Current nursing practice of point-of-care laboratory diagnostic testing in critical care units

BACKGROUND: The development of user-friendly laboratory analyzers, combined with the need for rapid assessment of critically ill patients, has led to the performance of in vitro diagnostic testing at the point of care by personnel without formal laboratory training. OBJECTIVES: To determine the range of laboratory testing performed by critical care nurses and their attitudes toward this role. METHODS: A survey of critical care nursing consultants was conducted, using a modified Likert scale, to assess objective measures of point-of-care testing practice in critical care units and to determine nurses' attitudes toward the practice of point-of-care testing. Statistical analysis was performed to determine significant trends in responses. RESULTS: Of the units responding to the survey, 35% used critical care nurses exclusively to perform point-of-care testing, 32.5% used laboratory technicians and critical care nurses, and 25% used other personnel. Of critical care nurses performing laboratory testing, 95.5% performed blood glucose analysis; 18.7%, arterial blood gas analysis; 4.5%, electrolyte analysis; 4.5%, hematology profiles; and 22.7%, other testing. Most agreed that stat tests were not reported promptly, thereby necessitating bedside testing. Respondents indicated that they would prefer that laboratory personnel operate in vitro diagnostic equipment and that requirements for critical care nurses to perform laboratory testing detracted from other patient care duties. CONCLUSIONS: Most nurses who perform point-of-care testing responded that it was necessary and helpful in patient management. However, they would prefer, because of their other patient care responsibilities, that laboratory personnel take this responsibility.     

Willingness to perform euthanasia. A survey of physician attitudes

BACKGROUND: In the United States, few studies have examined important variables in physician attitudes toward the practice of euthanasia, such as the patient's underlying disease, mental capacity, and age, and the physician's specialty and religion. We administered a case-based survey to analyze the impact of such specific variables on physician attitudes toward the practice. METHODS: A four-section survey solicited (1) physician responses to three hypothetical cases in which patients requested euthanasia; (2) physicians' general opinions about euthanasia and how its legalization might affect them personally and professionally; and (3) demographic information. Analysis focused on physicians' characteristics as they related to their responses to the various aspects of euthanasia elicited in the survey. Univariate and multivariate analyses, using logistic regression, were performed. RESULTS: Completed and analyzable surveys were returned by 740 physicians. We found that physicians felt more comfortable with euthanasia requests from nondecisional, nonterminal patients who had left advance directives than they did with requests from decisional patients suffering from grave illnesses or injuries, or from decisional patients who had early signs of a progressive but nonlethal neurologic disease. We also found that physicians' specialties and religions correlated with their responses to the hypothetical cases and with their generalized attitudes toward euthanasia. CONCLUSIONS: Given the disparity in responding physicians' attitudes toward euthanasia, along with the fact that values based on religious affiliation or profession may underlie many physicians' opposition to the practice, we conclude that if euthanasia is to be legalized, safeguards protective of patients and physicians must be incorporated.     

End-of-life issues: a survey of English-speaking Canadian nurses in AIDS care

This anonymous postal survey explored attitudes and experiences concerning end-of-life decisions. Respondents were English-speaking members of the Canadian Association for Nurses in AIDS Care (CANAC) and other nurses identified as working primarily in HIV/AIDS settings. Seventy-three percent believed that the law should be changed to allow physicians to practice voluntary euthanasia (VE) and assisted suicide (AS). Fifty-three percent indicated that nurses should be allowed to practice VE and AS. Although VE and AS are illegal, fewer than one in five nurses would report a colleague whom they knew to be involved in such acts. More than one in five nurses have received requests from patients to hasten their deaths by VE. Nearly 98% believe that the nursing profession should be involved in policy development concerning VE and AS, and nearly 78% believe that nurses should be involved in the decision-making process with patients if such acts were legal. Given that ethical codes for Canadian nurses promote client self-determination and that nurses are the largest group of care providers for the terminally ill, the profession must promote discussion and research if it is to take a leadership role with respect to end-of-life issues.     

