1
|
Haji Assa A, Cao X, Boehm LM, Umberger RA, Carter MA. The Relationship Between Uncertainty and Psychological Distress Among Family Caregivers of Patients With Delirium in Intensive Care Units: A Cross-Sectional Survey. Dimens Crit Care Nurs 2024; 43:61-71. [PMID: 38271309 DOI: 10.1097/dcc.0000000000000627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Although family caregivers experienced negative psychological symptoms associated with witnessing intensive care unit delirium in their loved ones, there is a lack of clear understanding of how delirium is associated with family caregiver psychological distress. Uncertainty could be a factor contributed to this association. OBJECTIVES The aim of this study was to examine the relationship between uncertainty and psychological distress among family caregivers of patients with delirium in intensive care units. METHODS A cross-sectional correlational design was used for this observational study of adult family caregivers of patients admitted to the intensive care unit and who reported witnessing delirium symptoms in their loved ones. Family caregivers completed an electronic survey in January 2022 that consisted of a family caregiver and patient demographic form, the Mishel Uncertainty in Illness Scale-Family Member, and the Kessler Psychological Distress Scale. Descriptive, correlational, and regression statistical analyses were applied. RESULTS One hundred twenty-one adult family caregivers were enrolled. Family caregivers reported substantial uncertainty (mean, 106.15, on a scale of 31-155) and moderate to severe psychological distress (mean, 31.37, on a scale of 10-50) regarding their witnessing of delirium episodes in their loved ones. Uncertainty was significantly correlated with psychological distress among family caregivers (rs = 0.52, P < .001). Uncertainty significantly predicted psychological distress among family caregivers (regression coefficient, 0.27; P < .001). DISCUSSION Family caregiver uncertainty was positively associated with psychological distress. This distress can interfere with family caregiver involvement in patient delirium care. These findings are essential to increase critical care nurse awareness and inform the development of nursing interventions to alleviate possible uncertainty and distress.
Collapse
|
2
|
Carter MA, Assa ASH. The problem of comparing nurse practitioner practice with medical practice. Nurs Inq 2023:e12551. [PMID: 36973938 DOI: 10.1111/nin.12551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 03/29/2023]
Abstract
Comparing the practice of nurse practitioners to medical practice began almost 50 years ago and continues to this day. This comparison is curious since the founders of this movement did not indicate that these advanced practice nurses were to be interchangeable with physicians. Nevertheless, substantial literature indicates that nurse practitioners perform equally or better when measured against physician practice standards. This paper compares the ontology and epistemology of both professions and concludes that the philosophical foundations are so different that comparisons are illogical.
Collapse
Affiliation(s)
- Michael A Carter
- Colleges of Nursing and Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Amal S H Assa
- College of Nursing, Umm Al-Quar University, Makka, Saudi Arabia
| |
Collapse
|
3
|
Abstract
Cultural stereotypes that equate aging with decreased competence and increased forgetfulness have persisted for decades. Stereotype threat (ST) refers to the psychological discomfort people experience when confronted by a negative, self-relevant stereotype in a situation where their behavior could be construed as confirming that belief. The purpose of this study was to examine the relationships of ST on memory performance in older adults over 24 months. The ST levels on average significantly declined, or improved in the memory training, but not the health training group. Although not significant at the .01 level, the bivariate correlation indicated that change in ST was moderately related to change in verbal memory, suggesting the possibility that improvements (or reductions) in ST may be related to increases in verbal memory scores. We discovered that the unique contribution of ST into the memory performance of healthy older adults offers a possible malleable trait.
Collapse
Affiliation(s)
| | - Todd B. Monroe
- The Ohio State University College of Nursing, Columbus, OH, USA
| | - Keenan A. Pituch
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Michael A. Carter
- The University of Tennessee Health Science Center, College of Nursing, Memphis, TN, USA
| | - Laurie Abbott
- Florida State University College of Nursing, Tallahassee, FL, USA
| |
Collapse
|
4
|
Anderson AR, Iversen WL, Carter MA, Moss KO, Cowan RL, Monroe TB. Experimentally evoked pain in Alzheimer's disease. J Am Assoc Nurse Pract 2021; 34:18-25. [PMID: 33731557 PMCID: PMC9118535 DOI: 10.1097/jxx.0000000000000580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Pain continues to be underrecognized and undertreated in Alzheimer's disease (AD) while existing guidance about pain assessment and management in dementia is not widespread. Brain regions involved in pain processing and modulation are damaged during AD, and the pain experience in AD is not well understood. Experimental pain studies using psychophysics can further our understanding of the pain experience in AD, which may lead to improved assessment and management of pain in people living with AD. OBJECTIVE A systematic review was conducted to explicate the current understanding of experimentally evoked pain in AD from primary research using psychophysical methods. DATA SOURCES Peer-reviewed publications were found via PubMed, CINAHL, and PsycINFO. A total of 18 primary research, peer-reviewed full articles that met inclusion criteria were included, representing 929 total participants. CONCLUSIONS Experimentally evoked pain in people with AD demonstrates that despite cognitive impairment and a reduced ability to effectively communicate, individuals with AD experience pain similar to or more unpleasant than cognitively intact older adults. This may mean amplified pain unpleasantness in people with AD. IMPLICATIONS FOR PRACTICE Our current best practices need to be widely disseminated and put into clinical practice. Self-report of pain continues to be the gold standard, but it is ineffective for noncommunicative patients and those unable to understand pain scales or instructions because of memory/cognitive impairment. Instead, pain treatment should be ethically initiated based on patient reports and behaviors, caregiver/surrogate reports, review of the medical record for painful conditions, analgesic trials, and regular reassessments.
