Elizabeth R. Lenz

The middle-range theory of unpleasant symptoms: an update.

A detailed description of the newly revised and updated theory of unpleasant symptoms is provided. Revisions have resulted in a more accurate representation of the complexity and interactive nature of the symptom experience. Examples are provided to demonstrate the implications of the revised theory for measurement and research, and its application in practice. A detailed exemplar describes how it guided the design of a multifaceted intervention to encourage successful breastfeeding.

Primary care outcomes in patients treated by nurse practitioners or physicians: Two-year follow-up

This study reports results of the 2-year follow-up phase of a randomized study comparing outcomes of patients assigned to a nurse practitioner or a physician primary care practice. In the sample of 406 adults, no differences were found between the groups in health status, disease-specific physiologic measures, satisfaction or use of specialist, emergency room or inpatient services. Physician patients averaged more primary care visits than nurse practitioner patients. The results are consistent with the 6-month findings and with a growing body of evidence that the quality of primary care delivered by nurse practitioners is equivalent to that by physicians.

Collaborative development of middle-range nursing theories: Toward a theory of unpleasant symptoms

One promising approach to strengthening theory-research and theory-practice linkages is to place greater emphasis on developing and using theories of the middle range to underpin nursing research and practice. In this article, a postpositivistic definition of middle-range theory is advanced, an argument is made for shifting nursings theory development activities from discipline-defining grand theories to middle-range theories, and a collaborative and incremental approach to middle-range theory development is described and illustrated, A sustained substantive example is provided by the beginning development of a theory of unpleasant symptoms.

Diabetes care processes and outcomes in patients treated by nurse practitioners or physicians.

PURPOSE the purpose of this study was to compare selected diabetes care processes and outcomes of nurse practitioners (NPs) and physicians (MDs) in the primary care of adults with type 2 diabetes. METHODS Adults with type 2 diabetes and no regular source of primary care were enrolled from the emergency room and randomized to an NP or MD practice. Chart reviews were conducted to assess processes of care; patient interviews and hemoglobin Al C (Al C) testing were performed to measure patient outcomes. RESULTS NPs were more likely than MDs to document provision of general diabetes education and education about nutrition, weight, exercise, and medications. They were more likely to document patient height, urinalyses results, and Al C values. No differences were found in documenting current medications; alcohol, illicit drug, or tobacco use; depression; weight and blood pressure; foot and cardiovascular exams; blood glucose and creatinine testing; or referral to ophthalmologists. No differences were found in patient outcomes. CONCLUSIONS This study provides preliminary evidence of interdisciplinary differences in the processes of care employed by primary care NPs and MDs in caring for patients with type 2 diabetes. NPs documented the provision of diabetes education and selected monitoring tests more frequently than MDs; however, these differences were not reflected in 6-month patient outcomes.

Measuring women's fatigue during the postpartum period.

The Fatigue Symptom Checklist (FSC) (Yoshitake, 1978), developed in Japan, was selected to measure postpartum fatigue among American women. Minor wording changes and a change in the reference time frame were made. Reliability and validity of this modification of the FSC were tested in this reanalysis of data from a longitudinal study of 285 mothers. Internal consistency reliability for the total 30-item FSC was acceptable. Evidence for criterion-related and construct validity was found. Original FSC subscales were not confirmed in these analyses. Using factor analysis, a shortened 10-item postpartum scale and two postpartum subscales, physical and mental fatigue, were identified. LISRAEL confirmatory factor analysis supported the subscales. Results support appropriateness of the total 30-item FSC, the shortened 10-item postpartum scale, and postpartum subscales for measuring postpartum fatigue in American women.

Promoting scientific integrity in nursing research part I: Current approaches in doctoral programs

Schools of nursing with doctoral programs were surveyed to determine current approaches and elicit suggestions for institutional- and professional-level strategies to promote scientific integrity. Results from 38 schools are reported in a two-part series. Part 1 reports findings concerning formal and informal instruction about responsible science and the standards, norms, and guidelines being used to direct scientific inquiry. Information on misconduct and scientific integrity was typically included in required research methods, courses, and optional workshops, but the extent and scope of the instruction was variable, and a majority of respondents judged it to be marginal or inadequate. A high value was placed on informal student-mentor interaction. Where they existed, institutional guidelines were more specific than federal guidelines, but dealt primarily with procedures for handling alleged misconduct rather than for promoting responsible science. Findings suggest the need for a more proactive and consistent approach to promoting scientific integrity in doctoral programs.

Sex-role attributes, gender, and postpartal perceptions of the marital relationship.

The relationships of sex-role attributes and gender to perceptions of changes in intimacy and in the overall marital relationship were examined, as was the quality of that relationship following the birth of an infant. For a sample of 165 couples, positive changes in intimacy and in the overall relationship following delivery were positively related to marital quality at four months postpartum. Of gender and sex-role attributes, only femininity contributed significantly to the prediction of overall change and quality. None of the variables predicted perceived change in intimacy.

Application of Cox's interaction model of client health behavior in a weight control program for military personnel: a preintervention baseline.

This study represents a limited application of Coxs Interaction Model of Client Health Behavior in a wwight control program for enlisted US Army soldiers. Relationships of client singularity variables (demographic characteristics, motivation, psychological distress, and designation as overweight or normal weight) to one another and to preintervention measures of client outcomes (health status, health risk) were examined in a sample of 154 soldiers. Hypotheses deduced from the model were tested using multiple regression. The Cox model received partial support, in that some client singularity variables were interrelated; they explained nearly half of the variance in health status, but less than 25% of the variance in health risk. Demographic characteristics were not effective predictors in the present study, perhaps because of the homogeneous sample. The model has potential utility for providing baseline information for preventive health programs in occupational settings.

Reliability of transportable instruments for assessment of infant length.

Transportable instruments for use in home and field settings have been used for decades on the basis of assumed reliability. This article describes a study that compares two portable devices for measuring length, the tape measure and the Measure Mat, against a clinical standard stadiometer with two convenience samples of Hispanic and African-American infants in an urban general pediatrics practice setting. Mean net difference between the stadiometer and the tape measure was 1.68 inches in the first sample and 0.92 inches in the second; the difference between the stadiometer and the Measure Mat was 0.92 inches. The least variability and random error (SD = 0.57 inch) was shown in the paired measurements using the stadiometer and the Measure Mat. Bland-Altman plots showed positive bias for both portable devices across the range of measurements.

Social support transactions between professional and nonprofessional women and their mothers.

A theoretical model predicting professional and nonprofessional womens perceptions of social support transactions with their mothers was tested. A sample of 210 Professional women and 165 nonprofessional women answered mailed questionnaires. LISREL VI was used to evaluate the quality of the measurement model and generate a revised model. Social support was greatest when employed women were professional, had positive filial responsibility attitudes, lived near their mothers, visited them frequently, and when mothers were not married. These findings provide a beginning theoretical model that can serve as a basis for nursing practice and research when working with intergenerational families.