Age as a factor in critical care unit admissions

BACKGROUND: Although the aged occupy a high proportion of critical care beds nationwide, few multicenter studies have been undertaken to specifically determine physician attitudes toward the elderly in a critical care setting. We attempt to determine the importance of patient age as a factor in the admission of acutely ill medical patients to critical care units. METHODS: In response to a hypothetical case scenario, physicians were asked to admit one of two patients to a last available critical care unit bed. An accompanying questionnaire was used to gain a ranking of several admission factors as compared with age, and to gain demographic data regarding the study population. Data were subjected to nonparametric statistical analysis. RESULTS: When age was the only difference between two patients in a hypothetical case scenario, 80.7% of respondents chose the younger patient (age 56 years) for admission, 13.2% chose the older patient (age 82 years), and 6.2% abstained. Following the provision of more detailed medical and social information, however, only 53.5% chose the younger patient, 41.2% chose the older patient, and 5.3% continued to abstain. In a ranking of several admission factors, age was found to be of less importance than severity of presenting illness, previous medical history, and do not resuscitate status, but of more importance than patient motivation, ability to contribute to society, family support, and ability to pay for care. When asked if they supported a definitive age criterion that would restrict all patients over a certain age from access to critical care units, 95.1% responded that they did not. CONCLUSIONS: Age is a factor considered by physicians in the admission of acutely ill medical patients to critical care units. Other medical and social factors, however, can affect the impact of patient age on treatment decisions. Further study and discussion are needed to clarify the appropriate role of age and other factors in critical care unit admissions.     

The role of the psychologist in determining competence for assisted suicide/euthanasia in the terminally ill.

This paper discusses the history of assisted suicide/euthanasia and public attitudes in Canada; discusses depression in the terminally ill and the potential role of the psychologist in the assisted suicide/ euthanasia process; and specifically addresses the importance of determining competence in terminally ill patients. One area in which the services of psychologists have not been used to their fullest potential is in the care of the terminally ill, particularly in helping them make end-of-life decisions. It is very important that individuals making end-of-life decisions be assessed for mental disorders in order to ensure they are able to make competent decisions. If assisted suicide and euthanasia were to become legalized, psychologists should be involved in the assessment process in order to determine competency. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Monday and non-Monday concentrations of lifestyle-related blood components in the Oslo Diet and Exercise Study

CONTEXT: Despite intense debates about legalization, there are few data examining the details of actual euthanasia and physician-assisted suicide (PAS) cases in the United States. OBJECTIVE: To determine whether the practices of euthanasia and PAS are consistent with proposed safeguards and the effect on physicians of having performed euthanasia or PAS. DESIGN: Structured in-depth telephone interviews. SETTING AND PARTICIPANTS: Randomly selected oncologists in the United States. OUTCOME MEASURES: Adherence to primary and secondary safeguards for the practice of euthanasia and PAS; regret, comfort, and fear of prosecution from performing euthanasia or PAS. RESULTS: A total of 355 oncologists (72.6% response rate) were interviewed on euthanasia and PAS. On 2 screening questions, 56 oncologists (15.8%) reported participating in euthanasia or PAS; 53 oncologists (94.6% response rate) participated in in-depth interviews. Thirty-eight of 53 oncologists described clearly defined cases of euthanasia or PAS. Twenty-three patients (60.5%) both initiated and repeated their request for euthanasia or PAS, but 6 patients (15.8%) did not participate in the decision for euthanasia or PAS. Thirty-seven patients (97.4%) were experiencing unremitting pain or such poor physical functioning they could not perform self-care. Physicians sought consultation in 15 cases (39.5%). Overall, oncologists adhered to all 3 main safeguards in 13 cases (34.2%): (1) having the patient initiate and repeat the request for euthanasia or PAS, (2) ensuring the patient was experiencing extreme physical pain or suffering, and (3) consulting with a colleague. Those who adhered to the safeguards had known their patients longer and tended to be more religious. In 28 cases (73.7%), the family supported the decision. In all cases of pain, patients were receiving narcotic analgesia. Fifteen patients (39.5%) were enrolled in a hospice. While 19 oncologists (52.6%) received comfort from having helped a patient with euthanasia or PAS, 9 (23.7%) regretted having performed euthanasia or PAS, and 15 (39.5%) feared prosecution. CONCLUSIONS: Intractable pain or poor physical functioning seem to be nearly absolute requirements for physicians to perform euthanasia or PAS. Only one third of cases are performed consistently with proposed safeguards. For some patients, end-of-life care that includes opioid analgesia and hospice care does not obviate their desire for euthanasia or PAS. While the majority of physicians seem comforted by their actions, some experience adverse consequences from having performed euthanasia or PAS.     