Collapse
Affiliation(s)
| | | | - Michael A. Carter
- University of Tennessee Health Science Center College of Nursing, Memphis, Tennessee
| | - Karen O. Moss
- The Ohio State University College of Nursing, Columbus, Ohio
| | - Ronald L. Cowan
- University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee
| | - Todd B. Monroe
- The Ohio State University College of Nursing, Columbus, Ohio
| |
Collapse
|
5
|
Anderson AR, Hyden K, Failla MD, Carter MA. Policy Implications for Pain in Advanced Alzheimer's Disease. Pain Manag Nurs 2021; 22:3-7. [PMID: 32684495 PMCID: PMC7854970 DOI: 10.1016/j.pmn.2020.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/05/2020] [Accepted: 06/15/2020] [Indexed: 12/13/2022]
Abstract
Untreated pain in people with Alzheimer's disease continues to be a serious public health problem. Pain is a subjective and complex experience that becomes increasingly challenging to assess as cognition declines. Our understanding of pain processing is incomplete, particularly for special populations such as people living with Alzheimer's disease, and especially in the advanced stages of the disease. Pain-processing networks in the brain are altered in Alzheimer's disease, yet evidence suggests people living with Alzheimer's disease do not experience less pain. Rather, their pain is not adequately recognized or treated. Although scholarly publications provide important assistance, recent widespread reports and guidelines do not include sufficient guidance, especially as Alzheimer's disease progresses to the last stages. Additionally, current pain measurements may not accurately evaluate pain in this condition, and the existing definitions of pain are not adequate when considering the effects of Alzheimer's disease on pain-processing in the brain. There is a need for new, widespread policies, guidelines, and definitions to help clinicians adequately manage pain in people with Alzheimer's disease. These will need to hinge on continued research because it remains unclear how Alzheimer's disease impacts central pain processing, pain expression, and communication of pain. In the meantime, policies and guidelines need to highlight current best practices as well as the fact that pain continues in Alzheimer's disease.
Collapse
Affiliation(s)
| | - Karen Hyden
- University of Colorado Denver, Anschutz Medical Campus, Denver, Colorado
| | - Michelle D Failla
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michael A Carter
- University of Tennessee Health Science Center College of Nursing, Memphis, Tennessee
| |
Collapse
|
6
|
Romano RR, Carter MA, Dietrich MS, Cowan RL, Bruehl SP, Monroe TB. Could Altered Evoked Pain Responsiveness Be a Phenotypic Biomarker for Alzheimer's Disease Risk? A Cross-Sectional Analysis of Cognitively Healthy Individuals. J Alzheimers Dis 2021; 79:1227-1233. [PMID: 33337380 PMCID: PMC7990440 DOI: 10.3233/jad-201293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND This study evaluated whether the apolipoprotein ɛ4 (APOE4) allele, a genetic marker associated with increased risk of developing late-onset Alzheimer's disease (AD), was associated with differences in evoked pain responsiveness in cognitively healthy subjects. OBJECTIVE The aim was to determine whether individuals at increased risk of late-onset AD based on APOE allele genotype differ phenotypically in their response to experimentally-induced painful stimuli compared to those who do not have at least one copy of the ɛ4 allele. METHODS Forty-nine cognitively healthy subjects aged 30-89 years old with the APOE4 allele (n = 12) and without (n = 37) were assessed for group differences in pain thresholds and affective (unpleasantness) responses to experimentally-induced thermal pain stimuli. RESULTS Statistically significant main effects of APOE4 status were observed for both the temperature at which three different pain intensity percepts were reached (p = 0.040) and the level of unpleasantness associated with each (p = 0.014). APOE4 positive participants displayed lower overall pain sensitivity than those who were APOE4 negative and also greater overall levels of pain unpleasantness regardless of intensity level. CONCLUSION Cognitively healthy APOE4 carriers at increased risk of late-onset AD demonstrated reduced thermal pain sensitivity but greater unpleasantness to thermal pain stimuli relative to individuals at lower risk of late-onset AD. These results suggest that altered evoked pain perception could potentially be used as a phenotypic biomarker of late-onset AD risk prior to disease onset. Additional studies of this issue may be warranted.
Collapse
Affiliation(s)
- Raymond R. Romano
- College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Michael A. Carter
- College of Nursing, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Mary S. Dietrich
- School of Medicine (Biostatistics, Psychiatry) and School of Nursing, Vanderbilt University, Nashville, TN, USA
| | - Ronald L. Cowan
- Departments of Psychiatry and Anatomy and Neurobiology,College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Stephen P. Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Todd B. Monroe
- College of Nursing, The Ohio State University, Columbus, OH, USA
| |
Collapse
|
7
|
|
8
|
Abstract
Early recognition of Alzheimer's disease (AD) in the prodromal period has not been robust yet will be necessary if effective disease-modifying drugs are to be useful in preventing or delaying the condition. The objective of this narrative review was to describe the current, evidenced based understanding of alterations in sensory data as potential biomarkers for AD. Review of empirical studies that tested senses as biomarkers for AD and were published in English within the past 50 years was completed. Eighteen empirical studies were identified that met the strict criteria for inclusion, with 12 of these studies being related to the olfactory system. Two studies examined auditory, two examined vision, one examined proprioception, and one examined taste. Thus, only olfaction has been studied to any extent, leaving a clear gap in the literature for the use of other senses. A promising area of research has begun to be reported concerning differences in responses to pain stimuli in AD relative to cognitively normal subjects. Pain is not a single sense like the others but integrates several senses and may allow for use as an early biomarker for AD, as it integrates several brain areas and pathways. Unlike the other senses, simple devices can be used to measure changes in pain perception in cognitively normal adults with genetic predispositions for possible AD, making this potentially useful for clinicians in the future.
