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The purpose of this study was to construct a reliable and valid instrument to measure job satisfaction among nurse practitioners (NP). The methodological approach consisted of a literature review and modification of an extant instrument (Mueller/McCloskey, 1990) to reflect primary care, followed by augmentation and validation of the items suggested by nurse practitioner faculty members and Master's prepared nurse practitioners. A 77-item scale was developed and mailed to 413 NPs recognized by the state boards of nursing in two states. Usable returns were received from 342 (83%) NPs. Items were reviewed for validity prior to field-testing the instrument. The 77 items were subjected to exploratory factor analysis to support construct explication using the maximum likelihood method of extraction and a promax rotation. An eigenvalue cutoff of 1.0 and item-to-factor loadings of at least .35 were criteria that guided item retention. Thirty-three items were deleted. The resultant six factors were named: (a) intra-practice partnership/collegiality; (b) challenge/autonomy; (c) professional, social, and community interaction; (d) professional growth; (e) time; and (f) benefits. The six factors (subscales) produced internal consistency reliability estimates of .94, .89, .84, .86, .83, and .79, respectively. The 44 retained items were used to create the final version of the Misener Nurse Practitioner Job Satisfaction Scale (MNPJSS), with a possible maximum score of 264 using a 6-point Likert-type scale.

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To explore women's experiences and beliefs concerning zidovudine (AZT) therapy during pregnancy, short-answer and open-ended questions were asked of 322 human immunodeficiency virus (HIV)-infected women at increased risk for pregnancy. Specifically, we examined what women believed they had been told concerning AZT therapy during pregnancy by health care professionals and peers, experiences with taking AZT, how effective they believed AZT therapy to be, and if they would take AZT if they became pregnant. Women in the study were predominately African American (88%), single (79%), with a mean age of 32 years, and had annual incomes less than $10,000 (64%). Although 81.4% of the women had been told to take antiretrovirals, only 69.1% of the women were actually taking HIV-related medicines. Almost three-fourths of the women (70.8%) reported being told that taking AZT during pregnancy would reduce perinatal transmission. Women reported the most frequent reason for their stopping AZT was its side effects. When women who were not presently taking AZT were asked what would make them consider taking it, they most frequently said they would begin AZT if their health deteriorated or based on the advice of health care professionals. A small group of women said nothing would make them take AZT-type medications. More than one-half of the women said they felt AZT was effective in preventing perinatal HIV transmission. However, almost 20% of the women reported believing that their health care provider would not be positive about their taking AZT during pregnancy. Significant relationships were found between intent to take AZT if becoming pregnant and specific AZT-related beliefs and experiences.

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HIV disease continues to grow at a staggering rate among women, with women of color becoming the group most frequently affected. Previous research has supported hope as an important factor associated with better health, quality of life, recovery from illness, and increased survival in life threatening illnesses such as HIV disease. The purpose of this study was to describe levels of hope in HIV-infected, African-American women, and to examine the relationships among hope and the women's reported symptoms, stage of illness, and perceived relationship with her primary health care provider (PHCP). A descriptive, quantitative design was used. The sample consisted of 49 African-American women 18 to 45 years of age. Face-to-face structured interviews were conducted. Hope was measured using the Herth Hope Scale, and the quality of the relationship with one's PHCP was measured using the Relationship with the PHCP Scale. The level of hope in these HIV-infected women was lower than women with breast cancer and hospitalized adults with cancer. No significant differences were found in level of hope related to relationship status, income, stage of illness, or if a woman had or did not have children. Hope was positively associated with a more positive relationship with the PHCP (r = .33, P = .02). This finding underscores the importance of the quality of the PHCP's relationship with their clients.

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Despite the potential benefits of antiretrovirals, HIV-infected women may not be accepting or adhering to recommended drug therapies. To help women make informed decisions surrounding antiretroviral therapy, health care professionals need insight into how HIV-infected women decide to take or not to take antiretroviral drugs. The purpose of this study was to describe the influences affecting decisions made by women in the southern United States to accept and adhere to antiretroviral therapy. Focus group data with subsequent dimensional analysis were used to discover themes surrounding antiretroviral decisions among 22 women in two predominantly rural, southeastern states. The focus groups included some women who were currently taking antiretrovirals, some who had taken them in the past, and some who had never taken them. The analyses revealed four overarching themes that influenced women's decisions regarding antiretrovirals: health professionals, beliefs about antiretrovirals, side effects, and attitudes of peers and family.

