The prevalence of migraine headache is 6% among men and 15% to 17% among women. (1) However, no standardized approach exists for the treatment of acute migraine headache. Systematic reviews of randomized controlled trials (RCTs) summarized that oral sumatriptan (Imitrex), eletriptan (Relpax), and rizatriptan (Maxalt) reduced migraine headache pain and increased the pain-free response rate for adults when compared with placebo. 2-4 The number needed to treat (NNT) ranged from 3.9 to 9.9 for a given triptan’s lower dose to 2.6 to 5.1 for the higher dose. (2-4) RCTs reported superior efficacy of oral almotriptan (Axert), frovatriptan (Frova), and zolmitriptan (Zomig), as well as intranasal sumatriptan and zolmitriptan when compared with placebo.

The following NSAIDs reduced headache severity more than placebo 2 hours after treatment: aspirin (1000 mg; NNT=2.4), ibuprofen (1200 mg; NNT= 1.8), naproxen (750 mg; NNT=2.0), tolfenamic acid (not available in the US; NNT=1.2), and the combination product of acetaminophen/aspirin/caffeine (Excedrin Migraine, et al) (NNT=1.7). (5) Acetaminophen 1000 mg orally has been reported to be superior to placebo for treating pain, functional disability, and photo/ phonophobia among patients who did not require bedrest with their headaches and did not vomit more than 20% of the time. However, it was not superior to placebo when given intravenously for more severe acute migraine. No placebo-controlled trials exist for the use of ketorolac (Toradol); there are only comparison studies against other active migraine medications. Ketoprofen (Orudis) has placebo-controlled RCT data supporting its efficacy.

A meta-analysis (6) of RCTs of parenteral metoclopramide (Reglan) revealed significant pain reduction (odds ratio [OR]= 2.84; 95% confidence interval [CI], 1.05-7.68). When compared with other antiemetics (chlorpromazine [Thorazine] and prochlorperazine [Compazine]), metoclopramide was either less effective (OR=0.39; 95% CI, 0.18-0.87) or no different (OR=0.64; 95% CI, 0.23-1.76) than other therapies for reducing migraine pain. No difference was noted between parenteral metoclopramide and subcutaneous sumatriptan (OR=2.27; 95% CI, 0.64-8.11); however, metoclopramide was more effective than ibuprofen in pain reduction scores (standard deviation data missing in this study).

A systematic review (7) revealed that dihydroergotamine (DHE) alone was less effective than subcutaneous sumatriptan in migraine pain reduction (OR=0.44; 95% CI, 0.25-0.77) or headache resolution (OR=0.05; 95% CI, 0.01-0.42). No differences were seen between DHE alone and chlorpromazine or lidocaine. Three studies revealed DHE plus metoclopramide was more effective than or equal to other agents for headache pain reduction at 2 hours: one vs ketorolac IM (OR=7; 95% CI, 0.86-56.89), one vs meperidine (Demerol) plus hydroxyzine (Vistaril, Atarax) IM (OR=47.67; 95% CI, 4.32-526.17), and one vs valproate IV (OR=0.67; 95% CI, 0.19-2.33). (7) Specifically, treatment with DHE plus metoclopramide was superior to ketorolac for pain reduction (P=.03), but patients did not differ in disability scores (P=.06). DHE plus metoclopramide achieved greater reductions in pain scale scores than meperidine plus hydroxyzine (P<.001). No significant difference in pain reduction was noted between DHE plus metoclopramide and valproate (P=.36).

A multicenter, double-blind, randomized parallel group study (8) showed no difference between the combination product isometheptene mucate, dichloralphenazone with acetaminophen (Midrin, Duradrin, etc) (used as recommended in the package insert with a maximum of up to 5 tablets within 24 hours) vs oral sumatriptan (initial dose of 25 mg with a repeat 25 mg dose in 2 hours). No placebo arm was used in this study.