Collapse
Affiliation(s)
- Raymond R Romano
- College of Nursing, 12326University of Tennessee Health Science Center, Memphis, TN, USA
| | - Michael A Carter
- College of Nursing, 12326University of Tennessee Health Science Center, Memphis, TN, USA
| | - Todd B Monroe
- College of Nursing, 2647Ohio State University, Columbus, OH, USA
| |
Collapse
|
9
|
Mundinger MO, Carter MA. Response to Letter to the Editor by Linda McCauley. Policy Polit Nurs Pract 2019; 20:192. [PMID: 31766947 DOI: 10.1177/1527154419890282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
| | - Michael A Carter
- College of Nursing, University of Tennessee Health Science Center, Memphis, TN, USA
| |
Collapse
|
10
|
Abstract
The Doctor of Nursing Practice (DNP) degree was established to expand nurse practitioner education by adding new competencies. In 2004, the American Association of Colleges of Nursing released a position statement that redefined practice from only clinical care of patients to include nonclinical care. This policy position likely contributed to the rapid growth of DNP programs. Historical background on the development of the DNP is provided. An analysis was conducted of the programs reported in the American Association of Colleges of Nursing list of accredited DNP programs between 2005 and 2018 to compare whether the programs prepared graduates for advanced clinical practice or administrative or leadership. During this time, 553 DNP programs were established, 15% (n = 83) are clinical, and 85% (n = 470) are nonclinical. The adequate production of nurse practitioners in the future may be in jeopardy with this imbalance in educational resources, especially with the nation's growing need for primary care clinicians.
Collapse
Affiliation(s)
| | - Michael A Carter
- 2 College of Nursing, University of Tennessee Health Science Center, Memphis, TN, USA
| |
Collapse
|
11
|
Romano RR, Anderson AR, Failla MD, Dietrich MS, Atalla S, Carter MA, Monroe TB. Sex Differences in Associations of Cognitive Function with Perceptions of Pain in Older Adults. J Alzheimers Dis 2019; 70:715-722. [PMID: 31256133 PMCID: PMC6700616 DOI: 10.3233/jad-190142] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Sex differences in pain have been shown to exist in older adults with normal cognition and people with Alzheimer's disease. It is unknown if sex differences in pain in older adults exist in a range of communicative older adults with varying cognitive ability from no impairment to moderately severe cognitive impairment. OBJECTIVE This study proposes to compare the association between psychophysical responses to experimental thermal pain between males and females to determine if sex differences in pain exist across the cognitive spectrum. METHODS We conducted a secondary analysis of data from an age- and sex-matched between-groups cross-sectional study examining the psychophysical response to contact heat in people with and without dementia. RESULTS Median age of males (n = 38) and females (n = 38) was 73 (range: 68-87) with similar distributions of Mini-Mental State Examination (MMSE) scores (range: 11-30). Findings revealed inverse statistically significant associations with the threshold temperature of warmth (females: r = -0.41, p = 0.010; males: r = -0.33, p = 0.044). There was an apparent divergent pattern of MMSE associations with unpleasantness ratings between the groups. At the moderate pain threshold, that difference became statistically significant (p = 0.033). Females demonstrated a positive association of MMSE with unpleasantness (r = 0.30, p = 0.072), while males demonstrated an inverse association at that respective threshold (r = -0.20, p = 0.221). CONCLUSIONS Between-group findings suggest that patterns of responses to thermal stimulus intensity may differ between males and females with worsening cognition with females reporting significantly less unpleasantness with the percept of moderate pain and males reporting significantly higher unpleasantness with moderate pain perception.
