Biomedical subjects
Publications and source records attributed to D Oakley.
Successful collaboration does not happen by chance. An understanding of organizations and systems, and planned preventive and corrective actions are needed. These two different experiences with health departments in two different states have helped elucidate the relevant principles and provided examples that may be useful to others in building collaborative research relationships.
A national sample of community health nurses were surveyed to assess their knowledge of, attitudes toward, and involvement with reproductive health services. Results indicated that slightly more than half of the nurses provided or administered contraceptive services to adolescents, although 73% worked in settings where contraceptive services were provided to adolescents. However, only 3.6% indicated that adolescents were their primary client population. The majority (64.3%) stated that they felt as prepared to work with adolescents as they did with adult clients. While 98% were aware that most adolescents are sexually active before seeking family planning services, a minority correctly answered questions about pregnancy and contraception among adolescents. Ninety-five percent agreed that contraceptives should be available to adolescents, and 90% agreed that parental consent should not be required for adolescents seeking contraceptive services. Yet only 21.5% were aware of the implications of the Adolescent Family Life Act.
Unintended pregnancy is a health problem that is particularly important in the practice of public health nurses (PHNs). Data from 844 PHNs showed that they were likely to practice in settings that incorporate family planning services and were knowledgeable about specific family planning methods. They favored family planning services and an expanded supportive government role in both family planning and abortion. Since PHNs are an important resource for the community activism required to build the consensus needed to expand these services, a multiple-regression analysis was performed to determine predictors of activism. Political participation was the major predictor for activism on both family planning and abortion.
Current concerns about sexually transmitted diseases (STDs) and acquired immunodeficiency syndrome (AIDS), as well as unintended pregnancy, have drawn increasing attention to reproductive health services for men. This report presents information about responses by 844 community health nurses (CHNs) to a self-administered mailed questionnaire that included questions about the extent of the nurses' involvement in delivering or administering family planning services to men, their knowledge and attitudes about men and family planning, and their preparation for working with men. Our sample included CHNs in practice in five states and a sample of CHNs belonging to a national organization of public health nursing, in order to gain information about CHNs in practice in the field and CHNs more likely to be in an educational or administrative position and thus able to influence or to set policy. Two thirds of the nurses surveyed work with men in their reproductive years but only 17.8% delivered or administered family planning services to men (23% of the state sample and 12.5% of the organization sample). Deficits in knowledge about male birth control methods were identified; for example, only 32% knew the use-effectiveness rate of the condom. However, 90% of the CHNs knew the condom has to be put on before any genital contact is made. The CHNs' attitudes were positive; more than 90% said they felt men had equal responsibility with their partners in preventing unwanted pregnancies, using contraception, and contraceptive decision making. Yet, only 9.6% of the CHNs felt men have as much knowledge about contraception as women do. Seventy percent of the nurses felt tha sex education in schools was directed more to female students than to male students. More than 90% said they believed that family planning providers have a responsibility to provide services to men; but two thirds felt that nurses are not as well prepared to work with male as with female clients. Increased educational preparation may improve CHNs' knowledge about men and family planning and enable them to feel professionally prepared to deliver and administer the services they feel are necessary for male as well as female clients. There are 101,430 CHNs in the United States, working in public health departments or other service agencies in almost every community across the country. These CHNs are a major resource for the family planning field.
Nursing actions to promote contraceptive self-care are described. Orem's self-care theory was used to develop assessment tools and to plan nursing actions.
The advancement of professional nursing requires integration of theory, practice and research. One realistic mechanism to achieve this integration is collaborative nursing research. A collaborative experience between clinical nurse specialists and faculty researchers is described and evaluated. The collaborative research project focused on contraceptive nursing care and self-care conceptualized within Orem's theory. A major finding was that while job titles and settings of the participants differed markedly, role components were not disparate; rather, they were compatible and complementary. The collaborative project strengthened both the theory base for a primary care nursing practice and the practice base for faculty research and theory development efforts.