Apoptosis, the heat shock response, hyperthermia, birth defects, disease and cancer. Where are the common links?

Euthanasia, whether active or passive, remains a controversial issue in health care, and allied health professionals are likely to encounter situations of potential active or passive euthanasia during their careers. This survey of allied health students sought to determine their attitudes toward euthanasia and whether their self-reported euthanasia ideology corresponded with their behavioral endorsement of euthanasia actions. Disciplines and educational levels were also compared to determine differences between the program groups and their pro- or anti-euthanasia beliefs. Differing attitudes about euthanasia were found from group to group, and a significant correlation was found between the euthanasia ideology scores and the euthanasia behavioral scores.     

The properties of simian coronavirus

OBJECTIVE: To determine the effect of a unique educational program in critical care medicine on the attitudes, knowledge, and skills of general internists who care for critically ill patients. DESIGN: Comparison of objective assessments and self-assessments obtained before and after the one-year educational program. SETTING/PARTICIPANTS: Eighteen general internists practicing in a 350-bed university-affiliated community teaching hospital. RESULTS: After the program, the internists felt significantly more competent in, knowledgeable about, comfortable with, and satisfied with caring for critically ill patients than they did when completing the precourse self-assessments (p < 0.05). Participants felt particularly more comfortable with managing ventilator patients and leading the advanced cardiac life-support team (p < 0.05). Comfort levels for other commonly performed critical care procedures did not vary. No significant change in knowledge test scores was noted from before to after the one-year program (61% vs 60%). Residents and nurses rated the internists' overall ability in critical care medicine to be the same as that of senior medical residents. They also favorably rated the internists on humanism, teaching skills, and interpersonal interactions. Residents also appreciated the decrease in their night call because of the program. CONCLUSIONS: This unique educational program increased comfort and satisfaction of general internists caring for critically ill patients. The program was well accepted by residents and nurses because of favorable interaction with the internists and a decrease in resident night-call responsibility. This curriculum is recommended to other teaching hospitals.     

Quality of life following spinal cord injury: knowledge and attitudes of emergency care providers

STUDY OBJECTIVES: To measure emergency care providers' attitudes toward quality of life after spinal cord injury (SCI) and to determine if their perceptions influence the care they provide. DESIGN: A closed-ended questionnaire. SETTING AND PARTICIPANTS: Two hundred thirty-three emergency nurses, emergency medicine technicians, emergency medicine residents, and attending physicians at three level I trauma centers were surveyed. Their responses were compared with previously reported quality-of-life ratings of a group of 128 high-level SCI survivors. MEASUREMENTS AND RESULTS: One hundred fifty-three emergency care providers completed the survey (response rate, 63%). Forty-one percent believed that resuscitation efforts after severe SCI are too aggressive, and 28% believed that future quality of life should be a factor in determining the interventions that should be provided. If they sustained severe SCIs themselves, 22% of providers would want nothing done to ensure their survival, and 23% would want pain relief only. Only 18% imagined they would be glad to be alive with a severe SCI, compared with 92% of a true SCI comparison group. Seventeen percent of providers anticipated an average or better quality of life compared with 86% of the actual SCI comparison group. CONCLUSION: The quality of life, self-esteem, and outcomes that emergency health care providers imaging after SCI are considerably more negative than those reported by SCI survivors. Because providers' knowledge and attitudes may affect the care they provide and may influence patients and families struggling with critical treatment decisions, emergency care providers must be aware of outcomes, well-being, and life satisfaction following severe SCI.     