Collapse
Affiliation(s)
| | | | - Michelle D. Failla
- Department of Psychiatry at Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mary S. Dietrich
- School of Nursing, Vanderbilt University, Nashville, TN, USA
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry and Behavioral Science, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Michael A. Carter
- College of Nursing, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Todd B. Monroe
- College of Nursing, The Ohio State University, Columbus, OH, USA
| |
Collapse
|
12
|
Carter MA, Accardo D, Cooper T, Cowan P, Likes W, Lynch-Smith D, Melaro L. Recommendations From an Early Adopter of a Doctor of Nursing Practice Program. J Nurs Educ 2016; 55:563-7. [DOI: 10.3928/01484834-20160914-04] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 07/06/2016] [Indexed: 11/20/2022]
|
13
|
Affiliation(s)
- Michael A. Carter
- School of Nursing, University of Colorado Health Sciences Center, Denver, Colorado
| | | |
Collapse
|
14
|
Thiele JE, Critic JS, Harrison OA, Carter MA, Congdon JAG, Brown D, Lierman L, Loustau A, Blair BJ, Mork N. Interventions I. West J Nurs Res 2016. [DOI: 10.1177/019394598200400309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Joyce Semradek Critic
- Office of Research, School of Nursing, Oregon Health Sciences University, Portland, Oregon
| | | | | | | | - Doralee Brown
- School of Nursing, Denver Veterans Hospital, Clinical Senior Instructor, University of Colorado, Denver, Colorado
| | - Letha Lierman
- College of Nursing, University of Utah, Salt Lake City, Utah
| | - Anne Loustau
- Department of Community Health Care Systems, University of Washington, Seattle, Washington
| | - Barbara J. Blair
- Seattle Veterans Administration Medical Center, Seattle, Washington
| | - Nancy Mork
- Hypertension Clinic, Seattle Veterans Administration Medical Center, Seattle, Washington
| |
Collapse
|
15
|
Woods NF, Davidson SB, Grant MM, Carter MA, Harrison OA, Blaufuss JA. Intervention. West J Nurs Res 2016. [DOI: 10.1177/019394598300500314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Sue B. Davidson
- School of Nursing, Oregon Health Sciences University, Portland, Oregon
| | - Marcia M. Grant
- Nursing Research, City of Hope National Medical Center Duarte, California
| | - Michael A. Carter
- College of Nursing, The University of Tennessee Center for the Health Sciences, Memphis, Tennessee
| | - O. Anne Harrison
- School of Nursing, University of Colorado Health Sciences Center, Denver, Colorado
| | | |
Collapse
|
16
|
Carter MA, Smith MC. Book Review: Nursing as Caring: A Model for Transforming Practice. Nurs Sci Q 2016. [DOI: 10.1177/089431849400700412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
17
|
|
18
|
Abstract
The education of nurse practitioners has undergone substantial evolution since Ford and Silver (1967) first reported on the preparation of nurses to assume the role of primary care providers for children. From this modest beginning in Colorado emerged a worldwide movement to prepare nurses to diagnose and treat patients in ways that in the past had been restricted to physicians. The early programs were not usually located in schools or colleges of nursing but rather were short-term continuing education programs. Later, nurse practitioner programs were transitioned to master’s degree programs and more recently began to evolve to Doctor of Nursing Practice (DNP) Programs. The American Association of Colleges of Nursing (2014) currently lists 243 active DNP programs and 70 planned programs.
Collapse
|
19
|
Monroe TB, Carter MA, Feldt KS, Dietrich MS, Cowan RL. Pain and hospice care in nursing home residents with dementia and terminal cancer. Geriatr Gerontol Int 2013; 13:1018-25. [PMID: 23506621 PMCID: PMC4850827 DOI: 10.1111/ggi.12049] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2013] [Indexed: 11/29/2022]
Abstract
AIM One condition associated with severe end-of-life pain that can lead to a poor quality of death is cancer. Cancer pain in people with dementia is of particular concern because of communication problems that occur with worsening disease. The aim of the current pilot study was to examine the association between hospice enrolment, dementia severity and pain among nursing home residents who died from advanced cancer. METHODS Between-groups cross-sectional chart audits of 55 nursing home residents with dementia who died from cancer were carried out. RESULTS A total of 45% of residents were in hospice at the end-of-life. Residents in hospice were more likely to receive an opioid (80% vs 43%, P = 0.005); but less likely to show severe cognitive impairment (20% vs 50%, P = 0.050). Enrolment in hospice was associated with an increased likelihood of receiving an opioid after controlling for level of cognitive impairment (OR = 3.9, 95% CI = 1.1-14.0, P = 0.037). Lower levels of cognitive functioning were associated with a decreased likelihood of receiving an opioid after controlling for enrolment in hospice (OR = 0.3, 95% CI = 0.1-0.8, P = 0.030). Notably, 40% of nursing home residents with dementia who died from cancer did not receive any opioid during this time. CONCLUSIONS Preliminary results suggest that hospice enrolment might be influenced by the facility or region of this particular country. Hospice enrolment predicts more opioid pain treatment in residents with dementia and terminal cancer; however, no resident with very severe dementia and terminal cancer was placed in hospice care. Severely cognitively impaired nursing home residents requiring opioids are at great risk of suffering from untreated advanced cancer pain. New methods are urgently required to improve end-of-life palliative care for nursing home residents with terminal cancer and severe dementia.
Collapse
Affiliation(s)
| | - Michael A Carter
- College of Nursing, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Karen S Feldt
- College of Nursing, Seattle University, Seattle, Washington, USA
| | - Mary S Dietrich
- Schools of Nursing & Medicine, Vanderbilt University, Nashville
| | | |
Collapse
|
20
|
Lee EAD, Bissett JK, Carter MA, Cowan PA, Pyne JM, Speck PM, Theus SA, Tolley EA. Preliminary findings of the relationship of lower heart rate variability with military sexual trauma and presumed posttraumatic stress disorder. J Trauma Stress 2013; 26:249-56. [PMID: 23568414 DOI: 10.1002/jts.21797] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Decreased heart rate variability (HRV) occurs with physical and psychological disorders and is a predictor of cardiac and all-cause mortality. This study was the first of which we are aware to examine and report the relationship between military sexual trauma (MST) and HRV measures. In a historical cohort study of female veterans with (n = 27) and without (n = 99) MST who received Holter and electrocardiogram evaluation at a Veteran Affairs medical center during 2007-2010, we examined the relationship between MST and the standard deviation of all R-R intervals (SDNN) and the square root of the mean of the sum of the squares of differences between adjacent R-R intervals (RMSSD). Female veterans with MST were younger, p = .002, frequently had a probable posttraumatic stress disorder diagnosis, 80% versus 15%, p = < .0001, and had lower SDNN, p = .0001, and RMSSD, p = .001, than those without MST. The SDNN and RMSSD of a 25-year-old female veteran with MST were comparable to that of female veterans aged 69 to 81 years without MST. Further research is needed to evaluate relationships between MST and HRV measures.
