Clinical Nursing Research

Agricultural injury occurrence was determined among 1,096 working farm women in Texas and Louisiana. The 1-year cumulative incidence was 4.8%. Lower extremities were the body parts most frequently injured. The leading external causes were contact with foreign object, followed by falls and overdoing/lifting. The seasonal pattern of injury was consistent with warm weather. The factors predictive of increased injury risk in multiple logistic regression included large animal farm type, greater time commitment, recurrent or persistent back conditions or weakness during the previous 12 months, hauling goods to market, and driving a tractor more than 52 days per year. Most women consulted a physician as a result of the injury. Resolving the problem of preventable farm-related injuries will require a major and coordinated effort aimed not only at farm women themselves but also at multiple variables that profoundly affect the underlying conditions and behaviors that lead to farm-related injuries.

Elderly individuals are at risk for acute confusion (AC) during hospitalization. Using a prospective design, this study assessed the relationship between admission risk factors and subsequent development of AC in 117 elderly hospitalized patients. AC was ascertained using the NEECHAM Confusion Scale. Other measures included demographic data, cognitive status, physical function, laboratory data, medications, infections, activity, pain, and nursing acuity. The cumulative incidence estimate was 14%. Patients who developed AC were more likely to be admitted to the hospital from somewhere other than home, to have lower admission NEECHAM and MMSE scores, and to have restricted activity levels, an infection, and abnormal lab values. These patients were more cognitively and physically frail and may have been chronically undernourished and dehydrated on admission to the hospital. Nurses can be trained to routinely assess for acute confusion using easily implemented instruments incorporated into a research-based protocol.

The purpose of this study was to evaluate a strategy designed to permit early detection of anxiety disorders in asthmatics. Ninety-one adult asthmatics were screened for anxiety disorders using the Sheehan Patient Rated Anxiety Scale (SPRAS) and the Anxiety Sensitivity Index (ASI) and then individually evaluated by a nurse trained in the administration of the Anxiety Disorders Interview Schedule-IV (ADIS-IV). Thirty-five (38%) of the participants met the diagnostic criteria for one or more anxiety disorders. Comparison of the SPRAS and ASI findings revealed that the SPRAS was more effective in detecting asthmatics likely to be suffering from coexisting anxiety disorders. Comparison of the nurses’ diagnostic formulations with those of an expert revealed that trained nurses using the ADIS-IV can diagnose anxiety disorders in the asthmatic population with a high degree of accuracy. These results have implications for resolving the problem of unrecognized and untreated anxiety disorders in the asthmatic population.

The purpose of this study was to ascertain if any gender differences existed in the behaviors of infants experiencing different levels of acute established pain and different levels of arousal within each level of pain. To do this, the behaviors of 152 two-week- to 12-month-old infants were videotaped and compared. Levels of pain were assessed by a panel of expert pediatric nurses. Results indicated that female 2-week- to 6-month-old infants performed more generally broadcast crying than did males and that the cries of female 7- to 12-month-old infants were of higher pitch than those of males. There was no gender difference in any facial or other bodily behavior. One cannot interpolate from these results that there are any gender differences in pain thresholds, only that there seem to be gender differences in behavioral responses to acute established pain.

Changes in health care delivery, specifically the addition of telephone advice, affect how nurses work and how patients perceive care. It is important to understand the resources available to these nurses, the process by which they provide care, and patient outcomes. This descriptive study describes one type of resource, the availability and use of protocols. It also describes relationships between protocols and the quality of the nursing process and patient outcomes. Two-hundred-three taped calls to 32 advice RNs and 156 patient follow-up calls were used to measure protocol usage, nursing process quality, and patient outcomes. Although protocols were available for 78.8% of the calls, nurses varied in their extent of use (63.9% not fully used). There was a negative relationship (r = −0.395, p < 0.000) between the availability of protocols and overall quality of the nursing process. Protocol availability and use did not affect patient outcomes.

The purpose of this study was to determine the feasibility of using home audio/video telehealth equipment for administering nursing interventions to families, observing the client response, and collecting research data over specific intervals of time. The study design was a descriptive comparison with observational data collection. The subjects were adult patients (n = 5) using nighttime mechanical ventilators for obstructive sleep apnea and their home caregivers (n = 7). Skin color, vital signs, spirometry, and pulse oximetry data collected simultaneously through telehealth equipment and through nurse observation in the home were the same. Care and the caregiver’s use of the patient equipment were also observed. When nursing interventions, equipment demonstrations, visual illustrations, and audiotaped educational directions were used to facilitate patient care, they were transmitted across telehealth with a few exceptions. Costs of telehealth visits were less than traditional home visits, and client evaluations of telehealth were positive.