Comparison between Urine Protein: Creatinine Ratios of Samples Obtained from Dogs in Home and Hospital Settings

Background

The urine protein:creatinine ratio (UPC) is used to quantify urine protein excretion and guide recommendations for monitoring and treatment of proteinuria.

Hypothesis/Objectives

Home urine samples will have lower UPCs than hospital samples. The objectives were to compare UPCs of samples collected in each setting and to determine whether environment of sample collection might affect staging, monitoring or treatment recommendations.

Animals

Twenty‐four client‐owned dogs.

Methods

Prospective, nonmasked study. Clients collected a urine sample from their dog at home and a second sample was collected at the hospital. Dogs receiving corticosteroids or angiotensin‐converting enzyme inhibitors were excluded, as were those with urine samples of inadequate volume, no protein on dipstick analysis, or active urine sediment. Samples were refrigerated after collection, dipstick and sediment evaluations were completed and each sample was frozen at −80°C within 12 hours. UPCs were performed on frozen samples within 2 months.

Results

From 81 paired samples, 57 were excluded. Of the remaining 24, 12/24 (50%) had higher hospital sample UPCs, 9/24 (38%) had identical UPCs, and 3/24 (12%) had lower hospital UPCs. The UPCs of hospital samples were higher than home samples for the total population (P = .005) and the subset with UPC > 0.5 (P = .001).

Conclusions

Setting and related circumstances of urine collection in dogs is associated with UPC differences; results are usually higher in hospital than in home samples. This difference has the potential to affect clinical interpretation.

International community health networking project: two year follow-up of graduates

AIM

This paper presents the perceptions of graduates 2 years post-exchange in a USA-European Union funded programme. The primary goal of this 8-week exchange programme was to increase cultural knowledge and sensitivity by teaching a common module of community health assessment and planning to multi-national groups of undergraduate students in four countries.

BACKGROUND

Cultural diversity and globalization are among the factors that encourage faculty in nursing to develop programmes of international exchange for students. The challenge is to combine the exchange with the teaching of other courses required by the home institution during the same semester.

METHODS

Twenty-one graduates of participating USA schools responded to an open-ended interview by telephone or email 2 years after graduation. Bennett's continuum (1993) of intercultural sensitivity was used to assess cultural development.

FINDINGS

Graduates overwhelmingly supported international education and described its continued impact personally and professionally. Gains in cultural sensitivity were perceived as the greatest benefit and influence on their practice. The majority of graduates were believed to be in Bennett's ethnorelative categories of acceptance and adaptation. The depth and breadth of previous cultural experiences, specific host and home schools, and previous travel were found to be related to development on the intercultural sensitivity continuum.

DISCUSSION

Most important are the findings from this evaluation that provide insight into the factors enhancing growth of intercultural sensitivity. Previous travel, characteristics of the home and host institutions, and the opportunity and willingness to be a cultural outsider were important influences.

A critique of cultural education in nursing

AIM(S) OF THE PAPER: This paper critiques cultural education in nursing. Current approaches to cultural education, embedded in traditional anthropology, are obsolete and fail to acknowledge the global environment that impacts even the most remote and isolated cultures. The argument is made that new, transformative approaches to cultural education are needed.

BACKGROUND

Cultural awareness of the other is the foundation of existing strategies to teach cultural education. Students are encouraged to learn about each culture, often described as a monolith, by learning the unique characteristics of a group with a common race, ethnicity, or other distinguishing feature. Despite the increased emphasis on cultural education in nursing worldwide, culturally based problems persist. Nurse and health care researchers continue to report disparities in health, an unequal distribution of health care, and the lack of knowledge and sensitivity when caring for clients from another culture.

DISCUSSION

Globalization contributes to differences within cultures that may equal or exceed differences between cultures. Evidence is presented that current nursing education emphasizes cultural distinctions that do not persist in the postmodern world. Problems adherent to the continued use of cultural monoliths as the foundation of cultural education are discussed and expanded perspectives on culture and cultural education are presented.