Collapse
Affiliation(s)
- Elizabeth A D Lee
- Department of Research and Development, Central Arkansas Veterans Healthcare System (CAVHS), Little Rock, Arkansas, USA.
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Thorn SA, Carter MA. The potential of health information exchange to assist emergency nurses. J Emerg Nurs 2013; 39:e91-6. [PMID: 23369772 DOI: 10.1016/j.jen.2012.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 11/01/2012] [Accepted: 12/05/2012] [Indexed: 10/27/2022]
Abstract
Health information exchange holds the promise of sharing critical information about patients across organizations. We have found that emergency nurses have little or no involvement in using health information exchange and, often, they are not granted access by individual hospital policies. Yet, emergency nurses need to know this information and must have full access to health information exchange. We provide recommendations to ensure that emergency nurses are able to reach their full potential in using health information exchange to care for patients.
Collapse
Affiliation(s)
- Shirley A Thorn
- Loewenberg School of Nursing, University of Memphis, Memphis, TN, USA.
| | | |
Collapse
|
22
|
Monroe T, Dornan A, Carter MA, Cowan RL. Using Functional Magnetic Resonance Imaging to Describe Pain Pathways in the 'Oldest Old': A Case Study of a Healthy 97-year-old Female. J Pain Relief 2012; 1. [PMID: 32206444 PMCID: PMC7089573 DOI: 10.4172/2167-0846.1000111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Todd Monroe
- Vanderbilt University School of Nursing, Vanderbilt University Institute of Imaging Science, Nashville, Tennessee, USA
| | - Andrew Dornan
- Vanderbilt Psychiatric Neuroimaging Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Michael A Carter
- The University of Tennessee Health Science Center College of Nursing, Memphis Tennessee USA
| | - Ronald L Cowan
- Vanderbilt Addiction Center, Vanderbilt Psychiatric Neuroimaging Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| |
Collapse
|
23
|
Abstract
Paratuberculosis control in the United States has a long history, but only since 2002 has the US Department of Agriculture (USDA) had a formal control program in place. Modeled after work by the United States Animal Health Association (USAHA), the program continues to be a voluntary effort by states and producers. Education on paratuberculosis continues to be heavily emphasized by states.
Collapse
Affiliation(s)
- Michael A Carter
- Ruminant Health Programs, National Center for Animal Health Programs, Veterinary Services, Animal and Plant Health Inspection Service, US Department of Agriculture, Riverdale, MD 20737, USA.
| |
Collapse
|
24
|
Carter MA. Prevalence and prevention of paratuberculosis in North America. Jpn J Vet Res 2012; 60 Suppl:S9-S18. [PMID: 22458196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The United States of America (U.S.) has made several attempts over the years to develop a producer accepted voluntary program. The focus of the U.S. Voluntary Bovine Johne's Disease Control Program (VBJDCP) is to provide producers with the tools to control Johne's disease on their farms and identify herds with a low risk for the presence of Mycobacterium avium subspecies paratuberculosis (MAP) infection. The VBJDCP includes an evaluation of producers' operations to identify practices that could allow the transmission of MAP among animals or between premises. Once risky practices havebeen identified, a herd management plan is developed to assist the producer in correcting risky practices. In addition to management changes, vaccination is a control tool allowed in the U.S. because it reduces the clinical signs of Johne's disease and the shedding of MAP. Testing is used in addition to management changes. While the classification component of the VBJDCP dictates the amount and type of testing herd owners are required to conduct, the education and management components of the VBJDCP does not specify testing protocols. The testing for control is intended to fit the needs and resources of producers and can be quite flexible. Management changes on the farm remain the key to control and programs cannot replace well thought out plans by producers that are specific to their resources, facilities, and operation.
Collapse
Affiliation(s)
- Michael A Carter
- National Center for Animal Health Programs, Veterinary Services, Animal and Plant Health Inspection Service, U. S. Department of Agriculture, Riverdale, Maryland, 20737, USA.
| |
Collapse
|
25
|
Monroe TB, Carter MA. A retrospective pilot study of African-American and caucasian nursing home residents with dementia who died from cancer. J Pain Symptom Manage 2010; 40:e1-3. [PMID: 20817471 PMCID: PMC6602905 DOI: 10.1016/j.jpainsymman.2010.06.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Revised: 06/21/2010] [Accepted: 06/24/2010] [Indexed: 11/17/2022]
|
26
|
Monroe TB, Carter MA. Hospice care in US nursing homes: benefits and barriers. Eur J Palliat Care 2010; 17:144-149. [PMID: 32218687 PMCID: PMC7098682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Todd B Monroe
- The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Michael A Carter
- The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| |
Collapse
|
27
|
Monroe TB, Carter MA. Biopsychosocial model & direct observation of behavior. Res Gerontol Nurs 2010; 2:4-5; author reply 5. [PMID: 20077987 DOI: 10.3928/19404921-20090101-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
28
|
|
29
|
Abstract
PURPOSE To describe the epidemiology of measles in Kenya and evaluate the Measles Initiative's (MI's) mass immunization campaign and its impact on measles control in Kenya. METHODS This descriptive study focused on evaluating the MI's simultaneous mass campaigns in the provinces of Kenya, the implementation process of the campaign strategy, post-campaign impact data, and pre-campaign measles trends. Secondary data were obtained from the Kenya Ministry of Health and MI documentation involving vaccine coverage, and morbidity and mortality rates. Analysis focused on program achievement with a comparison of immunization coverage results and program goals. OUTCOMES Campaign goals of vaccination coverage were successfully achieved, and subsequent surveillance data indicate significant decreases in measles morbidity and mortality. Barriers to participation, sociocultural factors, and environmental demographics were identified and addressed. IMPLICATIONS The success of the MI immunization program was the result of the commitment of expert international public health agencies in partnership with the Kenyan government. The strategies used for this successful public health activity can be applied to improve vaccination programs in other countries.