Co-amplification of nuclear pseudogenes and assessment of heteroplasmy of mitochondrial DNA mutations

As nurses begin to develop the sensitivities and skills necessary to preserve the integrity of clinical care and professional life, they must recognize the legitimacy of their perspectives and the value and consequences they have for the well-being of patient and family care. Nurses have much to contribute to the development of ethical practice environments for patients, families, multidisciplinary team members, and themselves. The frenzied, and at times anesthetized, culture of clinical settings can mitigate against the kind of deliberate reflection that is necessary if nurses are to act with ethical integrity. Knowing the rules of the road for end-of-life care and being attentive to common warning signs and addressing them proactively, enables nurses to provide patients and families with the highest quality care at the end of life.     

Attitude–behavior consistency: An individual difference perspective.

Tested the prediction that only individuals whose past behaviors have been relatively invariant (low behavioral variability) and who tend to infer their attitudes from those past behaviors (low self-monitoring) would express attitudes that summarize past behaviors and, hence, strongly predict future behaviors. In the 1st session, 103 undergraduates completed a self-monitoring scale. Ss' attitudes toward religion were also assessed, and they were asked to indicate the extent to which they varied from one situation to another in how religious they were. In the 2nd session approximately 1 mo later, several measures of Ss' reports of religious behaviors since the 1st session were obtained. Attitude–behavior correlations were then computed within each of the 4 groups of Ss produced by a Low/High Self-Monitoring by Low/High Variability classification scheme. As predicted, only low self-monitors whose past religious behaviors had been relatively invariant manifested high attitude–behavior correlations across all behavioral measures. (30 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Career experiences of doctors of psychology.

Surveyed 184 graduates (mean age 37 yrs) of 9 PsyD programs to determine the professional activities in which they were engaged, satisfaction with careers and graduate training in professional psychology, and public acceptance of the PsyD degree and compared the results with similar data on PhD clinicians. Most Ss were primarily engaged in direct professional services in professional settings. They were generally satisfied with their careers in professional psychology and significantly more satisfied with the graduate training they had received than were clinical psychologists trained in traditional PhD programs. More Ss reported that the PsyD degree was an advantage rather than a disadvantage when competing for jobs with candidates who had other degrees. PsyD Ss were found to be active joiners of professional associations. 91% of PsyD Ss who applied for licensure or certification encountered no difficulty due to their degree. Almost no unfavorable attitudes toward the degree were perceived among clients, employers, or colleagues. It is concluded that fears about perception of the PsyD as a second-rate credential are unfounded. (8 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Desire for euthanasia or physician-assisted suicide in palliative cancer care.

Objective: To investigate the attitudes of terminally ill individuals toward the legalization of euthanasia or physician-assisted suicide (PAS) and to identify those who would personally desire such a death. Design: In the Canadian National Palliative Care Survey, semistructured interviews were administered to 379 patients who were receiving palliative care for cancer. Patients who expressed a desire for physician-hastened death were followed prospectively. Main Outcome Measures: Attitudes toward the legalization of euthanasia or PAS were determined, as was the personal interest in receiving a hastened death. Demographic and clinical characteristics were also recorded, including a 22-item structured interview of symptoms and concerns. Results: There were 238 participants (62.8%) who believed that euthanasia and/or PAS should be legalized, and 151 (39.8%) who would consider making a future request for a physician-hastened death. However, only 22 (5.8%) reported that, if legally permissible, they would initiate such a request right away, in their current situations. This desire for hastened death was associated with lower religiosity (p = .010), reduced functional status (p = .024), a diagnosis of major depression (p     

Euthanasia and physician-assisted suicide: attitudes and experiences of oncology patients, oncologists, and the public