CONCLUSION

The principles of transformative education are offered as an alternative to the current approaches to cultural education. Students are encouraged to be vulnerable to personal change when interacting with people from other cultures because transformative education is as much about personal growth as it is about enhanced care of others. This modernized approach to cultural education transcends the standard adaptation of care from the dominant culture of the health care delivery system to the culture of the client/patient.

The development and psychometric evaluation of the Ethical Issues Scale

PURPOSE

To describe the Ethical Issues Scale (EIS), its conceptual development and psychometric evaluation, and its uses in determining how frequently nurses experience ethical issues in practice.

DESIGN

The EIS was validated with a sample (N = 2,090) of New England registered nurses (RNs) currently in practice. The sample was randomly split into two approximately equal samples. The calibration sample was used to derive the underlying components; the validation sample was used to confirm the component structure.

METHODS

Psychometric analysis of the 35-item EIS included: (a) item analysis, (b) confirmatory principal components analysis (PCA), and (c) internal consistency reliability using Cronbach's alpha.

RESULTS

Three components (end-of-life-treatment issues, patient care issues, and human rights issues) were demonstrated, confirming the original conceptually-derived structure. The calibration sample accounted for 42.4% of initially extracted common variance; the validation sample accounted for 41.5% of initially extracted common variance.

CONCLUSIONS

The three EIS subscales had satisfactory internal consistency reliability and factorial validity for use as independent scales in future studies.

Designing a health outcomes research study in infusion nursing practice. How to get from a great idea to research results

In infusion nursing practice, outcomes research involves identifying and measuring outcomes sensitive to, and most consistent with, current infusion nursing practice and theory. This article discusses what outcomes should be measured in infusion nursing; how to frame the study problem, develop a working research question, and define study variables; and how to design the method for sampling, variable measurement, data collection, and proposed data analysis. The article concludes with a discussion of how to apply research components using retrospective descriptive-comparative and prospective experimental approaches, and details how to write up the final research report.

The development of an instrument to measure the compliance of adolescents with a chronic disease

The purpose of this paper was to describe the process of developing an instrument for measuring the compliance of adolescents with a chronic disease. The aim was to develop an instrument that could be used in a clinical setting to evaluate the compliance of young people with a chronic disease and to test a theoretical model of compliance, which had been developed along with the instrument. The instrument was originally developed to measure the compliance of adolescents with diabetes and later adjusted to measure the compliance of adolescents with asthma, rheumatoid arthritis and epilepsy. To test and develop the instrument, face and criterion validity, factor analyses, linear structural relations (LISREL) analyses, correlation coefficients and Cronbach's alpha were used. The instrument has 13 background questions and 41 items to measure compliance and factors connected to it.

Conceptual analysis of compliance

Compliance has been studied from a wide range of scientific perspectives including medicine, nursing, psychology and health economics. There is no agreement regarding a commonly accepted definition. Lack of consistency in the definition and measurement of compliance is a major problem in research which becomes more complicated in an international study. The response to the confusion over the term compliance has been to suggest and use alternative terms such as adherence, co-operation, mutuality and therapeutic alliance. These terms are ill-defined and often are used as synonyms. The purpose of this paper is to analyse definitions of the concept of compliance. Abstracts from MEDLINE have been analysed in order to identify the types of compliance research that have been carried out.

The concept of adaptation: examining alternatives for the study of nursing phenomena

Clients' adaptation is frequently studied in nursing and used to guide nursing practice. Many nurse authors have suggested that adaptation may be a unique conceptual framework for nursing. Other nurse authors have suggested, however, that in focusing on adaptation, nursing limits its focus to changing clients to fit the environment and neglects to change the social system or environment to meet clients' needs. The purpose of this article is to argue that adaptation theory limits the range of clients' acceptable responses to change. Adaptation theory assumes clients are responsible for adjusting to the norms or standards established by a relatively immutable environment. An alternate set of assumptions broadens the range of acceptable responses by clients and targets the environment for change. On the basis of these assumptions, directives are given for nursing research aimed at studying clients' responses to change.

