Arlene W. Keeling

Nurse-initiated telephone follow-up after acute myocardial infarction: A pilot study

OBJECTIVES To determine the receptivity of patients with acute myocardial infarction and their spouses to postdischarge follow-up telephone calls from a nurse, and to describe the content of nurse-patient/spouse telephone conversation during early convalescence at home. DESIGN Descriptive pilot study using qualitative methods. SETTING University medical center and home. SAMPLE Twenty-one male patients with acute myocardial infarction and their wives who agreed to participate in the study. RESULTS All subjects were receptive to telephone follow-up by cardiac nurse clinicians. From data analysis of telephone calls, five content themes emerged. These included (1) difficulty accepting changed health status, (2) reports of attempts at risk factor reduction, (3) concern for financial difficulties, (4) dealing with uncertainty, and (5) expression of appreciation for the nurse-initiated telephone call. Nurse investigators provided information and emotional support and made referrals. CONCLUSIONS Further research should be done to test the feasibility and effectiveness of nurse-initiated telephone follow-up after hospital discharge for acute myocardial infarction in reducing patient and spouse stress and increasing patient/spouse information about self-care regimens. The clinical trial should also determine whether telephone follow-up by nurse increases patient satisfaction with the health care delivery system.

Postcardiac catheterization time-in-bed study: Enhancing patient comfort through nursing research

Cardiac catheterization has become a routine diagnostic procedure. Little has been written about standards for nursing care related to bed rest postcatheterization. The purpose of this experimental study was to determine whether there was a significant difference in incidence of bleeding from catheter insertion site between those patients who remained in bed for 12 hours and those who remained in bed for 6 hours post-procedure. There was no significant difference between the two groups. Postprocedure bed rest was reduced from 12 to 6 hours in this tertiary care medical center. Decreasing time in bed reduced cost and patient discomfort.

Addressing Disparities in Access to Care: Lessons From the Kercheval Street Clinic in the 1960s

Health disparities for racial and ethnic minorities have been present in the United States and persist today. NMHCs (Nurse-Managed Health Center), which can serve as “Medical Homes,” are one mechanism by which nurses can attempt to overcome these disparities within communities. In the mid-1960s, Nancy Milio developed and found funding for a NMHC to address disparities in Detroit, Michigan. History shows that the center was so valued by community members that it remained untouched during the Detroit riot of 1967, despite all buildings surrounding it having been burned down or destroyed. This article uses traditional historic methods to describe the establishment of the center in inner-city Detroit in the 1960s in historical context and analyze factors that led to Milio’s success. To address disparities via NMHCs, nurses must be persistent in acquiring funding and should involve a racially and culturally diverse group representative of community members in the development, planning, and ongoing operation of the enterprise.

Finance and faith at the Catholic Maternity Institute, Santa Fe, New Mexico, 1944-1969.

In 1944, the Medical Mission Sisters opened the Catholic Maternity Institute in Santa Fe, New Mexico, primarily to serve patients of Spanish American descent. The Maternity Institute offered nurse-midwifery care and functioned as a school to train nurse-midwifery students. Originally planned as a home birth service, the Catholic Maternity Institute soon evolved into a service in which patients chose whether to deliver in their own homes or in a small freestanding building called La Casita. In fact, despite their idealism about home birth and strong feelings that home birth was best, the sisters experienced significant ambivalence concerning La Casita. Births there met many of the institute’s pragmatic needs for a larger number of student experiences, quick and safe transfers to a nearby hospital, and more efficient use of the midwives’ time. Importantly, as the sisters realized that many of their patients preferred to deliver at La Casita, they came to see that this option permitted these impoverished patients an opportunity to exercise some choice. However, the choice of many patients to deliver at La Casita—which was significantly more expensive for the Maternity Institute than home birth—eventually led to the demise of the Maternity Institute.

Marfan syndrome teaching algorithm: does it make a difference?

Marfan Syndrome (MFS) is an autosomal dominant, connective tissue disorder that is due to a deficiency in the structural protein, fibrillin. MFS patients are more likely to experience aortic aneurysms and dissections, dislocated lens, and/or severe musculoskeletal deformities than non-MFS patients. Attainment of a longer lifespan in MFS patients is directly dependent on vigilant blood pressure (BP) control, frequent cardiology surveillance, annual eye exams and frequent dental hygiene visits. This study evaluated the effect of a Marfan Syndrome Teaching algorithm (MFSTA) on 20 MFS patients, with regard to BP management, cardiovascular medication adherence; adherence to activity restrictions; and attendance at scheduled eye, cardiology and dental exams. This study demonstrated adherence improvement in the attendance at scheduled cardiology, ophthalmology, and dental exams from 50%, 55% and 70% prior to the study, respectively, to 95%, 90% and 100% post study. Furthermore, subject adherence with self-administration of ordered cardiovascular medications increased from 50% (pre-study) to 93.3% (93.3%), and subject adherence with activity restrictions escalated from 70% (pre-study) to 95% (post study). All subjects demonstrated proficiency in regular testing and recording of their blood pressure. There was no significant change in the mean systolic BP (SBP) for 13 of the subjects who had both pre- and post-intervention BP recording, although the post intervention SBP was slightly higher (p = 0.30). However all subjects in the intervention period demonstrated a mean SBP of 124.7 mm Hg, with standard deviation (SD) of 12.9 mm Hg. Limited pre-intervention BP readings of 7 subjects prevented a pre- and post-SBP comparison. The MFSTA model should be considered for other patient populations involving chronic cardiovascular healthcare conditions.

Fire in the belly and the professionalization of nurses: a historical analysis of Crohn disease care.

Today, professional nurses around the world are stepping up to meet the needs of individuals with Crohn disease, using their specialized knowledge and skills that demonstrate areas of expertise that have not always existed. The gastrointestinal-specific knowledge being used by these 21st-century nurses exists today because progressive efforts of nurses in previous decades moved the profession of nursing forward. The purpose of this article was to describe and analyze the development of the role of nurses in responding to new challenges patients with Crohn disease face since the emergence of the disease in the early 20th century. The authors used traditional historic research methods to conduct the study. Primary sources include nursing journals and textbooks published in the 20th and 21st centuries and documents archived at The Mount Sinai Hospital in New York City, where Burrill B. Crohn conducted his seminal work. The significance of the findings is that the changing role of nurses in caring for patients with Crohn disease mirrors the professionalization of nursing during the 20th and early 21st centuries.

Nurses and Disasters: Global, Historical Case Studies

The book addresses such questions as: How did local, regional, and national communities mobilize for emergency care? What was the role of local nurses in emergency care after disasters? What was the role of the national or international Red Cross, local and federal governments, physicians, nurses, and other first responders? What was the impact of social attitudes and issues of race, class, and gender on the ways nurses and other health care professionals reacted to the disasters? How did unpreparedness for the type or scope of the disaster affect the response? The book will be of value to a wide variety of undergraduate and graduate students in nursing, social work, history, health policy, womens studies, public health, and urban studies.

Living in the epilepsy treatment gap in rural South India: A focused ethnography of women and problems associated with stigma

ABSTRACT In India, women with epilepsy face unique challenges. A focused ethnography of six women within the epilepsy treatment gap was conducted in rural South India. Women were asked to describe their day-to-day lives. Data were collected through open-ended, semistructured interview questions, participant observation, and field notes. Thematic analysis was done. The disease-related stigma contributed to the womens physical, psychological, and emotional struggles; the women and their family members made every effort to conceal the disease. Educational interventions to create awareness could help women seek effective treatments for their seizures, thereby reducing the stigma and improving the quality of their lives.