Carolyn A. Williams

Supports, stressors, and depressive symptoms in low-income mothers of young children.

We investigated the association of social supports and stresses with depressive symptoms in a sample of 111 predominantly low-income mothers of young children. The prevalence of high depressive symptoms, as measured by the Center for Epidemiologic Studies--Depression Scale (CES-D), was 48 per cent. Among unmarried women, everyday stressors were strongly associated with depressive symptoms, while life events were weakly related. Associations between these variables were not found for married women. Comparing the relative importance of two different types of support--the quality of primary intimate relationships, and the social network--only the quality of the husband-intimate relationship was associated with CES-D scores among married women, whereas the social network demonstrated a moderate, inverse association with CES-D scores among unemployed women.

Post-baccalaureate nurse residency program.

Increased registered nurse vacancy rates have resulted in new graduates being assigned to care for high acuity patients with complex needs. The authors discuss the research related to new graduate preparation, identify the need for a standardized accredited national residency program, and describe a demonstration project under way in academic health centers.

Postbaccalaureate nurse residency 1-year outcomes.

The authors document the 1-year outcomes of the postbaccalaureate residency program jointly developed and implemented by the University HealthSystem Consortium and the American Association of Colleges of Nursing. Data on 2 cohorts of residents (n = 679) in 12 sites across the country are presented. The 1-year termination rate was 12%, after those lost to the program because of National Council Licensure Examination failure, serious illness, or death were eliminated from the analysis. Additional analyses using data collected at entry to the program, 6 months, and 1 year using 3 instruments, the Casey-Fink Graduate Nurse Experience Survey, the Gerbers Control Over Nursing Practice Scale, and the McCloskey Mueller Satisfaction Scale, are presented and discussed.

The Edgecombe County High Blood Pressure Control Program: I. Correlates of uncontrolled hypertension at baseline.

To guide the planning of a multifacetted hypertension control program in Edgecombe County, North Carolina, a baseline survey of a stratified (by township) random sample of 1,000 households was conducted. All adults (greater than or equal to 18 years) were interviewed and had their blood pressures (BP) measured. Five hundred thirty-nine individuals, 27 per cent of the survey population, had diastolic BP greater than or equal to 90 mm Hg or were receiving anti-hypertensive drug therapy. The 539 hypertensives were divided into seven subgroups reflecting successive stages in the control of hypertension based on the awareness, treatment, and control of their hypertension. Unaware hypertensives were further subdivided into three groups according to the recency of their last BP check, and those aware but untreated were subdivided by whether they had previously received treatment. The seven subgroups of hypertensives were compared, separately for women and men, with respect to sociodemographic characteristics, health behaviors, and health status. In general, the progression from undetected hypertension to treatment and control appeared to be associated with being older, female, and White. This progression was further associated with greater educational levels and higher family incomes among women and increasing self-reported morbidity among men. The implications for intervention of these and other described associations are discussed.

The Edgecombe County (NC) High Blood Pressure Control Program: II. Barriers to the use of medical care among hypertensives.

As the initial step in a five-year project to improve control of high blood pressure in Edgecombe County, North Carolina, a survey was conducted in 1980 to determine the prevalence of hypertension and to identify factors which might constitute barriers to the use of medical care by hypertensives. This report summarizes the findings for the 539 hypertensives identified through the baseline survey. In general, Black hypertensives reported more access problems than Whites. Within race, however, males and females differed very little on selected measures of potential access to medical care. Among women, lower scores on potential access were strongly associated with being untreated, whereas for men, concerns about the safety of anti-hypertensive drug therapy were associated with being unaware. On a summary measure of the actual use of medical care in response to symptoms, both male and female treated hypertensives scored higher than their untreated counterparts. The implications of these and other findings for community-based blood pressure control activities are discussed.

The Edgecombe County High Blood Pressure Control Program: III. Social support, social stressors, and treatment dropout.

In a hypertension prevalence survey of a stratified random sample of 1,000 households, 2,030 adults (aged 18 years and over) were interviewed and information on psychosocial variables collected. Among 359 hypertensives, there was a consistent relationship between indicators of difficulty in the social environment and dropout from treatment in women. Compared to those who remained in treatment, women who dropped out can be characterized as having less social support on the job, having less perceived spouse approval (if married), having a lower level of perceived access to supportive resources, and being more likely to report feeling pushed most or all of the time if they are homemakers. Relationships between indicators of social support and dropout from treatment in men were found only with support on the job, and for White men, with perceived friend approval.