An innovative model for international undergraduate education

Educational exchange programs have a long academic history. Through such programs, students expand their knowledge of cultures in their home country and the larger world. Typically, students learn about a particular substantive area, such as politics, economics, health care, or language. There is also a loftier goal: to encourage understanding and respect for the people of other countries and share experiences with family and friends at home. In a biography of William J. Fulbright, the developer of the preeminent exchange program that bears his name, the senator is described as hoping that in a democratic country like the United States, "the knowledge and understanding of other cultures would inevitably trickle down through the educational system to those who were not privileged to travel abroad" (1, p. 131).

Family nursing practice in public health: Finland and Utah

This exploratory study of family nursing practice in public health care was conducted in Finland and Utah. Staff nurses were interviewed in focus groups and asked to describe their practice of family nursing, the factors promoting and restraining practice, and the impact of the changes in health care delivery on practice. Thirty-six Finnish and 30 Utah nurses participated. Pressure to do more activities with fewer nurses and resources, changes in family problems, and skill level of the nurses were common themes. However, differences were evident. Finnish public health nurses used emotional support and information to help families empower themselves to use resources and to strengthen their family unit. Utah nurses focused first on individual level goals and then family cohesion and health. Nurse-initiated referrals and direct physical care were the primary intervention strategies of Utah nurses. Unlike the U.S. health care system, access for all in maternal and child health care and school health allowed Finnish nurses to develop long-term relationships with families, thus advancing family nursing practice. This study identifies several potential variables for further study particularly related to the organization of health care and nurse-family relationships.

Determinants of reported health promotion behaviors in employed Mexican American women

This study based on the revised Pender Health Promotion Model (HPM) was conducted to determine the extent to which selected demographic modifying factors, health locus of control, self-efficacy, and current health status explained engaging in six health promotion practices in a sample of 397 employed Mexican American women aged 19 to 70 years who lived and worked in the Rio Grande Valley of Texas. Self-administered test packets contained measures of demographic characteristics, health locus of control, self-efficacy, health status, and the six health promotion practices. Canonical correlational analysis demonstrated two significant canonical variate pairs explaining 88% of variance in the dependent set, the subscale mean scores of the Health-Promoting Lifestyle Profile. Age; education; self-efficacy; internal and powerful others health locus of control; and prior, current, and future health status made statistically significant contributions. However, the demographic variables made only a minimal contribution, confirming the recent conclusions of researchers that the HPM as currently configured provides an inadequate explanation of the modifying factors' role in health promotion activity. Study results make an important addition to the understanding of how lifestyle factors contribute to Mexican American women's health and well-being.

Correlates of health-promotion activities in employed Mexican American women

The purposes of this study were to describe the health-promoting lifestyle behaviors of 397 employed Mexican American women and to compare them with women in other published reports that used the Health-Promoting Lifestyle Profile (HPLP). Mexican American women had the highest HPLP total scores of all minority groups, but lower scores than all predominantly White groups. HPLP self-actualization and interpersonal support were the highest subscale scores. The exercise subscale was the lowest score for all groups, including minorities. Canonical analysis revealed two significant canonical variate pairs explaining 88% of variance. Age, education, self-efficacy, health locus of control (internal and powerful others), and current health status made statistically significant contributions to all HPLP subscale scores. Study results support previous research findings and make an important contribution to understanding the factors that influence Mexican American women's health-promoting lifestyle behaviors.

Developing a nursing doctorate for the 21st century

Nursing in the next century will reflect changes in the health care system, and although the profession has made great strides in preparing nurse researchers, the current system has a serious gap that must be addressed; that of preparing clinical leaders. The article describes the need for a practice-focused doctoral curriculum that will produce a new type of senior clinician or expert practitioner to fill this gap. The envisioned graduates will be skilled in clinical decision making and information processing and will effect changes at both the micro- and macro-levels of the system. There is a clear future need to expand the number of primary care providers. The faculty required for their education must be doctorally prepared nurses who are themselves clinically proficient. The research and practice doctorates should be differentiated by faculty, the program of studies, resources, and placement/expectation of graduates. The article includes a model curriculum plan.