Recommendations from others

The Institute for Clinical Systems Improvement recommends the use of vasoactive drugs over narcotics and barbiturates for treatment of moderately severe migraine headaches. (9) The American Academy of Neurology recommends migraine-specific medications (triptans, DHE) for moderate to severe migraines or those mild to moderate migraines that responded poorly to NSAIDs or other over-the-counter preparations. (10)

EVIDENCE-BASED ANSWER

Medications collectively referred to as “triptans” (eg, sumatriptan, naratriptan, etc) have been shown to be effective for acute migraine (strength of recommendation [SOR]: A). Nonsteroidal anti-inflammatory drugs (NSAIDs)–including aspirin, ibuprofen, naproxen sodium, diclofenac potassium, ketoprofen, tolfenamic acid, and ketorolac–are also effective (SOR: A). The combination of acetaminophen/aspirin/ caffeine is effective (SOR: B). Parenteral dihydroergotamine (DHE), when administered with an antiemetic, is as effective as, or more effective than meperidine, valproate, or ketorolac (SOR: B). Prochlorperazine is more effective than metoclopramide in headache pain reduction (SOR: A). Isometheptene mucate/dichloral-phenazone/acetaminophen is as effective as low-dose oral sumatriptan (SOR: B).

Joining AFP’s list of selections drawn from systematic evidence reviews is a new series excerpted from the BMJ Publishing Group’s Clinical Evidence. On page 99 is the first in a series of chapters excerpted from BMJ’s collection of systematic reviews of evidence supporting key treatment recommendations on important clinical topics. Jay Siwek, M.D., editor of AFP, and Stuart Barton, M.D., editor-in-chief of Clinical Evidence, announce the collaborative effort in an editorial on page 27 of this issue. You won’t want to miss this introduction, which provides background on the BMJ Clinical Evidence series and explains how the new AFP feature ties in with other recently introduced components aimed at strengthening our approach to evidence-based continuing medical education (CME).

The BMJ Clinical Evidence series will appear regularly in AFP and will cover one topic each time, selected on the basis of relevancy to family practice. Full text for each topic selected for the series will appear on AFP’s Web site at www.aafp.org/afp. Because of the importance of incorporating evidence-based recommendations into practice, AFP is reinforcing concepts from the BMJ series by covering these topics in the “Clinical Quiz” (see page 25).

Another series recently introduced in AFP is “Cochrane for Clinicians: Putting Evidence into Practice,” which consists of case studies and critiques based on the Cochrane Collaboration. Two other new series are executive summaries of reports from the U.S. Preventive Services Task Force and the related case studies and quizzes called “Putting Prevention into Practice: An Evidence-Based Approach,” drawn from evidence collected by systematic reviews conducted under the auspices of the Agency for Healthcare Research and Quality. These series are also now part of AFP’s CME offering.

More exciting developments in AFP’s CME are under way as this year begins. Last summer we announced that AFP was going to start asking authors to identify, when possible, the strength of evidence supporting key recommendations for all clinical reviews. We are presenting the first strength-of-evidence labeling in the article on page 75 of this issue, entitled “Influenza in the Nursing Home,” by Brian J. Kingston, M.D., and Charles V. Wright, Jr., M.D., M.M.M. Our editors have worked together with the authors of the article to provide ratings of evidence according to AFP’s new system, which is explained on page 72.

For more details on AFP’s evidence rating system, please consult the “Information for Authors” online at www. aafp.org/afp/authors.html. There you will have an opportunity to preview updated author guidelines and a special article on writing evidence-based clinical reviews, by Dr. Siwek and colleagues Margaret L. Gourlay, M.D., David C. Slawson, M.D., and Allen F. Shaughnessy, Pharm.D. However, if you find yourself short of time during the post-holiday crunch, you can wait for the article and updated author guidelines to arrive in the January 15 issue.

We have one more announcement to kick off the new year: AFP has with this issue added a special new forum to enhance opportunities for academic exchange from readers. “Letters to the Editor,” traditionally a print medium, has been expanded to include extra letters online (available through the online table of contents at www. aafp.org/afp; see page 31 for list of online letters).

Culica, D., Rohrer, J., Ward, M., Hilsenrath, P., and Pomrehn, P. 2002. Medical checkups: Who does not get them? American Journal of Public Health 92(1):88-91.

Modern medical technology and economic impositions tend to dehumanize the medical patient. This paper describes a targeted use of the hypnotic modality for relationship building, symptom management, and restoring a sense of self to the patient. To humanize medical care one patient at a time, examples are given for the use of the Hypnotic Induction Profile, the Eye Roll sign and AOD (Apollonian - Odyssean - Dionysian) Mind-Style Questionnaire as a basis for choosing biopsycho-social treatment strategies. This trio of assessments can be used together, in approximately 10 to 15 minutes, or separately, if treatment decisions need to be made in a few minutes or less. The hypothesis presented is that matching treatment strategies, with or without formal hypnosis, to hypnotic capacity and mind style can increase respectful care and efficacy of treatment outcome. Clinical examples will illustrate this approach to enhance recovery, morale, and maximize patients’ ability to become active partners on their own behalf.

