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The purpose of this study was to describe patient outcomes in Army Medical Centers, identify differences in outcomes between mixed medical-surgical bed and specialty intensive care units (ICUs), and explore predictive models for outcomes attributable to nursing structure and processes. Data were collected from 138 patients and 103 nurses in four medical-surgical and four ICUs in two Army Medical Centers. Significant differences for unit type were found for length of stay and patient satisfaction with nursing care. Outcome predictive models were modest (adjusted [R.sup.2] = .16 to .24) and significant for length of stay, satisfaction with nursing care, satisfaction with pain management, and health status following discharge. Exploring differences and commonalities between military and civilian hospitals will ultimately provide insight into ways of improving patient outcomes and bettering the work environment of nurses. Keywords: military nursing; nursing structure; nursing processes; patient outcomes; patient satisfaction

Advocacy is an essential component of the registered nurse's professional role, yet experts provide no consistent definition of advocacy. The purpose of this study was to explore the experiences of military nurses as they engage in advocating practices and to describe their shared practices and common meanings. Heideggerian hermeneutic phenomenology, provided the framework and method for this study. Twenty-four U.S. Army nurses were individually interviewed and the researcher kept interview observational notes. The constant comparative method of analysis was used. The stories of these nurses revealed one constitutive pattern - safeguarding - and four related themes. The themes were advocating as protecting, advocating as attending the whole person, advocating as being the patient's voice, and advocating as preserving personhood. One conclusion was that military nurses must be prepared for the important safeguarding role. They must be coached in how to deal with other members of the health team on the patient's behalf.

There are few data-based reports about the perceptions of nurses toward marginalized groups and even fewer about the transformation of perceptions. The purpose of this study was to explore nurses' perceptions of people who are homeless and to describe transforming experiences. Rich, detailed experiences of the care provided to people who were homeless were elicited through in-depth interviews with 15 nurses and nursing students. Without exception, each participant in this study indicated that listening, connecting, and understanding were important to them in changing previously held negative beliefs. However when clients did not express appreciation or behave in expected ways, nurses became frustrated and voiced negative feelings about people who are homeless. Study findings emphasize the importance of listening and connecting with people who are different from ourselves so that our shared humanity is acknowledged and appreciated, People who are homeless are considered a marginalized group and sometimes viewed as undesirable clients by health providers (Hunter, Getty, Kemsley, & Skelly, 1991). Beliefs and attitudes toward groups of [...]

The purpose of this study was to understand nurses' perceptions and experiences regarding Quality of Life (QOL) of adolescents with complex congenital heart disease (CHD). Interpretive, hermeneutic, phenomenology was used to explore the perceptions and experiences of nurses who care for adolescents with complex CHD. The participants included 6 female registered nurses with experience taking care of adolescents with complex CHD. Data were collected using semi-structured interviews. Data analysis revealed 4 themes: QOL depends on how the psychological and social issues are interwoven with the physical; finding that balance between overprotection and too much freedom; setting goals to envision a future; and not being defined by a CHD. These results indicate that understanding nurses' perspectives and experiences may contribute to effective guidance for adolescents with complex CHD transitioning into adulthood. [ABSTRACT FROM AUTHOR]

Several ethical decision making processes help frame the series of actions leading to prevention of human immunodeficiency virus (HIV) infection for non-occupational exposure patients. The same post-exposure prophylaxis treatment regime recommended by the Centers for Disease Control and Prevention (CDC) for occupational exposure is appropriate in some circumstances. This article presents three ethical decision making processes described by Fremgen, Hinderer and Hinderer, and Nash. Ethical resolutions determined by using any of these processes, when applied by clinical practitioners and health care administrators, could greatly simplify this process. With dedicated commitment, treatment within the 48 hour maximum time frame recommended after initial exposure to HIV and instituting initial PEP treatment can occur. The literature and experience both indicate that fewer ethical dilemmas occur in the decision making body when the medication regime is adhered to by the at risk patient, and if drugs are prescribed in addition to providing prevention education which is designed to decrease repeat exposure to the virus. Additionally, lower viral load and potential prevention at initial or acute infection correlates with decreased cross infection to sexual partners unaware of their potential risk. Health care cost for HIV with progression to acquired immune deficiency syndrome (AIDS) is an ethical consideration for a seriously threatened health care economy. The literature supports a cost savings with the use of prophylaxis rather than treating HIV/AIDS. Implications for healthcare professionals when PEP is administered after rape and when requested after risky sexual activity are ethical considerations facing the 26th year of the HIV/AIDS pandemic. [ABSTRACT FROM AUTHOR]

Moral distress in healthcare results from a professional's inability to provide compassionate care to patients because of individual, organizational, or societal barriers. Research suggests that moral distress is a growing concern among nurses, and may be a major reason why nurses leave one job for another or abandon the profession of nursing. Some professionals, however, have identified strategies that help them work through their moral distress toward an experience of moral comfort. These strategies may be individual, organizational, or societal. The focus of this paper is to identify examples of strategies professionals have used to alleviate distressful feelings and enhance moral comfort.