Collapse
Affiliation(s)
- Charlotte A Bradsher
- Adjunct Faculty, DNP Program, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
| | | | | | | |
Collapse
|
30
|
Abstract
Recent advances in technology, research, and knowledge have amplified the need for longer and more in-depth education for neonatal nurse practitioners (NNPs). In this article we will briefly review the history of NNP's role and education, define the Doctor of Nursing Practice (DNP), and propose that the practice doctorate is the primary mechanism to meet that need and thus is the future of our profession. Doctor of Nursing Practice programs are designed to prepare the practitioner as an expert clinical NNP. Graduates obtain the highest level of practice expertise integrated with the ability to translate scientific knowledge into complex clinical interventions tailored to meet individual, family, and community health and illness needs. Doctor of Nursing Practice education also expands the scientific basis for practice and clinical practice education, and provides organization and system management and leadership, quality improvement, analytic methods to evaluate practice and apply evidence to practice, enhanced skills in information technology, health policy development, and interdisciplinary collaboration for enhanced patient outcomes.
Collapse
Affiliation(s)
- Bobby Bellflower
- Regional Medical Center, Memphis, Tenn; University of Tennessee Health Science Center, College of Nursing, Memphis, Tennessee, USA.
| | | |
Collapse
|
31
|
Carter MA. Review: brief multicontact behavioural counselling interventions in primary care reduce risky or harmful alcohol use. Evid Based Nurs 2004; 7:108. [PMID: 15487085 DOI: 10.1136/ebn.7.4.108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Michael A Carter
- University of Tennessee Health Science Center, Memphis, Tennessee, USA
| |
Collapse
|
32
|
Kassenborg HD, Smith KE, Vugia DJ, Rabatsky-Ehr T, Bates MR, Carter MA, Dumas NB, Cassidy MP, Marano N, Tauxe RV, Angulo FJ. Fluoroquinolone‐Resistant CampylobacterInfections: Eating Poultry Outside of the Home and Foreign Travel Are Risk Factors. Clin Infect Dis 2004; 38 Suppl 3:S279-84. [PMID: 15095200 DOI: 10.1086/381597] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 12-month, population-based, case-control study of Campylobacter infections was conducted at Foodborne Disease Active Surveillance Network surveillance areas during 1998-1999. Of 858 Campylobacter isolates tested for antimicrobial susceptibility to the fluoroquinolone ciprofloxacin, 94 (11%) were resistant. Travel outside of the United States was reported by 27 (42%) of 64 patients with fluoroquinolone-resistant Campylobacter infection and by 51 (9%) of 582 patients with fluoroquinolone-susceptible Campylobacter infection (odds ratio [OR], 7.6; 95% confidence interval [CI], 4.3-13.4). When patients with domestically acquired fluoroquinolone-resistant Campylobacter infection were compared with matched healthy control subjects in a multivariate analysis, those infected were 10 times more likely to have eaten chicken or turkey cooked at a commercial establishment (18 [55%] of 33 case patients vs. 7 [21%] of 33 controls; matched OR, 10.0; 95% CI, 1.3-78). Although travel outside of the United States was associated with fluoroquinolone-resistant Campylobacter infection, most infections among study participants were domestically acquired. This study provides additional evidence that poultry is an important source of domestically acquired fluoroquinolone-resistant Campylobacter infection. Control measures should include efforts to improve food handling in commercial establishments.
Collapse
|
33
|
Carter MA. Review: group interventions may improve coping, quality of life, and social support in patients with arthritic conditions, but more research is needed. Evid Based Nurs 2004; 7:51. [PMID: 15106606 DOI: 10.1136/ebn.7.2.51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Michael A Carter
- University of Tennessee Health Science Center, College of Nursing, Memphis, Tennessee, USA
| |
Collapse
|
34
|
Carter M, Blunt M. Crit Care 2002; 6:P84. [DOI: 10.1186/cc1788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
35
|
Abstract
In the rapidly evolving healthcare environment, perhaps
no role is in greater flux and redefinition than that of
the clinical bioethicist. The discussion of ethics
consultation in the bioethics literature has moved from
an ambiguous concern regarding its proper place in the
clinical milieu to the more provocative question of which
methods and theories should best characterize the intellectual
and practical work it claims to do. The American Society for
Bioethics and Humanities addressed these concerns in its
1998 report, Core Competencies for Health Care Ethics
Consultation. The report tries to answer the question
as to what disciplinary training, background experience, and
levels of knowledge in ethics the clinical ethics consultant
should have, and what specific skills and character traits the
clinical ethics consultant should cultivate. In addition to
acquiring knowledge of common bioethical issues, theoretical
concepts in ethical theory and moral reasoning, and health-related
law and policy, the report also recommends that ethics consultants
demonstrate knowledge of the health beliefs and perspectives
of patients and healthcare providers. In our opinion, this
recommendation underscores a crucial aspect of the practice of
ethics consultation in the increasingly multicultural settings
of healthcare institutions. Clearly, the dynamic of American life
and culture is permeated with diversity and variety as new groups
suffuse their own beliefs and faith perspectives into the health
sector. New immigrant groups force society to question traditional
healthcare practices and to accommodate changing medical needs.