The hypnotic modality is a practical and effective way to help people cope with major medical problems and all forms of life stress. A variety of therapeutic approaches and applications have been developed for people who are in immediate crisis as well as those facing chronic problems - sometimes involving matters of life and death (H. Spiegel & D. Spiegel, 2004; H. Spiegel, Greenleaf & D. Spiegel, 2005). Whether for medical patients facing mastectomy, breast reconstruction, ovarian cancer, organ transplants, open heart surgery, prostate cancer, radiological procedures, orthopedic repair, accident victims, chronic illness, and more; patients can learn to alter physiological responses and manage psychosocial issues (Anderson, Frischholz & Trentalange, 1988; Frischholz & Tryon, 1980; Ewin, 1999; Ginandes & Rosenthal, 1999; Ginandes, Brooks, Sando & Aker, 2003: Greenleaf, 1992; Greenleaf, Fisher, Miaskowski,& DuHamel, 1992; Kessler& Dane, 1996; Lang, Joyce, D. Spiegel, et al, 1996; Lang, Benotsch, Pick, et al, 2000; Lynch, 1999; Montgomery, Weltz, Seltz & Bovbjerg, 2002; Pinnell & Covino, 2000; D. Spiegel, 1993; H. Spiegel & D. Spiegel, 2004; H. Spiegel, Greenleaf, D. Spiegel, 2005). Attitude, morale, perception and mental focus can and do make a critical difference in coping, healing, and recovery. Sensitivity to the non-specific factors of belief systems in the healing process enhances the possibility of positive treatment outcome (A. Shapiro & E. Shapiro, 1997).

Becoming a Patient: Frontline Issues

As benefits increase from high-tech medicine and advances in medical specialization, many individuals are faced with making a “degrading shift from person to patient” (Carey, 2005). There are a wide variety of psychological and physical demands involved in undergoing diagnostic procedures, surgical interventions, and potentially toxic treatments. Mammography, sonograms, biopsies, chemotherapies, thallium stress tests, MRI’s, cardiac catherizations, organ transplants - to name but a few - bring on high anxiety. Patients and loved ones are forced to deal with the unexpected. In addition, while dealing with the stressors of medical practice, personal identity is often threatened as the patient and family members become part of an impersonal bureaucratic system.

When faced with the necessity of undergoing such procedures, specialized knowledge is needed by professional care givers to make good decisions about how to help persons cope and cooperate under stress (Greenleaf, 1992).

In general, people begin this journey seriously uninformed and unprepared. At the same time a person needs supportive help to manage the healthcare system, medical specialization tends to complicate coordination of care and may strain doctor-patient relationships (Carey, 2005). Under pressure from HMO’s, insurance companies, hospital administrations or the government, physicians are forced into ever higher volumes of patients and lower staffing. Hospitals themselves are driven to get patients out faster - sometimes with their wounds still draining-following the dictates of what insurance companies will and will not pay for (Bogdanich, 1991). For the patient and loved ones, a sense of isolation and being lost in a foreign territory intensifies feelings of helplessness and anxiety (Gross, 2005). Waiting for a diagnosis or prognosis - be it for a few hours or a few weeks - can compound the stress of the original physical insult. Fear and anxiety and the helplessness that accompanies them are powerful enemies of healing and recovery.

While much has been written about spontaneous trance under conditions of psychological trauma and physical abuse (Kluft, 1999; D. Spiegel, 1996; H. Spiegel & D. Spiegel, 2004), there are also spontaneous trance states (or “Trance-Equivalent States,” Ewin, 1999), that occur to accident victims, combat causalities and medical patients under the stress of physical trauma, acute medical problems and hospitalization (Greenleaf, Fisher, Miaskowski, & DuHamel, 1992; H. Spiegel, 1997, H. Spiegel, 2000).

The UCLA Medical Center and Hospital System hired Amir Dan Rubin as chief operating officer. Rubin was previously chief operating officer for the Stony Brook University Hospital in New York.

