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Biomedical subjects

K L Soeken

Publications and source records attributed to K L Soeken.

At least 19 recordsLinked to original sources

Women's responses to battering: a test of the model.

A volunteer community sample of 141 well-educated, economically heterogeneous, primarily African American (80%), urban battered women was used to test a model of women's responses to battering. The model, based on Orem's theory, was developed previously with an independent sample. The major independent variables were physical and nonphysical abuse, and self-care agency. The outcomes were physical and emotional health. Using structural equation modeling techniques, there was sufficient support for the model structure to conclude preliminary support for the overall model. There was both a direct effect of abuse on health, and an indirect effect mediated through self-care agency as a protective factor.

Adolescent

Outcome of trauma patients after brief intervention by a substance abuse consultation service.

The Substance Abuse Consultation Service (SACS) at the University of Maryland Medical System (UMMS) conducts assessments and brief interventions for patients at the University Hospital and the Shock Trauma Center of the UMMS. This project examined a 10-week sample of trauma patients (N = 30) seen by the SACS, for whom consultations and recommendations (including participation in formal treatment programs as well as 12-step meetings) were provided. The authors used medical record reviews for background information and telephone interviews for follow-up. Of 22 subjects reached by telephone, 6 reported that they had followed the SACS recommendations completely or partially, and 16 subjects reported they had not. Of the latter group, a majority reported self-imposed abstinence or decreased use. No relationships existed between demographic characteristics or patterns of substance abuse and whether or not subjects acted upon SACS recommendations.

Adult

Identification and referral of hospitalized patients in need of home care.

Given current concerns about the cost-effectiveness of home health care, better targeting of home health services for high risk groups is viewed as one way to provide controls on both service delivery and costs. The purpose of this exploratory study was to determine the degree to which patients with identifiable levels of need for services were referred for home health care and if selected clinical and functional status measures are useful in distinguishing need for service. Using a convenience sample of 145 patients ready for hospital discharge, data were collected on physical function, dependency at discharge, perceived helpfulness of others, social support, readiness for self-care, and planned adherence to treatment as well as demographic and medical variables. Using a combination of study variables, 93% of patients not in need of services could be correctly classified. In addition, patients in need of service but not referred by their physicians were found to differ significantly from patients not in need of care on all dimensions. Suggestions are offered for further research to determine if and what systematic factors influence referral decisions for home health care and which specific patient characteristics are associated with the most cost-effective long-term outcomes.

Female

The growth of meta-analytic literature from 1980 to 1993.

A search of the literature was undertaken to estimate the number of meta-analytic studies that have been published in the social and health sciences to date. Altogether, 1,874 published quantitative reviews were located by the end of 1994: 892 in the health sciences, 982 in the social sciences. Trends from 1980 to 1993 indicate that, while the social sciences embraced the technique earlier, health researchers are now publishing almost twice as many meta-analyses as their social science colleagues.

Data Collection

Realizing the meta-analytic potential--a survey of experts.

A survey of 99 authors of meta-analyses conducted between 1988 and 1993 was undertaken to identify policies and products that might be helpful in the realization of the procedure's ultimate potential. Although a number of differences were found between medical and social/nonmedically related health scientists, the greatest degree of overall enthusiasm for both groups was observed for the need to educate journal editors and primary researchers regarding information that needs to be reported in an empirical study. The respondents were also in general agreement that a consensus should be developed and disseminated on minimum standards for published meta-analyses. A number of the other proposals were less popular, although an argument is made that some of these have actually come to fruition since the original survey was conducted.

Data Collection

The Patient Intensity for Nursing Index: a validity assessment.

The psychometric assessment of a new measure of nursing intensity, The Patient Intensity for Nursing Index (PINI) is reported. Four dimensions of nursing intensity are measured by the PINI: (a) severity of illness, (b) dependency, (c) complexity of care, and (d) time. There are 10 items rated on a 5-point ordinal scale. A purposively drawn sample of 6,445 patients was obtained from five hospitals, with 487 registered nurses (RNs) providing daily patient ratings from 29 medical-surgical and intensive care units. Substantial interrater reliability was demonstrated. Validity testing included confirmatory factor analysis, hypothesis-testing, contrasted groups, and an observational study of time. The factor structure confirmed specified components of severity, dependency, and complexity, with time loading on all three factors. PINI scores were significantly related to medical severity of illness, length of hospital stay, disposition at discharge, number of secondary medical diagnoses and specialty consults, and scores on three different hospital classification systems used for staffing. PINI scores were significantly different for high- and low-intensity DRGs. Observed time spent delivering nursing care to specific patients was significantly correlated with nurse estimates of time.

Dependency, Psychological

Patient intensity for nursing index: the measurement model.

One part of the psychometric evaluation of the Patient Intensity for Nursing Index (PINI), a new measure of nursing intensity, is reported. The PINI has four interrelated components: (a) severity of illness, (b) dependency, (c) complexity of care, and (d) time. Taken together, the 10 items that make up these four components comprise the multidimensional construct of nursing intensity. Using the factor analytic approach and a model specification search, the measurement model for the Patient Intensity for Nursing Index was identified. The structure consists of Dependency, Severity, and Complexity with time (hours of nursing care) loading on each factor. When results were cross-validated using data from four other hospitals, support emerged for a consistent pattern of factor loadings. The loadings themselves, however, are only partially invariant. Further examination of the relationship between severity and time is suggested and areas for future research are identified.

Dependency, Psychological

Predictors of hospital readmission. A meta-analysis.