Influence of training and experience on selecting criteria to evaluate medical care

To determine whether training and experience affect the selection of process criteria for evaluating medical care, three groups of physicians (family physicians, general pediatricians, and pediatricians specializing in infectious disease) were sent a questionnaire asking their opinions about various clinical actions in 125 clinical situations concerning respiratory infections in infants. Five hundred and twenty-four (54 per cent) physicians returned completed questionnaires. The three groups agreed in 93 (74 per cent) situations, especially about history taking, physical examination, and follow-up observation. Disagreements occurred most often regarding antibiotic use. Of the three groups, the family physicians selected the most extensive list of recommended actions including the greatest number of indications for antibiotics. The general pediatricians selected the fewest situations requiring history taking, physical examination and diagnostic tests. The infectious-disease pediatricians felt the greatest necessity to record history and physical-examination items but were the most restrictive in recommending antibiotics and other drugs.

A method for selecting criteria to evaluate medical care.

This study tests a questionnaire method for eliciting process criteria for medical care appraisal. The questionnaire was sent to national samples of family physicians, pediatricians, and pediatricians specializing in infectious diseases asking their opinions about various clinical actions in 125 clinical situations concerning respiratory infection in infants. Five hundred twenty-four (54%) physicians returned completed questionnaires. Questionnaire responses favored the performance of a majority of actions and opposed very few. Opinions concerning individual actions, particularly diagnostic tests and treatments, varied widely depending upon the clinical situation presented. A second questionnaire sent one year later indicated that the opinions expressed in the first questionnaire remained stable over time, especially if the initial opinion favored performance of the action. Comparison of the questionnaire responses and medical records of a group of practitioners demonstrated that only 55% of actions favored in a practitioners questionnaire appeared in his records. Although the questionnaire method appears to be a feasible, specific, and reliable means of identifying clinical opinion, there remains considerable discordance between opinion as expressed in the questionnaire and recorded clinical practice.

The RN shortage: not just nursing's problem.

Mounting reports of local nursing shortages—coming amid an already aging registered nurse workforce, declining enrollments in nursing schools, and projections for deepening shortfalls in the nation’s RN supply—all have set off alarms throughout health care and health policy circles. While the emerging shortage has not yet reached epidemic levels, the nation nonetheless is experiencing the beginning of an epidemic of concern about the availability of nursing personnel. Concern is appropriate. But before effective responses can be devised, policymakers need to realize that nursing and the health system have been at this crossroads before. Across the past several decades, nursing has found itself caught not only in a revolving cycle of workforce shortages, but also in a cycle of shortsighted solutions that, over the long term, have failed to secure for nursing a sustained image as a rewarding professional destination for career-oriented men and women. At first glance, it may seem paradoxical that nursing is becoming less attractive to young people just as many new career opportunities beyond entry level are available to RNs and the responsibilities and decisions nurses make are increasingly important to patient welfare and satisfaction. But closer examination reveals serious problems, some due to hospital cost-cutting under the growing encroachment of managed care. For nursing, the result has been more demanding workloads with sicker and increasingly older patients and weakened infrastructures to support nursing roles. In a provocative paper in 1994, Lois Friss of the University of Southern California examined the recurring shortages that have plagued nursing for much of the 20th century. She noted that most attempts to prevent or overcome these shortfalls had focused on recruitment programs or image campaigns. Such efforts, Friss says, were misdirected. Few of these earlier attempts addressed the bigger obstacles at nursing’s very core, such as employment practices that hinder nurses’ autonomy over their own profession; compressed salary ranges; and salaries, licensure, and entry-level practice roles that have been largely unrelated to nurses’ levels of education.

Entry into community-based nursing practice: Perceptions of prospective employers

To better prepare new graduates for entry-level positions in community settings, faculty of one college of nursing gathered information using focus groups of prospective employers. The groups were to identify the skills and qualities nurses need to practice in the community and ways to redesign nursing curricula to better prepare undergraduates for community-based practice. Data for this qualitative study were collected in five separate focus groups conducted with prospective employers (N = 18) from four major areas of Kentucky. By collaborating with prospective employers in the community, a partnership was established between nurse educators and community health leaders to improve the marketability of baccalaureate graduates. Assessment was the most frequently named skill essential to nursing practice in the community. Independence, critical thinking, collaboration, and confidence consistently emerged as important skills and qualities. Prospective employers were positive about developing partnerships to improve under-graduate nursing curricula. Recommendations for curricula to better prepare undergraduates for community-based practice are suggested.