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If ST-segment shifts are markers for ischaemic heart disease, they must be recorded accurately so that reliable diagnoses may be made. It is important to establish whether ST segments are distorted when recorded with ambulatory recorders. The Tracker/Replay II system (Reynolds Medical Ltd) is a machine widely used in Europe, yet little has been published assessing its performance when recording ST segments. We have therefore investigated the Tracker/Replay II system using electrocardiograms from patients with ischaemic heart disease and synthesized test signals to see if it could accurately reproduce ST-segment levels. We found that when recording QRS complexes at the upper limit of normal (2 mV and 110 ms), significant (0.14 mV) artefactual ST-segment changes were produced. The distortion was less for narrower or smaller complexes.
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Two hundred and forty percutaneous transluminal coronary angioplasty procedures were performed in three centres over a two year period. Acute occlusion of the vessel undergoing angioplasty was seen on 20 (8%) occasions. The cause of occlusion was determined angiographically and in some cases confirmed at the time of emergency open heart surgery. The mechanism of coronary occlusion was arterial dissection in six cases, persisting coronary arterial spasm in seven, and coronary thrombosis in four. In three patients the mechanism could not be determined. Immediate reintroduction of a balloon dilatation catheter was attempted in 10 patients and resulted in restoration of adequate coronary flow in six. The remaining 14 patients underwent open heart surgery as an emergency procedure.
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The recent introduction of electrocardiographic mapping permits measurement of the precordial area and severity of exercise-induced S-T segment changes. This study was designed to compare this technique with a modified 12 lead electrocardiogram in defining the degree and site of coronary artery disease. One hundred patients, who later had diagnostic coronary arteriography, underwent an exercise test using both 16 point precordial mapping and a modified 12 lead electrocardiogram. The sensitivity of electrocardiographic mapping (96 percent) for the diagnosis of coronary artery disease was significantly greater than that of the modified 12 lead electrocardiogram (80 percent). However, the specificity of the two lead systems was similar. Typical precordial projections of S-T segment change were found when the left main stem or proximal left anterior descending coronary artery were narrowed or when there was isolated disease of the left anterior descending or right coronary artery. Widespread precordial changes were found in patients with three vessel disease. Although there was no significant difference in the sensitivity (66 percent) and specificity (100 percent) of electrocardiographic mapping and of the 12 lead system in identifying three vessel disease, there was a significant difference in sensitivity (electrocardiographic mapping 74 percent, 12 lead system 42 percent) in identifying isolated single vessel disease. In addition, information regarding the presence of left main stem or proximal left anterior descending coronary arterial narrowing was obtained only with electrocardiographic mapping. The superiority of electrocardiographic mapping over the modified 12 lead electrocardiogram has been shown, and clinical application of this technique should be useful in the management of patients presenting with chest pain.
One hundred patients with angina pectoris underwent 16-point electrocardiographic (ECG) mapping of the left hemithorax during a standardised exercise test. Forty-five patients had maximum ST-segment depression at position V5, while 35 had no ECG signs of ischaemia at this position. In 20 V5 was on the edge of the precordial area, which showed less severe ST-depression than the central positions. An Oxford ECG recorder and highspeed analyser were modified and used in 50 of the patients with daily angina for recording ST-segment changes over 24 hours. Serial 24-hour ambulatory recordings from the edge of the precordial area of ischaemia identified during exercise detected a mean of only 14 +/- SD 3% of the episodes of ST-segment changes recorded from the centre of the same area. Only 16 +/- 2% of the episodes detected by ECG were accompanied by chest pain. More episodes occurred between 4 am and 6 am than at any other time during the night. This study shows the importance of recording ECG evidence of ischaemia from the precordial position showing maximum changes during exercise. ECG evidence of ischaemia occurs more frequently than anginal pain. These objective measurements add important information to the frequency of chest pain reported by patients with ischaemic heart disease.
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