Summarizing the results of research related to identifying potential predictors of hospital readmissions has been difficult because of conflicting results across studies. Using the techniques of meta-analysis, the results from 44 studies were examined in the present study. Overall, the mean readmission rate was 27%, with significant differences based on patient diagnosis. Although diagnosis, age, initial length of hospital stay, and prior use of hospital resources were related to readmission, the strength of the relationship is trivial. Combining data from 12 intervention studies designed to reduce readmission indicated that the overall treatment effect was not significant. Further research is needed to determine demographic, clinical, and social predictors of readmission if strategies are to be developed to reduce readmission and the resulting health care costs.

Age Factors

The process of rater training for observational instruments: implications for interrater reliability.

Although the process of rater training is important for establishing interrater reliability of observational instruments, there is little information available in current literature to guide the researcher. In this article, principles and procedures that can be used when rater performance is a critical element of reliability assessment are described. Three phases of the process of rater training are presented: (a) training raters to use the instrument; (b) evaluating rater performance at the end of training; and (c) determining the extent to which rater training is maintained during a reliability study. An example is presented to illustrate how these phases were incorporated in a study to examine the reliability of a measure of patient intensity called the Patient Intensity for Nursing Index (PINI).

Employee Performance Appraisal

Hope and spiritual well-being: essentials for living with AIDS.

Without a cure on the horizon there is a need to identify ways to sustain hope and spiritual well-being in patients with AIDS. This article examines the impact of AIDS on the emotional and spiritual health of its victims and summarizes current research findings on spiritual well-being in the ill. It also summarizes the authors' study on hope and existential and spiritual well-being in a group of 65 adult male patients who were either serum positive for the human immunodeficient virus or who had been diagnosed with AIDS Related Complex or AIDS.

Acquired Immunodeficiency Syndrome

Alcohol use and its relationship to other addictive and preventive behaviors.

Immoderate consumption of alcohol was found to be related to three other potentially addictive behaviors (illicit drug use, smoking, and caffeine consumption) in a randomly drawn sample (n = 1253) of American adults. In addition, alcohol consumption was found to be related to nutritional, life style, safety, and health monitoring preventive behaviors. Although the underlying mechanism for these behaviors is not clear, possibilities include the subsumption of both addictive and other preventive behaviors under a more generalized risk taking (or risk avoidance) dimension.

Adult

Preventive behaviour: attitudes and compliance of nursing students.

As a professional, the nurse is called upon to serve as a role model for positive health behaviours. Because the practise of these behaviours may effect one's effectiveness as a role model, it is important to determine whether nurses lead a so-called preventive lifestyle and to identify what factors are predictive of compliance. Previous researchers have tended to examine individual behaviours. In this study, a prevention index was used to examine an overall preventive lifestyle. For a sample of senior year nursing students, the preventive behaviours were considered to be important. However, when compared to a national sample of females in the same age range, nursing students were found to be significantly less compliant for 12 of 19 behaviours and more compliant for only three behaviours. Both the desire to practise preventive behaviours and the perceived difficulty in doing so were the factors predictive of the level of compliance. Additional study is needed to determine how these factors can be mediated.

Adult

Measuring patient intensity. A reliability study.

The purpose of this study was to determine the interrater reliability for each of 12 dimensions of a measure of Patient Intensity for Nursing (PINI). Three hospitals in two states participated in this project with 121 Registered Nurses prepared in the use of the PINI. The interrater reliability was determined by day shift nurses rating their patients late in the shift and evening shift nurses rating the same patients early in their shift. Paired ratings of 657 patients were included in this analysis, and the reliability was substantial (kappa = greater than .60) for 10 of the 12 dimensions across hospitals. These findings provided the foundation for revision of the instrument, which is currently undergoing additional testing.

Activities of Daily Living

Assessment of physiologic instruments.

Nursing researchers are advised to consider the reliability and validity of psychologic instruments used in research; however, evaluation of physiologic, or clinical, instruments is not always given the same attention. Reliability and validity issues related to physiologic measures will be discussed. Terms commonly used for the evaluation of physiologic instruments, such as "accuracy," "precision," and "sensitivity," will be explained, with parallels drawn to traditional measurement terms. Sources of potential measurement error, such as environment, user, subject, machine, and interpretation error, will be explained and specific examples given from cardiopulmonary nursing research.

Diagnostic Errors

Responding to the spiritual needs of the chronically ill.

The steps of the nursing process apply to needs of the spirit as well as body and mind. Several nurses have provided guidelines for assessing spiritual needs. Stoll, for example, considers four areas of concern: the person's concept of God; source of strength and hope; significance of religious practices and rituals; and perceived relationship between spiritual beliefs and state of health. In approaching the patient about these four areas, it is important for the nurse to clearly articulate the purpose in seeking such information. For instance, a nurse might explain to a patient that research has demonstrated the positive relationship of spiritual concerns to a patient's ability to cope with chronic illness. Because the nurse is interested in assisting the patient to identify, strengthen, and develop a variety of coping strategies, spiritually related data are relevant to the patient's care. Having collected data from the patients, a nursing diagnosis can be made. Spiritual concerns, spiritual distress, and spiritual despair have been included in the accepted classification system. Meeting the spiritual needs of patients can be uncomfortable for the nurse. Several reasons for such discomfort include embarrassment, the belief that it is not the nurse's role, lack of training, and the lack of own spiritual resources. Experience with an elective course in spirituality for undergraduate nursing students would support the value of offering training. Discussing God-related issues can assist a health care professional to clarify a personal spiritual position.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Psychological

Issues in the use of kappa to estimate reliability.

Selected issues regarding the application of the kappa statistic in assessing the reliability of measures to classify patients are discussed. Data are used to illustrate how the methods used to estimate reliability can influence the resulting coefficient. Suggestions for a more comprehensive approach to the study of the psychometric properties of measures of patient classification are then offered.

Disease