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PubMed1995

Ethical dilemmas in the lived experience of nursing practice.

Through a series of semistructured interviews with 12 nurses delivering direct patient care in acute, long-term and home care settings, information was sought regarding the ethical concerns of practicing nurses. Although these nurses frequently did not specifically identify the areas of expressed concern as ethical in nature, thematic analysis of the transcribed interviews uncovered four major ethical areas of concern common to these 12 nurses. These areas are: (1) Withholding of information and truth-telling; (2) Unequal access or inequalities in care; (3) Differences between business and professional values; (4) Breaking and reporting broken rules. Several reasons are offered to explain the failure of nurses accurately to identify specific practice dilemmas as ethical in nature and the sequelae of these failures. Possibilities involving ongoing education and mentored experiences in practice areas are reported.

Adult↗
PubMed1994

Privacy and confidentiality of patient information. Challenges for nursing.

The growing interest in automating healthcare information and the emergence of the computer-based patient record-keeping have brought the issues of privacy and confidentiality to the fore-front. Nurse executives and nurse managers need to be sensitive to these issues, as never before, to guide their staffs and to prevent harm. Technology makes sensitive information more accessible to more people, with resulting benefits and dangers. The author presents a nursing ethical framework for discussing patient privacy and confidentiality issues, and highlights specific issues that reflect nursing's unique viewpoints.

Codes of Ethics↗
PubMed2003

Measuring hospital quality: can medicare data substitute for all-payer data?

OBJECTIVES: To assess whether adverse outcomes in Medicare patients can be used as a surrogate for measures from all patients in quality-of-care research using administrative datasets. DATA SOURCES: Patient discharge abstracts from state data systems for 799 hospitals in 11 states. National MedPAR discharge data for Medicare patients from 3,357 hospitals. State hospital staffing surveys or financial reports. American Hospital Association Annual Survey. STUDY DESIGN: We calculate rates for 10 adverse patient outcomes, examine the correlation between all-patient and Medicare rates, and conduct negative binomial regressions of counts of adverse outcomes on expected counts, hospital nurse staffing, and other variables to compare results using all-patient and Medicare patient data. DATA COLLECTION/EXTRACTION: Coding rules were established for eight adverse outcomes applicable to medical and surgical patients plus two outcomes applicable only to surgical patients. The presence of these outcomes was coded for 3 samples: all patients in the 11-state sample, Medicare patients in the 11-state sample, and Medicare patients in the national Medicare MedPAR sample. Logistic regression models were used to construct estimates of expected counts of the outcomes for each hospital. Variables for teaching, metropolitan status, and bed size were obtained from the AHA Annual Survey. PRINCIPAL FINDINGS: For medical patients, Medicare rates were consistently higher than all-patient rates, but the two were highly correlated. Results from regression analysis were consistent across the 11-state all-patient, 11-state Medicare, and national Medicare samples. For surgery patients, Medicare rates were generally higher than all-patient rates, but correlations of Medicare and all-patient rates were lower, and regression results less consistent. CONCLUSIONS: Analyses of quality of care for medical patients using Medicare-only and all-patient data are likely to have similar findings. Measures applied to surgery patients must be used with more caution, as those tested only in Medicare patients may not provide results comparable to those from all-patient samples or across different samples of Medicare patients.

Aged↗
PubMed1992

Infection control practices in cardiac transplant recipients. The Research Committee, Houston-Gulf Coast Chapter of the American Association of Critical-Care Nurses.

Infection is a common cause of morbidity and mortality among transplant recipients. Infection control measures lie within the realm of nursing interventions and involve large expenditures of resources. Because transplantation is such a new specialty, few standards exist. The research question for this study was What nursing interventions are being used to prevent infection in cardiac transplant recipients? A 156-item questionnaire was developed that included isolation procedures, dressings, invasive lines, medications, staffing, staff education, dress codes, unit design, visitation, infections, length of stay, survival, and other demographic data. Content validity was established by a panel of transplant experts. After local piloting, the tool was mailed to 120 cardiac transplant centers, and 68 were returned completed. Data were analyzed using descriptive and correlational statistics. Findings revealed wide diversity in practice. Older and larger transplant programs tended to use fewer precautions. Survival rates appeared unrelated to the number of precautions used.

