Jeri L. Bigbee

Hardiness: a new perspective in health promotion.

Hardiness is a developing concept of particular relevance to primary care nursing. Evolving out of existential psychology, hardiness is proposed as a personality characteristic that serves to mediate the stress-illness relationship, promoting health in the presence of high degrees of life change and stress. In this review, the concept of hardiness is analyzed and discussed. Its implications for nursing theory and primary care practice are demonstrated.

The Health of Caregiving Grandmothers: A Rural-Urban Comparison

Purpose: The purpose of this study was to compare the characteristics of rural versus urban caregiving grandmothers along with their physical and mental health status. Methods: A secondary analysis of data produced from the first wave of a longitudinal study of 485 Ohio grandmothers was conducted. Health status was measured using the SF-36 Health Survey and the 20-item CES-D depression scale. Rural-urban classification was made using Rural Urban Commuting Area (RUCA) codes based on resident ZIP codes, identifying 97 rural and 388 urban grandmothers in the sample. Findings: The rural and urban grandmothers were similar in age, educational level and employment status; however, 90% of the rural grandmothers compared with 60% of the urban grandmothers were white. Rural grandmothers were most likely to have traditional nonresidential relationships with their grandchildren. Approximately 38% of both the rural and urban grandmothers served as primary caregivers for their grandchildren, but a lower percentage of rural grandmothers lived in multigenerational homes. There was no significant difference between the rural and urban grandmothers in relation to physical or mental health. Among rural grandmothers, primary caregivers had significantly lower levels of mental health compared with the other caregiver groups. Conclusions: These findings suggest that rural and urban grandmothers have similar levels of physical and mental health, despite differences in demographics and caregiving arrangements. Health promotion efforts with rural caregiving grandparents are indicated, addressing both mental and physical health.PURPOSE The purpose of this study was to compare the characteristics of rural versus urban caregiving grandmothers along with their physical and mental health status. METHODS A secondary analysis of data produced from the first wave of a longitudinal study of 485 Ohio grandmothers was conducted. Health status was measured using the SF-36 Health Survey and the 20-item CES-D depression scale. Rural-urban classification was made using Rural Urban Commuting Area (RUCA) codes based on resident ZIP codes, identifying 97 rural and 388 urban grandmothers in the sample. FINDINGS The rural and urban grandmothers were similar in age, educational level and employment status; however, 90% of the rural grandmothers compared with 60% of the urban grandmothers were white. Rural grandmothers were most likely to have traditional nonresidential relationships with their grandchildren. Approximately 38% of both the rural and urban grandmothers served as primary caregivers for their grandchildren, but a lower percentage of rural grandmothers lived in multigenerational homes. There was no significant difference between the rural and urban grandmothers in relation to physical or mental health. Among rural grandmothers, primary caregivers had significantly lower levels of mental health compared with the other caregiver groups. CONCLUSIONS These findings suggest that rural and urban grandmothers have similar levels of physical and mental health, despite differences in demographics and caregiving arrangements. Health promotion efforts with rural caregiving grandparents are indicated, addressing both mental and physical health.

Relationships Between Nurse- and Physician-to-Population Ratios and State Health Rankings

OBJECTIVE To evaluate the relationship between nurse-to-population ratios and population health, as indicated by state health ranking, and to compare the findings with physician-to-population ratios. DESIGN Secondary analysis correlational design. SAMPLE The sample consisted of all 50 states in the United States. Data sources included the United Health Foundations 2006 state health rankings, the 2004 National Sample Survey for Registered Nurses, and the U.S. Health Workforce Profile from the New York Center for Health Workforce Studies. RESULTS Significant relationships between nurse-to-population ratio and overall state health ranking (rho=-.446, p tf?>=.001) and 11 of the 18 components of that ranking were found. Significant components included motor vehicle death rate, high school graduation rate, violent crime rate, infectious disease rate, percentage of children in poverty, percentage of uninsured residents, immunization rate, adequacy of prenatal care, number of poor mental health days, number of poor physical health days, and premature death rate, with higher nurse-to-population ratios associated with higher health rankings. Specialty (public health and school) nurse-to-population ratios were not as strongly related to state health ranking. Physician-to-population ratios were also significantly related to state health ranking, but were associated with different components than nurses. CONCLUSIONS These findings suggest that greater nurses per capita may be uniquely associated with healthier communities; however, further multivariate research is needed.

Conceptual Models for Population‐focused Public Health Nursing Interventions and Outcomes: The State of the Art

The conceptual basis of public health nursing (PHN) has evolved particularly over the past three decades. In October 2010, a national research agenda setting conference was held with grant support from the Agency for Healthcare Research and Quality. From the conference, public health nursing intervention models emerged as one of four top priorities. The need for a stronger theoretic base that can guide population-focused nursing practice and research was strongly emphasized. The purpose of this review, in concert with this priority, is to analyze the current status of PHN conceptual models. Based on the review, a set of recommendations is presented related to future conceptual development and testing, with an emphasis on PHN interventions and outcomes. A key recommendation is the refinement of the existing conceptual models with perhaps some consolidation of models, thereby establishing strong grand, middle-range and practice theories that include explicit PHN intervention and outcome components. Another recommendation calls for rigorous comparative analysis and testing. Professional support from the PHN community along with funding agencies will be needed to implement the recommendations related to PHN theory development and testing.

Promoting the Health of Frontier Caregiving Grandparents: A Demonstration Project Evaluation

Column Editor: Bonnie Gance-Cleveland Family-Centered Care provides a forum for sharing information about basic components of caring for children and families, including respect, information sharing, collaboration, family-to-family support, and confidence building.