Social networks and social support of recently divorced women

A study of the support networks and social support of recently divorced women with children was conducted over two years. Its purpose was to assess changes in the women's social support and identify their unmet needs. Data were collected from 148 women by mailed questionnaire and telephone interview soon after the final divorce decree, and again at two years. The women did experience a significant decrease in network size and social support over two years; however, the primary members of their networks--family and friends--remained stable. Women with preschool-age children had more family support than those with older children. Nine categories of unmet needs were identified. Most frequently cited, in descending order, were emotional support, financial assistance, need for a boyfriend/partner/spouse, time for herself, and child care. The average number of needs per woman was less than two. The findings of this study confirm the losses in overall network size and support that women experience after divorce. The identification of unmet needs helps nurses to target areas in which women may require assistance to find social support.

Determinants of health-promoting lifestyles in older persons

The purpose of this study was to determine the degree to which selected components derived from Pender's Health Promotion Model (1982) explained engaging in health promotion practices in a sample of 477 persons 65 years and older. One directional hypothesis was tested using canonical correlation analysis. Three significant canonical variates were demonstrated, explaining 88.7 percent of variance. Older healthy persons with high self-esteem and internal locus of control reported practicing five of the six health promotion strategies. Men with higher income and self-esteem but poorer health less often exercised or ate well. Older married subjects with higher incomes who were internally controlled were more likely to engage in exercise, health responsibility and stress management but not in interpersonal support. Findings provide direct multivariate support for the additive nature of the relationships posited in the Health Promotion Model.

Determinants of functional health of older persons

The study investigated relationships among demographics, self esteem, health locus of control, health promotion behaviors, perceived health and functional health ratings in 179 older men and women from 65 to 99 years. Canonical correlation and stepwise discriminant analyses demonstrated several meaningful and significant relationships suggesting that exercise and nutrition may be critical health promotion activities associated with better scores on five functional dimensions. The 85+ years age group differed from younger groups through having significantly higher reported exercise scores.

The Health-Related Hardiness Scale: development and psychometric analysis

This article describes the development and psychometric evaluation of the Health-Related Hardiness Scale (HRHS). The HRHS was developed to measure the effects of hardiness in individuals with actual health problems. Items were generated that measured the presence, rather than absence, of the hardiness dimensions based on theoretical definitions of health-related control, commitment, and challenge. Two factors were isolated using principal components analysis (n = 389). These two factors, Challenge/Commitment and Control, accounted for 32.1% of variance. Factor loadings were strong, ranging from .41 to .68. Parsimony of the HRHS was achieved by reducing the original 51-item scale to 34 items. Alpha reliability coefficients were .91 for the total scale and .87 for each subscale. Test-retest, reliability coefficients ranged from .74 to .78. The final scale retained only two of the originally conceptualized three dimensions of the health-related hardiness construct.

Personal goals of recently divorced women

This paper is a report of the synthesis of feminism and science in a study of the personal goals of recently divorced women with children. The divorce records of three counties were used to identify the participants; eight categories described the primary goals identified by 250 women. Independence, followed by employment and education were the most frequently cited categories. Analysis of variance was computed to analyze the relationships among the primary goal categories, the personal characteristics of the women and their feminist attitudes. Age was the only variable related to selection of a primary goal. Older women chose employment and environmental goals more often than they did mental health goals.

The process of providing support to recently divorced single mothers

Social support is a combination of a person's perceptions of support, the belief that the support is personally satisfying, and the actual provision of services. Although the literature is replete with the work of researchers who have addressed the components of support, there is a notable limitation--the perspective of the providers of support. This perspective is important for clinicians who work with a person's natural support system to enhance its effectiveness. In this descriptive study, 252 people identified by recently divorced women with children as providing their most significant support were interviewed. The authors' purpose in conducting the study was to identify the underlying processes involved in social support based on interviews with the women's significant support people. In the qualitative portion of the study the data analysis yielded eleven processes: deliberating, withdrawing, continuing, understanding, availing, anchoring, distancing, protecting, nurturing, valuing, and intruding. Each of these processes is described in this paper.

