Benko, Josip NRSG-445 April 4. 2013 Article Critique !

"ctors Associ"te# $it% &otenti"ll' &re(ent")le *ospit"li+"tion in Nursin, *o-e Resi#ents in Ne$ .ork St"te/ A Sur(e' o0 1irectors o0 Nursin,2 1. Research Problem Statement a. Identified 3ncre"se in pre(ent")le %ospit"li+"tion in p"tients $%o "re resi#ents o0 nursin, %o-es b. Significant .es, t%is is si,ni0ic"nt )ec"use t%e nu-)er o0 el#erl' p"tients li(in, in nursin, %o-es is e(er incre"sin, c. Researchable .es, t%is is rese"rc%")le )ec"use t%ere is " l"r,e "-ount o0 c"n#i#"tes in nursin, %o-es d. Feasible .es, t%is is "n issue 0"cin, e(er' p"tient in " nursin, %o-e e. All Components Identified .es Population: 4l#erl' resi#ents o0 nursin, %o-es Independent Variable: pre(ent"ti(e sickness "cquire# in " nursin, %o-e Dependent Variable: nu-)er o0 p"tients requirin, %ospit"li+"tion Problem: 5%ere is " l"r,e nu-)er o0 p"tients $%o require %ospit"li+"tion 0or re"son t%"t s%oul# %"(e )een pre(ente# . Research Purpose Statement a. Stated 5o #escri)e c%"r"cteristics o0 Ne$ .ork St"te nursin, %o-es "n# i#enti0' 0"ctors "ssoci"te# $it% potenti"ll' pre(ent")le %ospit"li+"tion in nursin, %o-e resi#ents2 6p,. 7018 b. Focused .es, t%is is 0ocuse# on nursin, %o-es in t%e st"te o0 Ne$ .ork All Ne$ .ork St"te nursin, %o-es 6N 9 :;58 $ere ,roupe# "ccor#in, to t%eir "-)ul"tor' c"re sensiti(e %ospit"li+"tion r"tes. !ro- e"c% o0 t%e t%ree ,roups, 100 nursin, %o-es $ere r"n#o-l' selecte# 0or t%e stu#'.2 6p,. 7028 c. !thical .es, "ppro(e# )' t%e *e"lt% Rese"rc% Science Bo"r# o0 t%e Ne$ .ork St"te 1ep"rt-ent o0 *e"lt% "n# t%e institution"l re(ie$ )o"r# "t t%e St"te <ni(ersit' o0 Ne$ .ork "t Al)"n', Ne$ .ork2 6p,. 7028 <se# " $e)-)"se# sur(e' t%rou,% Sur(e' =onke' to collect #"t". ". #iterature Re$ie% a. Pre$ious Studies .es. Conte-por"r' #"t" in#ic"te t%"t nursin, %o-e resi#ents ten# to )e ol#er "n# -ore #is")le# "n# to %"(e -ore c%ronic con#itions, s%orter len,t%s o0 st"', "n# %i,%er -ort"lit' r"tes t%"n nursin, %o-e resi#ents in t%e p"st2 6p,. 7018 o 5ren#s in Nursin, !"cilit' C%"r"cteristics. A-eric"n *e"lt% C"re Associ"tion> Rei-)urse-ent "n# Rese"rc% 1ep"rt-ent> 200;

