of trauma victims should be thoroughly familiar with the mechanics responsible for blunt abdominal injury, the initial steps for stabilizing the victim, and the usual tests and procedures that aid in diagnosis.