Sue Ellen Bell

DSM-III Personality Disorder in Bariatric Clinic Patients

AbstractThirty-eight patients (30 women, 8 men) with morbid obesity who presented for vertical banded gastroplasty (VBG) at a bariatric clinic were each compared with two age- and sex-matched community controls for DSM-III personality disorders using the Personality Diagnostic Questionnaire (PDQ), a well-validated self-report instrument. Fifteen (39.5%) morbidly obese patients and 10 (13.2%) control subjects met criteria for at least one personality disorder (odds ratio = 5.8, p < 0.001). Morbidly obese patients were significantly more likely to display eccentric cluster and dramatic cluster personality disorders and traits, particularly borderline personality. The clinical implications of these findings are discussed.

Testing a multi-group model of culturally competent behaviors among underrepresented nurse practitioners†

Diversifying the health professional workforce and enhancing cultural competence are recommended for decreasing health disparities. We tested a structural equation model of the predictors of culturally competent behaviors in a mailed survey of three groups of underrepresented nurse practitioners (n = 474). Our model had good fit and accounted for 29% of the variance in culturally competent behaviors. Life experiences with diversity had direct effects on awareness/sensitivity and behaviors, and diversity training had a direct effect on behaviors. Cultural awareness/sensitivity mediated the relationship between life experiences with diversity and culturally competent behaviors; all paths remained after controlling for covariates. For unique experiences that contribute to workplace diversity, life experiences with diversity, and diversity training are important for culturally competent behaviors.

Ethical climate in managed care organizations.

Managed care organizations employ nurses as medical utilization reviewers; however, little is known about the ethical climate of these organizations. This study describes different ethical climates in which utilization review nurses work and the implications of these differences for nurse administrators. The nurse participants, although demographically similar across three managed care organizations, perceived distinct ethical climates across the organizations. Nurses were employed to make complex decisions regarding medical care utilization; however, none of the organizations had an ethics committee to help nurse reviewers in this decision-making process. The need for such committees, as well as clarification of a consistent and deliberate ethical climate by nurse administrators, is discussed.

Heart failure and weight gain monitoring.

Heart failure is one of the most common diagnoses of the elderly in the United States. The nursing literature has demonstrated that nursing interventions aimed at effective discharge planning and appropriate self-care activities can improve outcomes for patients hospitalized with heart failure. The purpose of this research was to identify, through retrospective medical record review, the discharge instruction related to self-weight monitoring provided to a sample of heart failure patients. The patients in the sample were 65 years and older with an ICD-9 diagnostic code of heart failure upon discharge from an acute care hospital in the Midwest. Results demonstrated the lack of nursing attentiveness to teaching self-monitoring weight gain to heart failure patients while hospitalized and the need for more comprehensive planning for appropriate discharge referrals. Suggestions are made for expanding documentation tools to improve nursing discharge planning and case management to ensure that the patient or caregiver is able to carry out self-care activities at home.

Translating social justice into clinical nurse specialist practice.

Translating social justice into clinical nurse specialist (CNS) practice involves not only facilitating equitable access to healthcare resources but also changing the definition of health from individual centric to population based. Clinical nurse specialists working within hospitals or healthcare systems generally have not explored the ethical conflicts between demand and available healthcare resources. Application of social justice to CNS practice requires microallocation decisions in direct patient care and macroallocation decisions in the distribution of all societal goods that alleviate health disparities. This article reviews the meaning, history, and current basis for the application of the principle of social justice to CNS practice.

Current Issues and Challenges in the Management of Bariatric Patients

Morbid obesity is an increasingly common healthcare problem, and providers and patients currently face numerous challenges in dealing with this problem effectively. Issues addressed in this article include the effect of stigma, the need for more evidence regarding effective management options, and the declining insurance coverage for bariatric surgery. The role of bariatric surgery in effective management of morbid obesity is discussed, along with the effect on and possible reasons for declining coverage. A comparison between benefits and coverage for bariatric surgery and angioplasty/stent placement is included.

Community health nursing, wound care, and...ethics?

Because of changing demographics and other factors, patients receiving care for wounds, ostomies, or incontinence are being referred in increasing numbers to community health nursing organizations for initial or continued care. As home-based wound care becomes big business, little discussion is being focused on the moral and ethical issues likely to arise in the high-tech home setting. Progressively more complex and expensive home care relies on family members to take on complicated care regimens in the face of decreasing numbers of allowable skilled nursing home visits. A framework and a principle-based theory for reflection on the character and content of moral and ethical conflicts are provided to encourage informed and competent care of patients in the home. Common moral and ethical conflicts for WOC nurses in the United States are presented. These conflicts include issues of wound care supply procurement; use of documentation to maximize care or profit; problems of quality, care consistency, and caregiver consent; and dilemmas of tiered health care options. The advantages of a framework to address ethical conflicts are discussed.