Patient classification systems: A new approach to computing reliability

Patient classification systems are an integral part of managing nursing care that requires accuracy and consistency. Assessing interrater reliability is essential in monitoring and evaluating patient classification systems. Unfortunately, little attention has been paid to statistically assessing reliability. The most commonly used method, percentage of agreement, is limited and tends to be inflated due to chance variation. The ANOVA method, although more complex computationally, offers more accuracy and flexibility.

Associations of Provider-to-Population Ratios and Population Health by County-Level Rurality

PURPOSE To explore the relationship between provider-to-population ratios, rurality and population health in the United States using counties as the unit of analysis. METHOD Population ratios for registered nurses (RNs), primary care physicians, and dentists were included in multivariable regression analyses. Population health indices assessed were premature death rate, self-rated health, teen birth rate, and mammography screening rate. FINDINGS County levels of health and health care providers per capita declined as rurality increased. In adjusted regression models, the highest RN-to-population ratio was associated with significantly better health measures in most urban/rural categories, with the magnitude of these associations generally increasing as rurality increased. In the smallest rural counties, the highest RN-to-population quartile was associated with 1,655 fewer years of potential life lost (YPLL), 2% lower rates of poor or fair health, 11/1,000 fewer teen births, and 6% more mammography screening relative to the lowest quartile. For primary care physicians, more significant associations were found in medium and small rural counties where the highest quartile was associated with 1,482 fewer YPLL, 3% lower rates of poor or fair health, 7/1,000 fewer teen births, and 4% more mammography screening. The highest quartile of dentist-to-population ratio was generally associated with lower rates of premature death and poor or fair health in urban, large-, and medium-sized rural counties, but not in small rural counties. CONCLUSIONS The consistency of the results by provider type suggests that the supply of health care professionals, particularly in rural areas, positively impacts the health of the population.Purpose To explore the relationship between provider-to-population ratios, rurality and population health in the United States using counties as the unit of analysis. Method Population ratios for registered nurses (RNs), primary care physicians, and dentists were included in multivariable regression analyses. Population health indices assessed were premature death rate, self-rated health, teen birth rate, and mammography screening rate. Findings County levels of health and health care providers per capita declined as rurality increased. In adjusted regression models, the highest RN-to-population ratio was associated with significantly better health measures in most urban/rural categories, with the magnitude of these associations generally increasing as rurality increased. In the smallest rural counties, the highest RN-to-population quartile was associated with 1,655 fewer years of potential life lost (YPLL), 2% lower rates of poor or fair health, 11/1,000 fewer teen births, and 6% more mammography screening relative to the lowest quartile. For primary care physicians, more significant associations were found in medium and small rural counties where the highest quartile was associated with 1,482 fewer YPLL, 3% lower rates of poor or fair health, 7/1,000 fewer teen births, and 4% more mammography screening. The highest quartile of dentist-to-population ratio was generally associated with lower rates of premature death and poor or fair health in urban, large-, and medium-sized rural counties, but not in small rural counties. Conclusions The consistency of the results by provider type suggests that the supply of health care professionals, particularly in rural areas, positively impacts the health of the population.

Better Together: Expanding Rural Partnerships to Support Families.

Chronic shortages of health, social service, and mental health professionals in rural areas necessitate creative partnerships in support of families. Cooperative extension professionals in Family and Consumer Sciences and community health nurses, who can bring critical skills to human services teams, are introduced as trusted professionals in rural communities. Multidisciplinary prevention programs offer particularly good contexts for county extension educators and community health nurses to work in collaboration with social workers. The case of grandparents raising grandchildren illustrates the critical roles that can be filled by professionals in these two fields to extend the reach of family support programs.

The Impact of Insurance Instability on Health Service Utilization: Does Non-metropolitan Residence Make a Difference?

PURPOSE Discontinuous and no health insurance are major barriers to health care utilization. This paper examines if nonmetropolitan versus metropolitan residence is associated with differences in health care utilization in the face of insurance instability. METHODS A cross-sectional analysis of adults aged 18-64 years was conducted using the 2006-2010 Medical Expenditure Panel Survey data set (N = 61,039). Negative binomial regression was used to model measures of health service utilization (emergency room [ER] visits, inpatient discharges, office-based visits, dental care visits, prescriptions filled, home health visits) as functions of insurance continuity, adjusted for sociodemographic and health-related covariates. Models were stratified by metropolitan versus nonmetropolitan residence. FINDINGS Health insurance continuity was significantly associated with several measures of health service utilization, including more ER visits for individuals with gaps in health insurance (IRR [incident risk ratio] = 1.29; 95% CI: 1.16-1.42) and fewer inpatient discharges for individuals without insurance (IRR = 0.50; 95% CI: 0.43-0.57) when compared with individuals with continuous insurance. Individuals who were discontinuously insured or uninsured had significantly fewer office-based visits. They also had significantly fewer dental visits, prescription fills, and home health visits; moreover, the magnitudes of these associations were generally significantly greater for residents of nonmetropolitan areas. CONCLUSIONS Insurance instability is associated with higher use of emergency services and reduced use of nonhospital health care services. Residents of nonmetropolitan areas with unstable or no insurance coverage may be at particular risk for reduced access and use of some health services relative to their counterparts living in metropolitan areas.

Innovation-Diffusion Theory and the Evolution of the Nurse Practitioner Role: How a Good Thing Has Caught On

&NA; Nurse practitioners are one of the most unique innovations in health care delivery in recent decades. In this article, Rogers innovation‐diffusion theory is applied to an analysis of the evolution of the nurse practitioner role. The four elements of the diffusion process, the innovation, communication, time, and social system, are addressed. Consequences of the innovation‐diffusion process, as well as research implications, are presented.