Audrey G. Gift

Validation of a vertical visual analogue scale as a measure of clinical dyspnea.

&NA; The purpose of this study was to validate a vertical visual analogue scale (VVAS) as a measure of clinical dyspnea. Concurrent validity was demonstrated by having asthmatics score their dyspnea intensity on both a VVAS and a horizontal visual analogue scale (HVAS), and then measuring their peak expiratory flow rate (PEFR). Correlation between the VVAS and HVAS was r =.97; between the VVAS and the PEFR, correlation was r =−.85, demonstrating the concurrent validity of the VVAS as a measure of dyspnea. Construct validity then was established, using the contrasted‐groups approach with repeated measures. Both asthmatics and those with chronic obstructive lung disease (COPD) rated their dyspnea on the VVAS during times of severe and little airway obstruction. The dyspnea ratings at times of severe versus low obstruction were found to be different for both the asthmatic and COPD subjects. The VVAS was shown to have both concurrent and construct validity as a measure of dyspnea.

Depression, somatization and steroid use in chronic obstructive pulmonary disease

Steroid therapy has become part of the adjunctive treatment for COPD patients in some settings. Emotional changes have been reported in some patients while on these medications, but whether these changes are associated with the pathophysiological state or a side effect of the medication is not known. In this study self-reports of depression and somatic complaints were compared between two groups of COPD patients, 20 not receiving steroids and 20 receiving steroids. Both groups demonstrated comparable levels of disease and somatic complaints. Mean FEV1 value for those not receiving steroids was 34% of predicted while the mean for those receiving steroids was 30% of predicted. Depression was found to be significantly higher (t = 11.21, df = 38, p less than 0.01) in the group receiving steroids when compared to those not receiving steroids using a Students t test. The higher degree of depression among steroid treated COPD patients has implications for clinical practice. The emotional status of this group of patients needs to be monitored and interventions initiated when necessary.

The effects of a program of systematic movement on COPD patients.

&NA; The intent of the study described in this article was to determine (a) if patients with chronic obstructive pulmonary disease (COPD) who regularly participate in less vigorous exercise programs, such as the program of systematic movement sponsored by the American Lung Association, differ from those who do not participate; and (b) whether these differences, if they exist, persist over time. Two convenience samples of COPD patients—those who practice systematic movement by participating in a pulmonary exercise program (PEP) and those who do not—were obtained through the American Lung Association of Maryland. Demographic information and health history were obtained from the participants and their physicians. They all completed the vertical visual analogue dyspnea scale (VADS) and the Beck Depression Inventory (BDI) on two occasions 8 weeks apart and described the strategies they used in dealing with their illness. Differences were found between the groups on the BDI and VADS at both measurement times. Those who participated in the program had lower depression (5.9 versus 17.75) and lower dyspnea (58.9 versus 78.8). These findings persisted 8 weeks later, with exercisers having depression levels of 5.5 versus 19 for the nonexercisers and dyspnea levels of 55.2 versus 79.4 for the nonexercisers. Exercisers used fewer emotion‐focused coping strategies than nonexercisers. These findings have implications for the rehabilitation of COPD patients.

Use of quality management to provide nutrition to intubated patients.

CLINICAL NURSE SPECIALISTS are in a pivotal position to impact patient outcomes. Quality management is one method CNSs can use to measure and validate the effect they are having on patient outcomes. An example of such a quality management program was implemented by the CNS to monitor initiation of feeding for intubated patients. Because it was determined that many patients were not being fed for over 7 days after intubation, nutritional guidelines were developed and implemented for physicians and nurses to follow. One year after implementation of the guidelines, 51 patients were identified as needing nutritional support. The average number of days to institute feeding was reduced by a mean 6.4 days across all types of feeding, including oral feeding, enteral bolus feeding, continuous postpyloric feeding and parenteral nutrition. The early nutrition quality management program initiated by the CNS had a positive outcome for patients.

Cost Effectiveness: Designing Research for Product Evaluation

THE FOCUS OF this paper is planning of research to evaluate products or interventions used by nurses in the acute care setting. Research designs that can be used are presented with a discussion of problems encountered when implementing the designs in a hospital setting. Techniques to standardize care delivered to treatment and control groups are presented. Outcome measures, analytic techniques, and funding sources for this type of research are discussed.

Utilization pattern of clinical nurse specialists in the Baltimore-Washington area.

In the present cost containment environment, hospitals often change their employment patterns. Nurses in advanced practice roles are particularly vulnerable to reassignment. In order to determine if the employment of Clinical Nurse Specialists (CNSs) in the Baltimore-Washington area had decreased and to determine what specialty areas employed the most CNSs, a survey of all area hospitals was conducted. The nursing departments of all 88 hospitals were contacted by phone with 40 of them (45%) agreeing to provide data. Seventeen institutions reported employing a total of 119 CNSs. Of these, only 12 required a Masters degree for nurses to hold that position. As expected, larger institutions employed more CNSs. This role appears to be stable, with only two institutions having eliminated CNS positions recently and five reporting plans to add such positions in the near future. Most CNSs reported either directly or indirectly to the Director of Nursing. Those in positions funded by another source reported to personnel in the funding department or agency. Almost all CNSs had clinical titles, and Psychiatric, Oncology, Medical and/or Surgical, Pediatrics or Critical Care were the most prevalent specialties mentioned. The CNS role is a viable role in the Baltimore-Washington area even in this time of cost containment. Most CNSs are identified with their area of clinical specialization.

Clinical research with patients in crisis: pitfalls and solutions.

Clinical research involving patients in crisis may be difficult to conduct because of the psychaphysiological changes in the patient and the hectic environment of the health care setting Clinical nurse specialists have the opportunity to expand nursing knowledge and contribute to nursing practice through initiation and/or participation in research with people in crisis. This article identifies potential pitfalls in conducting research with patients in crisis and suggests strategies for selecting a research design, data colection methodologies, and obtaining consent or approval.