Carol L. Macnee

Development and testing of the barriers to cessation scale

The purpose of this research was to develop and test a measure of barriers to smoking cessation. Barriers, reconceptualized within the Transactional Model of Stress (Lazarus, 1966), reflect specific stressors associated with smoking cessation. The measure consists of a 19-item scale, which has been tested in three studies. Cronbachs alpha coefficients ranged from .81 to .87. Construct validity was demonstrated by correlations between barrier scores and scores on the Daily Hassles Scale (DeLongis, Folkman, & Lazarus, 1988). Predictive validity was demonstrated by findings that barriers scows significantly contributed to classification of abstainers versus relapsers 8 weeks after smoking cessation group participants quit smoking.

WEAVING A NEW SAFETY NET OF MENTAL HEALTH CARE IN RURAL AMERICA: A MODEL OF INTEGRATED PRACTICE

Life in rural America is often idealized, yet rural Americans suffer from mental illness in rates comparable to urban America and require similar types of support and services. However, millions of individuals living in rural areas go without needed mental health services. The dominant care model allows the treatment of mental illness to be delivered by non-mental health professionals with little or no education or training in psychiatric care and who have little desire to provide this type of care, resulting most often in ineffective or inappropriate treatment. Lacking access to appropriate and effective care, rural mentally ill individuals are more often symptomatic than their urban counterparts and may never find relief from the disabling symptoms of treatable mental illnesses. This article will focus on the current state of psychiatric-mental health care in the context of these realities and discuss the impact of the current trend of mental illness being treated by non-mental health professionals. The article will conclude by proposing a model of advanced practice nursing that the authors believe will increase both access and efficacy of treatment for the mentally ill living in rural America. This Integrated Model views the current system of care that completely separates location for traditional physical and mental health care as antithetical to integration and to holism and presents a new model for understanding and provided integrated health care to meet the needs of rural mentally ill individuals and families.

Factors Associated with Return Visits to a Homeless Clinic

Associations between characteristics of homeless clients and their return visits to a nurse-managed primary health care clinic were examined using a retrospective chart review of 1,467 records from clients seen between 1991 and 1994. Client characteristics examined included age, education, race, gender, sheltered status, report of chronic disease, and report of family living in the area. Only 47 percent of clients made return visits to the clinic. Logistic regression indicated that those with reported chronic disease, males, whites, and those living on the street were more likely to have returned to the clinic for care than those without chronic illness, females, nonwhites, and those living in some type of shelter. Results suggest the need for program planning and evaluation for this population, which particularly considers women, nonwhites, and those without chronic disease as target groups for services.

The Albrecht Nursing Model for Home Healthcare: Predictors of Satisfaction with a Self-care Intervention Program

Satisfaction with a self-care intervention program was evaluated through this quantitative study of arthritis clients at home. The results indicate that the clients were highly satisfied with the intervention. In this era of consumer satisfaction with their care, nurse administrators knowledge of which interventions are satisfying is important for staff development and case management in the community.