Heart Transplantation↗
PubMedDate not supplied

When cost-saving strategies are unacceptable.

With health care redesign, nurses in every setting are challenged to provide more cost-effective care. While quality models for health care have been developed, nurses are at times asked to implement unsafe practices in the name of cost reduction or profit building. Both legal and ethical dilemmas arise when an emphasis on economic considerations supersedes patient well-being. Nurses must recognize their primary duty as patient advocates, and work to modify unsafe plans. The ANA's Code for Nurses and Guidelines for Reporting Incompetent, Unethical or Illegal Practices, and the Nursing Practice Act are primary resources in this effort.

Codes of Ethics↗
PubMed1994

Pain management and potentially life-shortening analgesia in the terminally ill child: the ethical implications for pediatric nurses.

Optimal pain control in the dying child often requires aggressive opioid therapy that exceeds recommended parameters and may hasten death caused by respiratory depression. For pediatric nurses caring for the dying child, the administration of potentially life-shortening analgesia gives rise to a number of ethical issues. Pediatric nurses often express concern that aggressive pain control is a form of euthanasia or fear the child will develop a drug dependence. Lack of clarity about the ethical obligations and professional responsibilities of nurses who administer potentially life-shortening analgesia may also contribute to the dilemmas surrounding such situations. If left unresolved, these issues can interfere with the nurse's ability to implement an appropriate pain regimen. To provide adequate pain control, pediatric nurses who care for dying children must accomplish the following: critically examine ethical issues and underlying principles; understand the phenomena of addiction, tolerance, and physical dependence; and identify the boundaries of acceptable nursing practice when administering potentially life-shortening analgesia to terminally ill children.

Child↗
PubMed1992

Developing an organizational ethos.

A code of ethics and an ethics committee are tools that can improve the quality of the ethical judgment calls that home care agencies and their hands-on providers face daily.

American Hospital Association↗
PubMed1998

Requests for assisted suicide: a nursing issue.

At the heart of the debate over assisted suicide is the recognition that not all persons can be healed and not all suffering can be relieved. This article addresses the ethical, professional and legal issues to be considered by the nurses in the United States who are facing patients' requests for assisted suicide. Both personal and professional risks, and the consequences of an action must be evaluated. Ultimately, a decision is based on some ranking of patient values; personal values and beliefs; professional codes, standards and other guidelines; and societal laws and regulations.

Beneficence↗
PubMed2001

A preliminary report of the occupation of patients evaluated in patch test clinics.

BACKGROUND: The interplay between the occupational environment and worker's skin can result in contact dermatitis of both irritant and allergic types. Other forms of dermatitis can also be influenced by occupational exposures. OBJECTIVE: The aim of this study is to compare the occupations and allergens of occupational contact dermatitis cases with nonoccupational contact dermatitis cases. METHODS: Diagnostic patch testing with allergens of the North American Contact Dermatitis Group and occupational coding by the National Institute for Occupational Safety and Health methods. RESULTS: Of 2,889 patients referred for evaluation of contact dermatitis, 839 patients (29%) were found to have occupational contact dermatitis. Of the 839 cases deemed occupational, 455 cases (54%) were primarily allergic in nature and 270 cases (32%) were primarily irritant in nature. The remaining 14% were diagnoses other than contact dermatitis, aggravated by work. The occupation most commonly found to have allergic contact dermatitis was nursing. Allergens strongly associated with occupational exposure were thiuram, carbamates, epoxy, and ethylenediamine. CONCLUSION: Some contact allergens are more commonly associated with occupational contact dermatitis. Nursing and nursing support are occupations most likely to be overrepresented in contact dermatitis clinics.

Allergens↗
PubMedDate not supplied

Determinants of physical activity and low-fat diet among low income African American and Hispanic middle school students.