This study used a sample of 209 repeat-respondent medical technologists over a 4-year period to investigate correlates of intent to leave one’s job. Correlates measured included two job search behaviors (i.e., preparatory and active) and three job search motives (i.e., gain leverage, leave employer, and family related). Results showed that active job search and the leave employer job search motives were each positively related to final intent to leave one’s job. The gain leverage job search motive was negatively related to final intent to leave one’s job. In addition, job satisfaction was negatively related, while only initial job loss insecurity was positively related, to final intent to leave one’s job. J Allied Health 2006; 35:94-100.

JOB SEARCH remains an important applied topic and research area for study across different samples, for example, graduating students entering the job market,1,2 the unemployed,3-5 and the employed.6-8 Job search is also a topic of international interest.4,9-11 Recent research on further understanding job search has focused on personality-motivation and cognitive ability variables,7 including a meta-analysis by Kanfer et al.12 The dominant research samples captured in the meta-analysis by Kanfer et al. were individuals entering the job market following a period of full-time education or those who were unemployed. Boudreau et al.7 argued for focusing more job search research on those currently employed because they compose a larger domain. There is a current general shortage of health care employees in the United States, including nursing, radiologic technology, and medical technology employees.13-15 Any type of labor shortage in a particular occupation can make it easier for those currently employed to change jobs across organizations.16 The purpose of this study was to further investigate the impact of correlates on medical technologists’ intent to leave their jobs.

Why Do the Employed Job Search? Different Motives

Using a sample of higher-level managers, Boswell et al.6 distinguished between specific leverage-seeking versus separation-seeking job search motives or objectives. They found that leverage-seeking but not separation-seeking search was positively associated with actual use of leverage one year later, while separation-seeking but not leverage-seeking search was positively associated with voluntary turnover one year later.

Bretz et al.17 observed that because job search activity may not always be associated with separation, there can be greater observed variance in search behavior than turnover. Using a sample of 1,388 employed managers, Bretz et al.17 found that a considerable amount of managers’ job search activity did not lead to subsequent voluntary turnover. Whether it leads to voluntary turnover or not, job search by itself can be a costly behavior because it can distract an employee from his or her current job duties18 or reduce the employee’s commitment to his or her current employer.19

Beyond its relevance to voluntary turnover, research has suggested that job search can serve several other distinct purposes for the employed.17 A second “motive” suggested for job search is to increase one’s leverage or advantage in a current job,20 such as gaining higher pay or other improved employment conditions. Clearly this motive is related to at least some degree of employee unhappiness with the current job situation. However, this motive suggests that employees do not necessarily want to leave their employer but to improve their situation (e.g., pay, promotion) while remaining with their current employer.21 Deshpande and Schoderbek22 found that getting a job offer elsewhere was used by subordinates to get a pay raise from their current boss. There can be “other” motives for job search, such as family related. For example, if one’s working spouse is transferred, the affected individual must now find a new job in the working spouse’s new location. Another family-related reason for job search is if an employee moves to be closer to an elderly parent to help care for that parent.16

Job Search Activity

For an individual who voluntarily changes jobs, most prior turnover research suggests that the closest proximal determinant to such change is the intent to leave that job.”16,23 Prior theory on job search activity suggests distinct preparatory and active search phases (Rees24 and Soelberg,25 as noted by Power and Aldag26). During the preparatory phase, individuals gather their resources (e.g., prepare/revise their resume, research getting/changing jobs) and collect potential job leads through various sources (e.g., Internet, newspaper, friends, previous employers); in the active phase, individuals apply to specific job positions/employers they have identified (e.g., sending a resume to or interviewing with an employer, filling out a job application). Generally, it is assumed that preparatory job search precedes active job search, because often individuals will want to first determine the perceived availability of “greener pastures” (preparatory job search) before determining their accessibility,27 which involves active job search.
 

To obtain CME credits, complete the test below, following these guidelines:

1. Read each article carefully.

2. Choose the most appropriate response to each of the following questions and record these on the registration form. Unanswered questions are considered incorrect.

3. Send the completed registration form and your payment (check, money order, VISA, MasterCard, American Express) to the Center for Continuing Education, University of Nebraska Medical Center (UNMC).

4. After your test has been graded, you will receive a receipt, a copy of the correct answers, and a credit statement certifying completion from the UNMC. Questions about the test should be addressed to UNMC Center for Continuing Education (402-559-4152).