Determinants of health promotion in midlife women

Health locus of control, self-esteem, and health status were analyzed for their impact on health-promoting life-style activities in 262 women between 35 and 65 years of age. Negative chance health locus of control, self-esteem, current health status, health worry/concerns, post-high-school education, and internal health locus of control explained 25% of the variance of likelihood to engage in health-promoting life-style activities. Two canonical variates explained 72.8% of the variance in the criterion set, the subscale scores of the Health-Promoting Lifestyle Profile (Walker, Sechrist, & Pender, 1987). Internal health locus of control, self-esteem, current health status, and future health status explained 36.3% of the variance of the self-actualization, interpersonal support, and exercise subscales; age, negative chance health locus of control, health worry/concern, and negative (poor) prior health status explained 36.5% of the variance of the health responsibility, nutrition, and stress management subscales. The canonical correlations for the two variates were .78 and .66, respectively. The study results support in part the relationships posited in the Pender health promotion model and previous research on women's health.

Health promotion in the family: current findings and directives for nursing research

This paper reviews the current nursing research findings on health promotion within the family and provides directives for future research. The concept of health promotion-the overall enhancement of well being--is contrasted with primary or disease prevention, the specific protection from a health threat. The conceptual parameters of health promotion were used to search the nursing research journals for studies of health promotion in the family. The four major nursing research journals were reviewed and yielded five articles in 105 issues which addressed this phenomenon. The findings from these studies as well as other research literature are used to develop future directives. The directives are presented for both the internal environment of the family and its external environment. Areas for study related to the internal environment include definitions of health and health promotion, descriptions of current health promotion behaviours and those practised over time, decision making, fathering, and methods of intervention. Research of the external environment includes the societal norms, societal interventions, and the effects of societal institutions. This discussion of health promotion in the family describes an agenda for nursing research which is necessary to support nursing practice with families if 'health for all' is to be reached by the year 2000.

Primary prevention behaviors: the female-headed, one-parent family

The purpose of this study was to describe the primary prevention behaviors of 59 female-headed, one-parent families and the barriers which deter their practice. Two interviews, a health diary, and a card sort were used for data collection. Descriptive statistics and content analysis were used to analyze the qualitative data. Nutrition was the behavior the families felt was most important for maintaining health. Time was the major barrier to primary prevention practices. A relationship was found between the family's ability to change and grow and their practice of primary prevention behaviors. Families that consciously risked lifestyle changes also were willing to try to incorporate primary prevention behaviors. On the contrary, families with stagnant lifestyles expressed the desire to change their primary prevention behaviors but made no visible attempt to do so.

Designing nursing research: the qualitative-quantitative debate

Nursing research has not evolved with immunity from the qualitative-quantitative debate which has surrounded the behavioural and social sciences. The outcome of this debate should be better nursing science since researchers are forced to face and address the controversial issues. Attaining this goal requires researchers to debate the issues with a knowledge of epistemology and methodology and not blind devotion to the tradition of the hard sciences. This paper addresses the issues of epistemology, methodology, and ethics for two prototypes of the qualitative-quantitative continuum. Grounded theory explains the issues of qualitative research: the search for meaning, the inclusion of environmental factors, the depth of data, and the treatment of participants as subjects. The true experiment, the epitomy of the quantitative approach, seeks to identify existing truths by isolating the significant variables and controlling for contaminating factors. Based on these arguments, recommendations are made for nursing research which rely on both approaches.

Research on teaching research in the baccalaureate nursing curriculum

This article is based on a review of the research literature on teaching research to undergraduate nursing students. A paucity of this research exists yet a variety of approaches are used to teach research. These approaches are categorized into 'learn by doing', 'learn by proposing to do', and 'learn by critiquing'. The strengths and weaknesses of each approach are examined. The research literature that does exist is primarily descriptive and lacks adequate sample size and methods of inquiry. Students' attitudes and knowledge towards research are described in response to various teaching methods. Larger surveys in the United States of America and abroad provide disappointing statistics concerning the utilization and the pursuit of research knowledge by nurse clinicians. Lastly, suggestions are made for further research in teaching research to baccalaureate students in order to enhance their research knowledge and commitment to research as clinicians. The Thomas-Price Inventory for evaluating research preparation on the baccalaureate level is described.