African Americans, Hispanics, and those with low income experience disproportionate health problems that can be prevented by physical activity and a lower fat diet. In this descriptive cross-sectional study, antecedents of diet and exercise within the Health Promotion/Transtheoretical Model were examined among low-income African American and Hispanic seventh-grade students (n = 127). Total support was associated with higher physical activity for girls. African Americans perceived greater social support for activity than Hispanics. Family models and support for physical activity and low-fat diet were greater as family income increased. However, higher family role models and lower dietary fat were found among the lowest income Hispanic students' residing ZIP code with a higher concentration of Hispanics and greater availability of Hispanic foods and culture. A school-based approach may be useful to build peer support for physical activity and lower dietary fat. Parish nurse or clinic settings may be most appropriate for building family role models and support. Living in a neighborhood with traditional Hispanic culture and foods appears to have ameliorated the harmful effects of lower income, although further study with larger samples followed over time is needed.

Adolescent↗
PubMedDate not supplied

Said another way. Our obligation to float.

TOPIC: Floating is one method that can help alleviate the burden and consequences of the nursing shortage. PURPOSE: The devastating effects that occur as a result of the nursing shortage are discussed. As a result, floating is argued as a viable solution. The practice of floating is explored from an ethical approach. SOURCES OF INFORMATION: Professional literature, electronic resources, nursing textbooks, from statements provided from the American Association of Colleges of Nursing, Joint Commission on Accreditation of Healthcare Organizations, Six Sigma, legal cases, and personal experience. CONCLUSION: Although many nurses oppose the practice of floating, it remains not only necessary, but it is also our obligation. It is acknowledged that floating has its opposition, but the arguments posed are not justifiable when they are weighed against the consequences of not floating.

Attitude of Health Personnel↗
PubMed1994

Simulated pediatric cardiopulmonary resuscitation: initial events and response times of a hospital arrest team.

BACKGROUND: Cardiopulmonary resuscitation (CPR) training programs exist to enhance knowledge and skills retention. However, they do not ensure that effective CPR will be performed by trainees or resuscitation teams. One aspect of CPR effectiveness is the ability of the team to respond to an emergency call in a timely manner. METHODS: We prospectively evaluated the time required for team members to respond to an emergency call and to initiate definitive treatment in our pediatric facility. The medical staff who responded had no prior knowledge of the simulated cardiac arrest (SCA) events. All events were recorded on audio-cassette tape to determine the sequence of events and response time of arrest team members. SCA scenarios represented examples of cardiac, hematologic, renal, respiratory, and pharmacologic pathophysiology. All participants were instructed to respond as though the SCA were an actual emergency. RESULTS: From December 1991 to January 1993, 37 SCAs were evaluated. Documentation began after a concise arrest scenario had been presented to a designated nursing representative who was to be the first rescuer on the scene. The rescuer first assessed the patient's condition, activated the cardiac arrest system (median elapsed time, MET, 0.50 minutes), and then initiated single-person CPR (MET 0.58 minutes). Administration of oxygen occurred at an MET of 2.25 minutes. The first member of the arrest team to respond was the pediatric resident (MET 3.17 minutes) followed by the respiratory therapist (MET 3.20 minutes), an ICU nurse (MET 3.58 minutes), a pharmacist (MET 3.42 minutes), and anesthesiology personnel (MET 4.70 minutes). DISCUSSION: The use of SCAs (termed "Mega Code") serves as an extension of Basic Life Support and Advanced Cardiac Life Support education and provides a valuable learning experience and quality assurance tool. Limitations that might influence patient outcome during an actual in-hospital arrest have led to refinements in our cardiac arrest procedures. Of particular note was the delay in oxygen administration, which may be linked to its omission from the 1986 and 1992 American Heart Association Basic Life Support Guidelines. CONCLUSION: We believe that BLS education for hospital employees should include and emphasize oxygen delivery for resuscitation.

Cardiopulmonary Resuscitation↗
PubMedDate not supplied

Measuring the domain completeness of the Nursing Interventions Classification in parish nurse documentation.