BACKGROUND: Euthanasia and physician-assisted suicide are pressing public issues. We aimed to collect empirical data on these controversial interventions, particularly on the attitudes and experiences of oncology patients. METHODS: We interviewed, by telephone with vignette-style questions, 155 oncology patients, 355 oncologists, and 193 members of the public to assess their attitudes and experiences in relation to euthanasia and physician-assisted suicide. FINDINGS: About two thirds of oncology patients and the public found euthanasia and physician-assisted suicide acceptable for patients with unremitting pain. Oncology patients and the public found euthanasia and physician-assisted suicide least acceptable in vignettes involving "burden on the family" and "life viewed as meaningless". In no vignette--even for patients with unremitting pain--did a majority of oncologists find euthanasia or physician-assisted suicide ethically acceptable. Patients actually experiencing pain were more likely to find euthanasia or physician-assisted suicide unacceptable. More than a quarter of oncology patients had seriously thought about euthanasia or physician-assisted suicide and nearly 12 percent had seriously discussed these interventions with physicians or others. Patients with depression and psychological distress were significantly more likely to have seriously discussed euthanasia, hoarded drugs, or read Final Exit. More than half of oncologists had received requests for euthanasia or physician-assisted suicide. Nearly one in seven oncologists had carried out euthanasia or physician-assisted suicide. INTERPRETATION: Euthanasia and physician-assisted suicide are important issues in the care of terminally ill patients and while oncology patients experiencing pain are unlikely to desire these interventions patients with depression are more likely to request assistance in committing suicide. Patients who request such an intervention should be evaluated and, where appropriate, treated for depression before euthanasia can be discussed seriously.     

A study of hospital nurses' attitudes toward continuing education in Kaohsiung City, Taiwan

The purpose of this study was to investigate hospital nurses' attitudes toward continuing education. Continuing education was defined as non-credit organized educational programs designed for nurses by hospitals, nursing institutions, or other related organizations to maintain or improve professional competence. It included "in-service education", "on-the-job training", and other synonymous educational activities. Six hundred and seventy-four randomly selected hospital nurses in Kaohsiung City participated in this study. The data was collected by delivering a 34-statement questionnaire through the directors of nursing. Cronbach's Alpha Coefficient was applied to determine the reliability with a value of 0.79. Factor analysis and a group of experts' suggestions were applied to determine the validity. Frequency distribution, Analysis of Variance, Scheffe' test, and Multiple Regression Analysis were conducted to analyze the research questions. The level of significance was set at 0.05 or less. The results indicated that the majority of nurses (92.65%) hold positive attitudes toward continuing education (M = 86.32). Nurses' attitudes toward continuing education were related to selected personal and professional characteristics, and hospital policies regarding continuing education. To maintain nurses' positive attitudes and to develop positive attitudes for those who hold negative attitudes, some strategies for continuing education should be considered by nursing administrators.     

Do women sometimes say no when they mean yes? The prevalence and correlates of women's token resistance to sex.

We investigated whether women ever engage in token resistance to sex—saying no but meaning yes—and, if they do, what their reasons are for doing so. A questionnaire administered to 610 undergraduate women asked whether they had ever engaged in token resistance and, if so, asked them to rate the importance of 26 possible reasons. We found that 39.3% of the women had engaged in token resistance at least once. Their reasons fell into three categories: practical, inhibition-related, and manipulative reasons. Women's gender role attitudes, erotophobia–erotophilia, and other attitudes and beliefs varied as a function of their experience with token resistance and their sexual experience. We argue that, given society's sexual double standard, token resistance may be a rational behavior. It could, however, have negative consequences, including discouraging honest communication, perpetuating restrictive gender stereotypes, and—if men learn to disregard women's refusals—increasing the incidence of rape. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A liver-specific isoform of the betaine/GABA transporter in the rat: cDNA sequence and organ distribution

This paper discusses the findings of a quantitative study of nurses' willingness to care for patients with AIDS. It identifies several factors that enable nurses to confront the fear of AIDS nursing and to turn fear into compassion, and negative attitudes into positive ones. These factors include professional values, organizational support, group identity, patients' responses, spirituality, family and friends with AIDS, knowledge about AIDS, and the importance of personal choice. The value of these factors are further supported through personal statements made by nurses on AIDS-dedicated units as they express their feelings, thoughts, and positive experiences and expectations regarding AIDS nursing.     