Collapse
Affiliation(s)
- M A Carter
- University of Texas Medical Branch, Galveston, USA
| | | |
Collapse
|
36
|
Abstract
This article explores ethical concerns and emerging dilemmas associated with the proliferation of information resulting from the extraordinary advances in molecular genetics. It provides an overview of the ethical and legal challenges associated with predictive testing for inherited disease currently being addressed in the literature. Finally, it offers a framework of ethical principles that can be used to guide nurses and other practitioners in the appropriate application of research findings to the clinical practice setting. The ethical guidelines of self-determination, benefit-burden ratio, and justice promulgated in The Belmont Report are interpreted in the new context of predictive genetic testing. The author concludes by discussing how to balance the technical imperative to advance genetic knowledge for the sake of human health with the ethical imperative to preserve the fundamental rights and liberties of both individuals and communities who are its recipients.
Collapse
Affiliation(s)
- M A Carter
- Institute for the Medical Humanities, University of Texas Medical Branch, Galveston 77555-1311, USA.
| |
Collapse
|
37
|
Brooks D, Anderson CM, Carter MA, Downes LA, Keenan SP, Kelsey CJ, Lacy JB. Clinical practice guidelines for suctioning the airway of the intubated and nonintubated patient. Can Respir J 2001; 8:163-81. [PMID: 11420592 DOI: 10.1155/2001/920160] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To provide physicians, physiotherapists, nurses and respiratory therapists with guidelines for the application of airway suctioning. DESIGN This clinical practice guideline was developed using the model by Browman and colleagues. A working group of representatives from four professional colleges (nurses, physicians and surgeons, physiotherapists and respiratory therapists) and research experts was formed to conduct a systematic review, develop evidence-based recommendations and generate clinical practice guidelines. MEDLINE (1966 to 1998), CINAHL (1982 to 1997) and EMBASE (1974 to 1996) as well as the reference lists of identified articles were searched. Inclusion of articles was determined by at least two group members, and studies were classified according to type. Randomized, controlled; randomized; and nonrandomized crossover and comparative cohort trials were grouped by type of intervention and population for use in the development of recommendations. Other observational and animal studies dealing with adverse effects of suctioning were included in the review but were not used in the development of recommendations. Input on the evidence-based recommendations was sought and incorporated from members of all four professions and from experts on content and methodology. SETTING Any setting (hospital or home) where suctioning is performed. POPULATION Intubated and nonintubated adults, infants and children. RESULTS AND CONCLUSIONS An attempt was made to develop recommendations in each of the subcategories of suctioning techniques addressed by at least one study. In some subcategories, definite recommendations were made (13 in adults, and three in children and infants); in other subcategories, insufficient evidence precluded recommendations. The recommendations addressed the following aspects of suctioning: preoxygenation, hyperinflation, insufflation, hyperoxygenation, hyperventilation, saline instillation, adaptor use, medication use, open and closed systems, and various types of catheters.
Collapse
Affiliation(s)
- D Brooks
- Department of Physical Therapy, University of Toronto, Ontario, Canada.
| | | | | | | | | | | | | |
Collapse
|
38
|
Boisaubin EV, Carter MA. Optimizing ethics services and education in a teaching hospital: rounds versus consultation. J Clin Ethics 2000; 10:294-9. [PMID: 10791279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Affiliation(s)
- E V Boisaubin
- Institute for the Medical Humanities, University of Texas Medical Branch, Galveston, Texas, USA
| | | |
Collapse
|
39
|
Carter MA. A synthetic approach to bioethical inquiry. Theor Med Bioeth 2000; 21:217-234. [PMID: 11073171 DOI: 10.1023/a:1009966824505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This paper attempts to sort out some of the current tensions and ambiguities inherent in the field of bioethics as it continues to mature. In particular it focuses on the question of the methodological relevance of theory or ethical principles to the domain of clinical ethics. I offer an approach to reasoning about moral conflict that combines the insights of contemporary moral theorists, the philosophy of American pragmatism, and the skills of rhetorical deliberation. This synthetic approach locates a proper role for moral theory in the practice of clinical ethics, thus linking abstract philosophical ideas about morality, humanity, suffering, and health to specific deeds, actions, and decisions in the concrete lives of particular individuals. The aim of this synthetic approach of bioethical inquiry is a rapprochement between theoretical knowledge in moral philosophy and the contextualized, relational, and practical understanding of what morality demands of us in our daily lives. I argue for a conception of bioethical inquiry that takes morality to be a study of certain practical, socially embedded concerns about matters of right and wrong, good and evil, as well as a study of the moral theories by which these actual concerns can be explored and critically evaluated.