o Nursin, *o-e C"re. N"tion"l Center 0or *e"lt% St"tistics> 200; *ospit"li+"tion is not onl' costl', )ut "lso incre"ses t%e risk o0 i"tro,enic #ise"ses "n# ot%er "#(erse outco-es2 6p,. 7028 o ?usl"n#er JG, @ein)er, A1, &%illips A. 3n"ppropri"te %ospit"li+"tion o0 nursin, 0"cilit' resi#ents/ A s'-pto- o0 " sick s'ste- o0 c"re 0or 0r"il ol#er people. J AGeri"tr Soc 2000> 4B/230C231. As " result, potenti"ll' "(oi#")le %ospit"li+"tions "re "n in#ic"tor o0 poor nursin, %o-e qu"lit' "n# " t"r,et 0or qu"lit' i-pro(e-ent2 6p,. 7028 o Gr")o$ski 1C, ?D="lle' AJ, B"r%'#t NR. 5%e costs "n# potenti"l s"(in,s "ssoci"te# $it% nursin, %o-e %ospit"li+"tions. *e"lt% A00 6=ill$oo#8 200;> 2:/1;53C1;:1. &re(ious stu#ies s%o$e# t%"t, in st"tes $it% no )e#-%ol# policies, lon,-st"' resi#ents $ere -ore likel' to #ie in pl"ce. Ne$ .ork St"te %"s )e#-%ol# policies, )ut t%e in0or-"tion on "ssoci"tions )et$een )e#-%ol# policies "n# tr"ns0er #ecisions $"s not "("il")le.2 o S"li)" 1, Ein,ton R, Buc%"n"n J et "l. Appropri"teness o0 t%e #ecision to tr"ns0er nursin, 0"cilit' resi#ents to t%e %ospit"l. J A- Geri"tr Soc 2000> 4B/154C 1:3. o Cre#itor =C. *"+"r#s o0 %ospit"li+"tion o0 t%e el#erl'. Ann 3ntern =e# 1773> 11B/217C223. b. References current A)out %"l0 o0 t%e liste# re0erences "re current 1. 200; 2. 200; 3. 2004 4. 2000 5. 177: :. 2010 ;. 17B7 B. 1773 7. 1777 10. 2005 11. 2001 12. 200: 13. 200B 14. 2000 15. 2004 1:. 2003 1;. 2003 1B. 2003 17.2001 22. 200B c. Primar& Resources .es )ec"use t%e rese"rc%ers $%o con#ucte# t%e stu#ies $rote t%e re0erence "rticles. d. Studies criti'ued b& the researchers ". .es. Alt%ou,% pre(ious stu#ies %"(e s%o$n " co-pleF r"n,e o0 clinic"l "n# nonclinic"l 0"ctors pre#ict potenti"ll' pre(ent")le %ospit"li+"tions, pu)lis%e# rese"rc% re-"ins sc"nt'

G#espite t%e potenti"l 0or si,ni0ic"nt re#uctions in %e"lt%c"re spen#in, 0or institutions2 6p,. 7028 e. Current (no%ledge of research problems described .es. 5r"#ition"ll', nursin, %o-es %"(e )een equippe# to t"ke c"re o0 0r"il resi#ents $%o nee# "ssist"nce $it% #"il' "cti(ities )ec"use o0 0unction"l #is")ilities. Nursin, %o-es -ust c"re 0or resi#ents $it% incre"sin,l' co-pleF c%ronic #ise"ses "n# -ore-se(ere #is")lin, con#itions )' pro(i#in, "cute or intensi(e c"re. 5o ser(e t%e #i00erent pro0ile o0 inco-in, resi#ents, nursin, %o-es "re const"ntl' "#Hustin,, "#"ptin,, "n# recon0i,urin, t%eir ser(ices to respon# to t%e unprece#ente#, c%"n,in, lon,-ter- c"re en(iron-ent. 5%is is necess"r' to pro(i#e qu"lit' o0 c"re to resi#ents "s $ell "s 0or nursin, %o-e sur(i("l. <n#er cur- rent 0in"nci"l "n# )u#,et constr"ints, i-pro(in, qu"lit' o0 c"re $it%in t%e eFistin, resources "("il")le is " c%"llen,e 0or nursin, %o-e "#-inistr"tors. Iu"lit' o0 c"re ties to -"n' "spects o0 nursin, %o-e oper"tions, "n# qu"lit'-o0-c"re -e"sures "re )ro"#.2 6p,. 7018 ApproFi-"tel' 15J o0 lon,-ter- st"' resi#ents "re "#-itte# to %ospit"ls #urin, "n' :-ont% perio#, "n# #epen#in, on t%e stu#' #e0inition, 23J to 40J o0 t%ese %ospit"li+"tions "re "(oi#")le.4,: 3n 2004, "pproFi-"tel' K7;2 -illion $"s spent on %ospit"l "#-issions 0ro- nursin, %o-es in Ne$ .ork St"te. ?0 t%is ",,re,"te "-ount, K223.B -illion 623J8 re0lects potenti"ll' "(oi#- ")le "#-issions 0or con#itions "-en")le to c"re in " nursin, %o-e settin,.2 6p,. 7028 ). *heoretical Frame%or( a. !+plicitl& e+pressed, implied, or identifiable None ,i(en b. Description and definition of the concepts of interest Ee' $or#s ,i(en/ potenti"ll' pre(ent")le %ospit"li+"tion> nursin, %o-es c. Relationship bet%een concepts e+plained No d. Relationship to nursing-s bod& of (no%ledge *ospit"li+"tion i-poses unnecess"r' e-otion"l stress on p"tients "n# 0"-ilies "n# incre"ses t%e potenti"l 0or i"tro,enic illness, "#(erse outco-es, "n# %i,%er cost o0 c"re. Nonclinic"l 0"ctors s%"pe nursin, %o-e c"re "n# pre#ict potenti"ll' "(oi#")le %ospit"l "#-issions.2 6p,. 70:8 .. Research /b0ecti$es, 1uestions, 2&pothesis a. Identified .es. 5o #escri)e c%"r"cteristics o0 Ne$ .ork St"te nursin, %o-es "n# i#enti0' 0"ctors "ssoci"te# $it% potenti"ll' pre(ent")le %ospit"li+"tion in nursin, %o-e resi#ents2 6p,. 7018 b. *ied to a research problem, theoretical frame%or( and literature re$ie% 5ie# to t%e un#erst"n#in, t%"t $it% )etter con#itions insi#e nursin, %o-es, t%en eFpense p"i# 0or pre(ent")le con#itions $oul# #ecre"se. 3. Stud& Variables a. #abels /utcome Variable: &otenti"ll' &re(ent")le *ospit"li+"tions Predictor Variables: o !"cilit' 4n(iron-ent o Nurses "n# Ai#s