Credit: The University of Nebraska Medical Center, Center for Continuing Education is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The University of Nebraska Medical Center, Center for Continuing Education designates this educational activity for a maximum of 3 hours in category 1 credit towards the AMA Physician’s Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity.

This CME activity was planned and produced in accordance with the ACCME Essentials.

1. Schweinfurth, in this month’s Laryngoscopic Clinic, cites a source that reports as much as what percentage of patients in whom stenosis occurs after they have been subjected to more than 10 days of endotracheal intubation?

a. 1.4%

b. 4.1%

c. 14%

d. 41%

2. What should be monitored in patients who are on long-term minocycline therapy, according to Pantanowitz and Tahan’s recommendation in this month’s Pathology Clinic?

a. thyroid function

b. liver function

c. kidney function

d. blood pressure

3. According to Ruenes and Palacios in this month’s Imaging Clinic, approximately 20% of extramedullary plasmacytomas occur in the head and neck.

True or False?

4. With which of the following statements regarding juvenile xanthogranuloma would Sahhar and colleagues disagree?

a. It is benign.

b. It is the least common form of non-Langerhans’ cell histiocytosis.

c. It usually appears as a localized cutaneous lesion.

d. When lesions occur cutaneously, they can be either solitary or multiple.

5. Of the following, which is the most common extracutaneous site of juvenile xanthogranulorna, according to Sahhar et al?

a. larynx

b. spleen

c. kidney

d. eye

6. According to Cinar et al, which of the following terms is/are synonymous with oncocytic carcinoma?

a. oncocytic adenocarcinoma

b. malignant oncocytoma

c. malignant oxyphilic adenoma

d. all of the above

7. Cinar et al state that radiation does not appear to favorably alter the biologic behavior of oncocytic carcinoma.

True or False?

8. According to a source cited by Purcell and her colleagues, prominent ears occur in approximately what percentage of the population?

a. 3%

b. 5%

c. 7%

d. 9%

9. According to the article by Church et al, which of the following statements regarding pigmented villonodular synovitis is false?

a. It is a malignant disease.

b. It usually involves a major joint.

c. It arises from the synovial membranes of the joints, bursae, and tendon sheaths.

d. It is usually monarthric.

10. At which of the following sites does pigmented villonodular synovitis occur most frequently?

a. hip

b. ankle

c. knee

d. shoulder

A number of clinical experts have contributed to the revised and updated edition of this manual, which contains organized sections about more than 145 health disorders. Each section provides current information related to a disorder, suggested NANDA-approved care plans, flow charts, resources, and suggested readings. The book also contains the newest infection prevention and control guidelines issued by the Centers for Disease Control and Prevention.

This manual will be a valuable resource for all health care providers, especially student nurses. It is small enough to be stowed in a purse, backpack, or laboratory coat pocket to use for reference during clinical rotations. It also will be a useful resource for writing care plans and research papers.

The information is current and presented in a concise format. Each section begins with the NANDA diagnosis and a suggested nursing care plan. Readers are given a clear direction to assess, plan, and implement patient care. For example, the chapter on perioperative care begins with a diagnosis of patients’ deficient knowledge about the surgical procedure. The expected outcome is that patients will verbalize knowledge about the surgical procedure, including preoperative preparations and sensations and postoperative care and sensations. The instruction continues with assessment and clarification of understanding, acting on necessary patient education and interventions, and discussion of postoperative activities and exercises. Other nursing diagnoses follow the same format.

In any patient care plan, one diagnosis usually is not enough to provide complete, quality care. The references noted at the end of each section refer readers to related health disorders and care plans incorporating holistic care. Some sections give detailed information about web sites and addresses and telephone numbers of organizations that can act as resources and assist with continued research. This book is a valuable reference that belongs in every student nurse’s book bag, health care provider library, and hospital unit.

Background and Purpose. Little quantitative research exists describing the effectiveness of instructional strategies for developing medical screening and patient referral abilities of physical therapist (PT) professional degree students. The purpose of this study was to compare the effectiveness of 2 patient case-based instructional strategies designed to promote these abilities: (1) a traditional lecture (TL) format and (2) student/faculty role-playing (RP) sessions.

Methods/Model and Description and Evaluation. Fifty-one first-year Master of Physical Therapy (MPT) students enrolled in a cardiopulmonary course volunteered to participate in the study. Four patient cases were presented in either a TL or RP format. After completion of the instructional unit, students took a written examination, rated their levels of confidence in medical screening and patient referral abilities, and completed a unit evaluation assessing the instructor’s behavior and teaching methods.