Collapse
Affiliation(s)
- M A Carter
- Institute for the Medical Humanities, The University of Texas Medical Branch, Galveston 77555-1311, USA
| |
Collapse
|
40
|
Sojka MG, Carter MA, Thorns CJ. Characterisation of epitopes of type 1 fimbriae of Salmonella using monoclonal antibodies specific for SEF21 fimbriae of Salmonella enteritidis. Vet Microbiol 1998; 59:157-74. [PMID: 9549856 DOI: 10.1016/s0378-1135(97)00189-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Monoclonal antibodies (mAbs) were used to identify and characterise epitopes of type 1 (SEF21) fimbriae of Salmonella enteritidis. The distribution of the epitopes among salmonellas and other enterobacteria was investigated, as well as the influence of growth media and temperatures on their expression. At least four different epitope clusters were identified on SEF21 fimbriae of S. enteritidis. Two of these clusters were associated with fimbrial haemagglutinins that were either common to all salmonellae tested, or restricted only to S. enteritidis and S. dublin. The four epitope clusters were identified on type 1 fimbriae of most Salmonella serotypes, as well as non-haemagglutinating type 2 fimbriae of S. pullorum and S. gallinarum, and on many other enterobacterial species. The expression of the epitopes was affected by growth conditions.
Collapse
Affiliation(s)
- M G Sojka
- Department of Bacteriology, Central Veterinary Laboratory, Surrey, UK
| | | | | |
Collapse
|
41
|
Abstract
The U.S. health care system is more costly per person, is less accessible, focuses on more intensive levels of care, and has poorer outcomes than any other industrialized country in the world. Several solutions for these problems are suggested and all of these rely on the full use of nurse practitioners.
Collapse
Affiliation(s)
- M A Carter
- College of Nursing, University of Tennessee, Memphis, USA
| |
Collapse
|
42
|
Gonzalez CM, Kuzel T, Carter MA. Metastatic adenocarcinoma of the prostate to the orbit as a presenting symptom. J Urol 1997; 157:625. [PMID: 8996376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- C M Gonzalez
- Department of Urology, Northwestern University, Chicago, Illinois, USA
| | | | | |
Collapse
|
43
|
Carter MA. Ethical framework for care of the chronically ill. Holist Nurs Pract 1993; 8:67-77. [PMID: 8227227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
|
44
|
Abstract
The poor are at high risk for fire- and scalding-related injuries and deaths, many of which could be prevented by installing smoke detectors and reducing residential tap-water temperatures to safe levels. The goal of this study was to measure the prevalence of smoke detectors and safe tap-water temperatures among welfare recipients and compare subjects living in safe and unsafe homes. We interviewed 109 black women residing in inner-city Memphis who were receiving Aid to Families with Dependent Children and inspected their homes for functional smoke detectors and safe tap-water temperatures. Of the 533 residents reported to live in the homes visited for this study, 53.1% were not protected by smoke detectors. More crowded residences were substantially more likely to lack detectors. Most of the smoke detectors which were present were provided by landlords. Of 69 smoke detectors examined, 17.4% did not work. Of the 153 children age 0-5 years living in the homes we visited, 79.1% lived in residences with excessively hot tap water (> 54 degrees C). We conclude that additional efforts are needed to increase the use of smoke detectors and to decrease excessively hot tap water in the homes of welfare recipients.
Collapse
Affiliation(s)
- G B Sharp
- College of Graduate Health Sciences, University of Tennessee, Memphis 38163
| | | |
Collapse
|
45
|
Carter MA. Distant learning in nursing. NLN Publ 1992:99-103. [PMID: 1408716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
46
|
Sharp GB, Carter MA. Use of restraint devices to prevent collision injuries and deaths among welfare-supported children. Public Health Rep 1992; 107:116-8. [PMID: 1738802 PMCID: PMC1403609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Evidence that death and injury rates for young children involved in automobile collisions could be reduced if children were restrained prompted the State of Tennessee to pass the nation's first child passenger law, a law that became effective in January 1978. Although similar laws have now been enacted throughout the United States, usually restraint devices are not provided to low-income groups who may have difficulty affording them. Few studies have examined the use of such devices by welfare recipients. A total of 56 black women, receiving Medicaid and residing in inner city Memphis, were interviewed about their use of passenger restraints during automobile travel for their children ages 0-3 years. About two-thirds of the mothers interviewed said they rarely or never used child passenger restraint devices when transporting their child. Children age 3 years were significantly less likely to be transported in child restraint devices than younger children. Women who had received welfare payments for 3 years or more or who made fewer than one automobile trip a week with their child were significantly less likely to use child passenger restraints. These results suggest that, in spite of child passenger laws, automobile restraint devices are not used for a high percentage of children ages 0-3 years receiving medical care under State and Federal Medicaid programs. Since treatment costs are paid under these programs when children are injured in collisions, program administrators may have strong incentives to increase the proportion of these children being restrained while traveling in motor vehicles.
Collapse
Affiliation(s)
- G B Sharp
- Department of Biostatistics and Epidemiology, University of Tennessee, Memphis
| | | |
Collapse
|
47
|
Wright ME, Hudson MB, Carter MA, Hanson D, Christopher L. Death by Choice. Am J Nurs 1991. [DOI: 10.2307/3426786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
48
|
Wichman A, Carter MA. Bioethics at the National Institutes of Health. Kennedy Inst Ethics J 1991; 1:257-262. [PMID: 10114320 DOI: 10.1353/ken.0.0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The National Institutes of Health is the largest biomedical research institution in the world. It has become one of the world's most highly respected research centers in part because of its efforts over the years to provide the research community with leadership in both the ethical and scientific parameters of research involving humans. As its 113th birthday approaches at the turn of the century, its great legacy is providing an environment to stimulate and nourish the diversity and creativity of ideas, and thereby enable science to progress. This research must continue to be guided and tempered by consistent and critical federally-supported ethical analyses.
Collapse
Affiliation(s)
- A Wichman
- National Institute of Neurological Disorders and Stroke
| | | |
Collapse
|
49
|
|
50
|
|