Attitudes of U.S. and Czech/Slovak mental health and health professionals toward five types of sexually explicit materials

Mental health and health professionals' attitudes toward sexually explicit materials in the U.S. and Czech/Slovak Republics were investigated. An instrument measuring attitudes toward educational, soft-core, hard-core, violence, and bizarre/paraphiliac sexually explicit materials was administered to sexologists, psychologist/counselors, and medical professionals. These professionals were attending conferences in the U.S. and the Czech/Slovak Republics between November 1992 and September 1993. Mental health and health professionals had the most favorable attitudes toward educational sexually explicit materials followed by soft-core and hard-core materials, respectively. They had unfavorable attitudes toward violent and bizarre/paraphiliac sexually explicit materials, with particularly negative attitudes toward violent materials. Analysis of covariance showed that strength of religious conviction was a significant covariate; thus professionals with stronger religious conviction had more negative attitudes toward all five types of sexually explicit materials. When controlling for strength of religious conviction: (i) sexologists had more positive attitudes toward most types of sexually explicit materials; (ii) Czech professionals generally had more positive attitudes toward such materials than their U.S. counterparts; and (iii) there were few differences between female and male professionals in their reported attitudes. While previous literature has reported gender differences in attitudes toward sexually explicit materials, findings from this study suggest that this effect may be due to differences in religiosity among women and men, namely, that women tend to be more religious.     

Attitudes of health care providers and students towards tattooed people

Attitudes of health care providers and medical and nursing students (n = 513) towards tattooed adults and adolescents were examined. No respondent group had mean scores reflecting a positive attitude towards tattooed persons. Overall, physicians (MDs) and registered nurses (RNs) rated tattooed people less positively than did students. Womens' attitudes were consistently less favourable than those of men, especially towards tattooed professional women. Attitudes towards tattooed adolescents were generally less positive than attitudes towards the adult groups. Research has found that negative attitudes impact patient care. This study suggests that tattooed persons, especially adolescents, may be at risk of being negatively perceived when they seek health care. Increased efforts are needed to assure that those with tattoos receive non-judgemental and sensitive care.     

Ratings of the performances of practicing internists by hospital-based registered nurses

PURPOSE: To examine the feasibility and reliability of ratings completed by hospital-based registered nurses of the humanistic qualities, communication skills, and selected aspects of the clinical skills of practicing internists. METHOD: In 1988-1989, registered nurses who worked in the same 175 hospitals as 232 internists with admitting privileges at these hospitals rated the internists' performances. The nurses were selected from medicine floors, specialty floors, and intensive care units and/or critical care units, using lists provided by head nurses. A total of 1,877 rating questionnaires with 13 performance categories were collected (with a mean of 8.01 nurses per internist). The ratings were analyzed to determine measurement characteristics and the relationships of the nurses' demographic characteristics to the ratings. In addition, for each of ten performance categories for 152 of the internists, the average rating each internist received from nurses was compared with the average rating each internist received from peer physicians. Statistical analysis used Pearson correlations, canonical correlations, factor analyses, Student's t-tests, analysis of variance, and stepwise multiple regression. Finally, the internists themselves, including physicians who were not actually rated by the nurses, were asked to complete a brief questionnaire that included questions about their opinions of the use of nurses' ratings. RESULTS: The nurses' ratings correlated moderately strongly with the peer physicians' ratings and had a common structure. However, the nurses' ratings were lower for several humanistic qualities, including respect, integrity, and responsibility, and their ratings were higher for medical knowledge and verbal communications. Across the 13 performance categories, approximately 10-15 ratings from nurses were needed to obtain a reliable assessment of an internist's humanistic qualities and communication skills. Many internists felt that nurses' ratings should be used equally with, or at least as a lesser contribution to, ratings by peer physicians of humanistic qualities and communication skills. CONCLUSION: Nurses' ratings appear to provide a feasible and reliable method of evaluating the internists' communication skills and humanistic qualities, when used in conjunction with ratings by peer physicians.