Outcomes. Compared to the TL group, the RP group: (1) achieved higher overall scores on the written examination (P = .01), and on questions representing the Application level of Bloom’s Taxonomy (P = .01); (2) reported higher self-confidence in medical screening and patient referral abilities (P

Discussion and Conclusion. The RP group’s examination performance, self-confidence, and satisfaction appeared to be enhanced by the teaching strategy, rather than student characteristics or instructor bias. Our results suggest that case-based active learning activities including RP strategies should be incorporated into physical therapist education program curricula to develop medical screening and patient referral skills.

In order to assume the role of diagnostician, the physical therapist (PT) student must learn how to recognize patients for whom a referral to other health care professionals is warranted. The importance of physical therapists fulfilling this role is illustrated in several published patient case reports where early identification of patients requiring the expertise of a physician resulted in a more timely diagnosis of diseases associated with morbidity and mortality.1-9 The diseases described in these case reports included cancers, infections, and acute exertional rhabdomyolysis, reflecting the possible urgent nature of the referral of patients presenting with suspicious findings.

The term medical screening has been used to describe this process resulting in the patient referral (most often to a physician or a physician extender, such as a nurse practitioner or a physician assistant).10,11 Medical screening includes the collection of data relevant to this aspect of clinical decision making (eg, patient medical and family history, investigation of symptoms, review of systems, and systems review) during the examination element of patient/client management.11,12 The decision of whether to proceed with intervention or to initiate a referral is the first phase of the differential diagnostic process utilized by physical therapists.13 The importance of this step is underscored by the fact that it is described throughout the Guide to Physical Therapist Practice under the “Five Elements of Patient/Client Management Model,” in the Standards of Practice for Physical Therapy and Criteria, and in the Guide for Professional Conduct.12

Once the PT decides to refer a patient to another health care provider, he or she must: (1) determine the urgency of the action (eg, concerns of a life-threatening nature or nonurgent concerns); (2) decide what type of practitioner should be contacted (eg, physician, nurse practitioner, clinical psychologist, etc); (3) prioritize the list of patient concerns to be communicated from most important to least important; and (4) effectively make the referral itself. Davis14 noted the importance of the physical therapist’s communication skills; the PT must know how best to contact the practitioner (eg, written note, phone call, etc) and how to request the needed consultation. The PT’s clear articulation of relevant patient data is essential for the consulted practitioner to take appropriate action. Such data includes patient demographics and findings of concern from the history, physical examination, and tests and measures, with the findings prioritized in order of importance. The effectiveness of the referral also depends on the physical therapist communicating in a professional manner, that is, introducing himself or herself properly and using appropriate terminology. Finally, the referral must be made in a timely fashion.10 This process sounds relatively easy and straightforward, but in clinical practice arenas it can be extremely complicated. The challenge to PT educators is determining how to best foster the development of medical screening and patient referral skills.

Stith et al15 presented a professional (entry-level) curriculum designed to prepare physical therapist diagnosticians. These authors noted the importance of identifying clusters of symptoms and signs associated with significant medical conditions that mimic the musculoskeletal disorders commonly treated by physical therapists. Moreover, they emphasized the need for students to recognize the “red flag” manifestations that would result in the immediate referral of the patient to a physician. DavisH presented a model for teaching diagnosis to postprofessional PT students. This model is based on the premise that passage of direct access legislation and the assumption of primary care roles by physical therapists both necessitate the identification of clinical “red flags” and referral to other health care practitioners when warranted.

PURPOSE. To compare the Nursing Interventions Classification (NIC) interventions used in two countries, Korea and the United States.

METHODS. Data were collected from 167 nurses working in eight hospitals in Korea and analyzed with descriptive statistics.

FINDINGS. Korean nurses selected 202 interventions, nine of which were used by more than 50% of nurses surveyed. In comparison, the Academy of Medical-Surgical Nurses (AMSN) in the United States identified 68 interventions as core interventions. Among the top ranked 68 interventions selected by Korean nurses, 29 (43%) matched those selected by U.S. nurses.

CONCLUSION. The nursing interventions selected by Korean nurses were more heavily focused on the physiologic domain than those selected by the U.S. nurses.