As the healthcare industry moves toward automating the patient record, care providers have been challenged to capture their domain of practice in a computerized format. Nurses have responded by developing a number of American Nurses Association (ANA) recognized nursing standardized terminologies. This study measured the domain completeness and uses of one such terminology, the Nursing Interventions Classification (NIC), within the specialty of parish nursing, a spiritually focused, community-based practice. Documentation samples from 170 health records submitted by 13 parish nurses in 7 sites across the country, stratified by urban, suburban, and rural sites were used. The nursing interventions that were documented in 1607 unique interactions in these charts were mapped into NIC using standardized mapping procedures. Intercoder reliability was assessed, with a final kappa of 0.92 (93% agreement) and code-recode reliability with a kappa of 0.72 (74% agreement). Overall, 93% of the 3059 interventions mapped into NIC. Recommended modifications in existing NIC labels and additional NIC labels are presented. The results suggest that NIC supports the documentation of parish nursing practice and has the capability of capturing the spiritual dimension of care.

Attitude of Health Personnel↗
PubMed2005

Polymorphisms in the interleukin 17F gene (IL17F) and asthma.

Interleukin17F (IL17F) is a regulatory cytokine for T-cell-mediated immune responses. The gene coding for IL17F (IL17F) is located on chromosome 6p, a genomic region linked to asthma and asthma-related phenotypes in multiple genome scans. IL17F is expressed in lung tissue, in bronchoalveolar lavage fluid from asthmatic subjects, and in activated CD4+ cells. We were thus interested in testing for association between single-nucleotide polymorphisms (SNPs) and haplotypes in IL17F and asthma. To characterize polymorphisms in IL17F, we sequenced this gene in a group of African Americans and a group of European Americans. A total of 50 SNPs (30 not previously reported in a public database (dbSNP build 118)) and two insertions/deletions were detected in IL17F; five of these polymorphisms were genotyped in participants of the Nurses' Health Study. We then tested for association between SNPs and haplotypes in IL17F and physician-diagnosed asthma in subjects with (cases) and without (control subjects) physician-diagnosed asthma. None of the SNPs or haplotypes tested in IL17F were associated with asthma. The polymorphisms identified in this study may be used in future studies of association between IL17F and phenotypes related to immune responses.

Black or African American↗
PubMed1995

Hospitalization for major depression among older Americans.

BACKGROUND: The objective of this study was to report the pattern of hospitalization for major depression among older Americans and to examine correlates of those hospitalizations. We sought to investigate the hypothesis that hospitalization for major depression would be more common among those respondents with declining functional status whose ability to adapt to this decline was impaired by inadequate social support systems or economic stressors. METHODS: The data were taken from Version 5 of the Longitudinal Study on Aging (LSOA), which includes 7,527 subjects who were aged 70 and older in 1984. We identified all subjects with any hospitalizations for which major depression was a discharge diagnosis (ICD9-CM codes 296.2, 296.3, 300.4, and 311), and all subjects for whom depression was the primary discharge diagnosis. Only patients with a first-listed discharge diagnosis of depression were considered to have been hospitalized for major depression. RESULTS: The yearly incidence of hospitalization for which depression was the primary discharge diagnosis was 0.1%. The mean length of stay was 14.6 days and the mean hospital charge was $6,742. Length of stay and charges did not vary by hospital type (general vs psychiatric), but both charges and length of stay were significantly longer when major depression was the primary discharge diagnosis rather than a secondary diagnosis. Patients with a hospitalization for major depression had more hospitalizations, longer total lengths of stay, and greater total hospital charges over the seven-year period as compared to patients with at least one hospitalization for any other reason. These differences in hospital resource use dissipated when hospitalizations for depression were excluded. Hospitalization for major depression was not associated with gender, race, education, or social support. Hospitalization for major depression was independently associated with a forced residential move, a history of nursing home stays, decline in household activities of daily living, younger age, and perceived health rated as less than excellent. CONCLUSIONS: One older American per thousand is hospitalized each year with a primary discharge diagnosis of major depression. These individuals did not have evidence of greater total hospital resource use if episodes of hospitalization for depression are eliminated. Hospitalization for major depression was more common among those with a loss of independent living.

Aged↗