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Safer-sex guidelines established during the early days of the HIV/AIDS epidemic have undergone very little revision despite some controversy. Although these guidelines have been widely disseminated in the gay community, many gay men continue to engage in behaviors that are believed to put them at high risk for transmission of HIV. This suggests either that they have not accepted safer-sex guidelines as accurate or that other factors override personal implementation of the guidelines. The study examined seronegative gay men's beliefs about the accuracy of safer sex guidelines and the men's participation in behaviors risky for transmitting HIV. The greatest disagreement between the men's beliefs and behaviors centered on the risk of oral intercourse; this suggests a need for clarification of the safer sex message about this behavior. The findings of this study support the need to reformulate safer-sex guidelines. When unprotected oral and anal sex are classified at the same level of risk, those who engage in unprotected oral sex may proceed to unprotected anal sex with less reservation.

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There is growing recognition that race and socioeconomic variables in health research demand greater attention. The investigators compared racial differences in health definition, health value, and health-promoting behavior of 62 pairs (N = 124) of Black and White college women matched on age, body mass index, and socioeconomic status. Both groups of women had similar definitions of health, valued health to the same extent, and reported similar levels of self-actualization, health responsibility, exercise, and stress management. Black women, relative to White women, practiced fewer nutrition behaviors and had less interpersonal support. Interventions to reduce health risk associated with nutrition practices of Black women are warranted and further research is needed to explore the influence of the social structure of educational institutions on interpersonal relationships and other health behaviors. When socioeconomic status is taken into consideration, Black and White college women demonstrated more commonalities in health behavior than differences.

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PURPOSE: To identify competencies needed by nurse leaders in public health programs. DESIGN: Five-round national Delphi. SAMPLE: Convenience sample of members of major public health nursing associations and nurse and non-nurse public health leaders in the USA. METHODS: Mailed survey in 1994-1995 using a modified snowball technique based on a modification of the Pew Foundation health professions' competencies for Round 1. Four additional rounds produced consensus. FINDINGS: Initially, 62 competencies were identified. Factor analysis resulted in four factors: political competencies, business acumen, program leadership, and management capabilities; 57 competencies were clustered in the four groupings and accounted for 91.4% of the variance. CONCLUSIONS: Graduate schools in nursing and public health must prepare students with broad-based competencies from a variety of disciplines. Findings of this national survey provide a database for curriculum development and evaluation of programs to prepare nurse leaders for roles in public health-based delivery systems.

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As the epidemiologic picture of HIV changes to include increased numbers of women of childbearing age, particularly those of African American heritage and those from rural southern cultures, those who provide services to these women need to understand the processes used by HIV-infected women to make reproductive decisions. Focus-group data with subsequent content analysis were used to discover themes surrounding pregnancy decisions among 22 women in two predominantly rural southeastern states. The results both validated and amplified previous findings and added new perspectives. The analyses revealed six overarching themes: spiritual and religious beliefs, knowledge and beliefs about HIV, previous experience with childbearing attitudes of families and sex partners, personal health, and intrapersonal motivation to have a baby.

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The purpose of this study was to assess the validity of the McCloskey/Mueller Satisfaction Scale (MMSS) in the West Bank, a dissimilar society and culture from the United States, where the instrument was developed. A second purpose was to measure the correlation between the MMSS total score and a single-item measure of job satisfaction. In contrast to the 31-item scale with eight factors of Mueller and McCloskey, four factors emerged in the current study: Interaction, Extrinsic Rewards, Control Over Work Environment, and Professional Participation. The resulting model is more similar to the original 1974 McCloskey conceptual framework than the 1990 eight-factor model.

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Testicular cancer is the most common solid tumor among men 20 to 34 years old, and it accounts for one of every seven deaths in late adolescent and young adult men. However, studies during the past 20 years continue to show that a majority of men in the most vulnerable ages are unaware of their risk for testicular cancer, deny having had testicular examinations as a part of their routine physical assessments, and lack knowledge of testicular self-examination techniques. This descriptive study used a mailed questionnaire and evaluated self-reported testicular cancer detection behaviors among primary care physicians (N = 116). Breast exams and colorectal screening were included for masking and comparative purposes. Forty-nine percent of the physicians reported routinely performing age-appropriate testicular exams on patients, in contrast to performing breast (83%) and colorectal exams (68%). Instructing male patients to perform testicular self-examination was reported as a routine procedure by 29%, and breast exams were taught routinely by 86% of the physicians. Providing an opportunity for patients to give a return demonstration of the technique was reported 16% of the time for breast self-examination and 4% of the time for testicular self-examination. Teaching patients to do appropriate self-examinations can enhance the provider-client partnership in the provision of healthcare. When providers do not teach the patient to perform self-examinations, a valuable opportunity is missed.