PRACTICE IMPLICATIONS. The identified intervention lists can be used to develop nursing information systems, staff education, competency evaluation, referral networks, certification and licensing exams, and educational curricula for nursing students.

Comparaison des interventions réalisées par les infirmières de Médecine-Chirurgie en Corée et aux Etats-Unis

BUTS. Comparer les interventions (tirées de la Classification des Interventions) utilisées dans deux pays: La Corée et les Etats-Unis.

MÉTHODES. Les données furent collectées auprès de 167 infirmières travaillant dans huit hôpitaux Coréens et furent analysées à l’aide de statistiques descriptives.

RÉSULTATS. Les infirmières Coréennes ont choisi 202 interventions, neuf d’entre elles furent utilisées par plus de 50% des infirmières incluses dans l’étude. En comparaison, l’Académie des Infirmières en Médecine-Chirurgie (E.U.) ont identifié 68 interventions clés. Parmi les 68 premières interventions choisies par les infirmières Coréennes, 29 (43%) correspondent à celles qui ont été choisies par les infirmières Américaines.

CONCLUSION. Les interventions de soins choisies par les infirmières Coréennes furent plus fortement centrées sur les domaines physiologiques que celles choisies par leurs collègues Américaines.

IMPLICATIONS POUR LA PRATIQUE. L·s listes d’interventions identifées peuvent être utilisées pour développer des systèmes d’information, la formation du personnel, l’évaluation de la compétence, les réseaux de soin, les examens de certification et les programmes de formation des étudiantes infirmières.

Translation by Cécile Boisvert, MSN, RN

Comparaçao das Intervençoes Realizadas por Enfermeiras Médico-Cirúrgicas na Coréia e nos Estados Unidos

OBJETIVO. Comparar as intervençoes contidas na classificaçao de intervençoes de Enfermagem (NIC) usadas nos dois paises, Coréia e Estados Unidos.

MÉTODOS. Os dados foram coletados com 167 enfermeiras que trabalhavam em oito hospitals na Coréia e analisadas com estaticista descritiva.

RESULTADOS. As enfermeiras coreanas selecionaram 202 intervençoes, nas quais foram usadas por mais de 50% das enfermeiras entrevistadas. Em comparaçao, a Academia de enfermeiras médico-cirúrgicas (AMSN) nos Estados Unidos identificaram 68 intervençoes como principals. Dentre as 68 intervençoes como principals. Dentre as 68 intervençoes mais importantes selecionadas pelas enfermeiras coreanas, 29 (43%) coincidiram corn aquelas selecionadas pelas enfermeiras americanas.

CONCLUSAO. As intervençoes selecionadas pelas enfermeiras coreanas foram mais fortemente focadas no domínio fisiológico do que aquelas selecionadas pelas enfermeiras americanas.

IMPLICAÇOES PARA A PRÁTICA. As listas das intervençoes identificadas pode ser usada para o desenvolvimento de sistemas de informaçao de enfermagem, educaçao-permanente da equipe, avaliaçao da competência, rede de referências, exames de certificaçao e licença e currícula educacional para estudantes de enfermagem.

Translation by Alba Leite de Barros, PhD, RN

Estudio Comparative de las Intervenciones Enfermeras Realizadas por Enfermeras Especialistas Médico-Quirúrgicas en Korea y Estados Unidos (EUA)

PROPOSITO. Realizar un estudio comparativo entre las intervenciones enfermeras de la taxonomía NIC (Clasificación de las Intervenciones Enfermeras) utilizadas en dos paises, Korea y EUA.

METODOLOGÍA. Los datos fueron recogidos entre 167 enfermeras que trabajaban en ocho hospitales de Korea y fueron analizadas utilizando medidas estadísticas descriptivas.

HALLAZGOS. Las enfermeras koreanas seleccionaron 202 intervenciones, nueve de las cuales fueron utilizadas por más del 50% de las enfermeras estudiadas. A diferencia, la Academia de Enfermeras especialistas Médico-quirúrgicas (AMSN) de los EUA, había identificado 68 intervenciones enfermeras. Entre las 68 intervenciones seleccionadas más frecuentemente por las enfermeras koreanas, 29 (43%) coincidían con las seleccionadas por las enfermeras americanas.

CONCLUSION. Las intervenciones seleccionadas por las enfermeras koreanas estaban más centradas en el dominio fisiológico que las seleccionadas por las enfermeras americanas.