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The purpose of this study was to identify research questions and priorities in public health nursing based on the perceived needs of practicing public health nurses, and to assess whether the respondents believed that the profession should provide leadership in the study of the identified questions. Using a modified Delphi survey, 76 research priorities were ranked and produced three factors or categories of questions during the two rounds: outcomes in maternal-child and family planning, outcomes in home health services, and public health nurse recruitment, retention, job satisfaction, and image. Forty-seven (62%) of the 76 priorities were deemed appropriate for nursing to assume leadership in seeking answers. Results reveal a consensus of research priorities generated by front-line nurses consistent with year 2000 health objectives for the nation.

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The current sociopolitical and economic forces affecting health care may lead to job dissatisfaction among nurse practitioners, according to results of a South Carolina study. A mailed survey that consisted of the Index of Job Satisfaction and the Minnesota Satisfaction Questionnaire--Short Form was used to test Herzberg's dual-factor theory of job satisfaction. A response rate of 90 percent was attained, with a final sample of 132 nurse practitioners and midwives. Consistent with the predictions of Herzberg's model, intrinsic factors served as sources of job satisfaction, while extrinsic factors were the primary sources of job dissatisfaction. Nurse practitioners in the sample reported a moderate amount of satisfaction with their "overall jobs." Suggestions are provided for ways both nurse practitioners and health administrators can enhance job satisfaction.

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Job satisfaction influences employee retention, worker productivity, and performance quality. To retain qualified nurse practitioners (NPs), health administrators must identify sources of job satisfaction and dissatisfaction. Herzberg's dual-factor theory of job satisfaction addresses extrinsic and intrinsic work-related factors. Expansion of the model to include global job satisfaction and individual differences provided a broad framework for the assessment of nurse practitioner job satisfaction. The expanded model was used to analyze the job satisfaction of 132 NPs registered with the South Carolina State Board of Nursing in 1988 (final response rate = 90%). Participants completed the Index of Job Satisfaction (IJS), the Minnesota Satisfaction Questionnaire-Short Form (MSQ-SF), and the Personal and Work Background Questionnaire (PWBQ). Although the NPs were moderately satisfied with their overall jobs, extrinsic factors were found to be major sources of dissatisfaction. The optimal combination of variables predicted by regression analysis to influence global job satisfaction were age, number of children, urban locations, achievement, company policies and practices, creativity, independence, and compensation. Implications for health administrators to improve the work environments of NPs are discussed.

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Community health nurses who focus on the needs of the community as client, and not simply individual and family services, are aware of the demand for increased services. This demand, however, is usually coupled with the absence of resources to deliver the needed services. Therefore, leaders in community agencies must consider attracting nurses as volunteers to augment resources. Volunteer service can be highly synergistic when a symbiotic relationship exists between the agency and the volunteer. A one-year volunteer home visiting program was developed to provide services to families with new infants at one U.S. Army installation in the western United States. We assume the program methodology would be successful in civilian communities as well as other client populations.

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To determine whether nurses operationally define child maltreatment in a like manner regardless of their practice specialty, eight practice groups (N = 596) participated in a mail survey. The survey allowed nurses to judge the potential seriousness of child maltreatment incidents. Multivariate statistical analyses revealed significant group differences. Follow-up analyses of variance (ANOVAs) revealed a difference between anesthetists and community health nurses on one factor (parental sexual mores). However, an investigator-developed scale demonstrated the differences would lack substantive value in clinical practice. It was concluded that nursing specialty groups define similarly the seriousness of child abuse and neglect despite varied backgrounds.

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In a large-scale survey of rural consumers (n = 3,056), respondents were asked whether they would allow a nurse practitioner to perform each of 12 functions. The results indicate general acceptance of a broadly defined role for the nurse practitioner. Only two functions were not acceptable to a majority of the respondents. A factor analysis revealed two relatively weak factors, which were labeled nontraditional and traditional. Scores on a nurse practitioner acceptance scale, constructed from the 12 functions, were analyzed using analysis of variance and multiple regression. Acceptance of a nurse practitioner was greatest among respondents who are relatively young, male, whose income is relatively low, who are dissatisfied with the explanation of diagnosis and treatment they receive at their usual source of health care, and who are generally dissatisfied with their usual source of health care. None of these relationships, however, is strong.

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