o A("il")ilit' o0 =e#ic"l 3n0or-"tion "n# Resources o &ercei(e# 1eter-in"nts o0 *ospit"li+"tion o Nursin, *o-e &r"ctice b. Conceptual and operational definitions stated No. 4. Demographics 5!+amples6 14; #irectors o0 nursin, 61?Ns8 $ere sur(e'e#2 6p,. 7018 7. Sample a. *&pes Cross-section"l sur(e' o0 r"n#o-l' selecte# nursin, %o-es in t%e Ne$ .ork St"te b. Inclusion Criteria 1?Ns o0 nursin, %o-es in t%e st"te o0 Ne$ .ork c. Description 1"t" collecte# (i" online sur(e' tool d. 8ortalit& *i,% risk o0 -ort"lit' "ssoci"te# $it% #"t" 0in#in,s 9. Research Design a. *&pe Iu"ntit"ti(e Stu#'> $e)-)"se# sur(e' b. Appropriate .es. 3t ,"(e t%e rese"rc%ers " $"' to recei(e " l"r,e "-ount o0 in0or-"tion $it%out %"(in, to inter(ie$ p"rticip"nts in#i(i#u"ll' 6" lot less ti-e to recei(e #"t"8 c. Feasible .es. A l"r,e "-ount o0 #"t" recei(e# $it%out too -uc% cost "n# ti-e in(este# 1:. 8easurement 8ethods a. Instruments 5%e #"t" "n"l'sis pl"n inclu#e# uni("ri"te, )i("ri"te, "n# step$ise -ulti("ri"te st"tistic"l "n"l'ses. !requenc' #istri)utions "n# su--"r' st"tistics #escri)e# t%e #"t" set. <ni("ri"te "n"l'ses $ere per0or-e# to #escri)e t%e nursin, %o-e c%"r"cteristics usin, percent",es "n# -e"ns. &e"rson correl"tion "n"l'ses $ere per0or-e# to "ssess t%e stren,t% o0 correl"tion )et$een selecte# nursin, %o-e c%"r"cteristics "n# ACS %ospit"li+"tion r"tes. A"ri")les "ssoci"te# $it% pre(ent")le %ospit"li+"tions t%"t $ere si,ni0ic"nt "t &o.25, $ere clinic"ll' rele("nt, or $ere pu)lis%e# in liter"ture $ere ret"ine# 0or su)sequent "n"l'ses. Step$ise -ulti("ri"te line"r re,ression -o#els qu"nti0ie# t%e "ssoci"tion )et$een nursin, %o-e c%"r"cteristics "n# potenti"ll' pre(ent")le %ospit"li+"tions. All st"tistic"l tests $ere con- #ucte# usin, SAS (ersion 7.0 6SAS 3nstitute, 3nc., C"r', NC8.2 6p,. 7038 b. Validit& and reliabilit& of instruments reported .es. Alt%ou,% t%e' 0eel t%e sur(e' $"s e00ecti(e, t%e' reporte# so-e )i"s. 5%e stu#' $"s )"se# on in0or-"tion reporte# )' Ne$ .ork St"te 1?Ns, $%o -"' %"(e )een )i"se# in t%eir responses in 0"(or o0 t%eir institutions, "lt%ou,% t%is )i"s is pro)")l' e(enl' #istri)ute#. 5%e turno(er r"tes o0 nursin, st"00 in t%e nursin, %o-es un#er stu#' see-e# lo$. 3t $"s not possi)le to per0or- " %o-o,eneit' test )ec"use #"t" rel"tin, to turno(er r"tes in nonp"rticip"tin, nursin, %o-es $ere not "("il")le2 6p,. 70:8

11. Procedures for data collections stated .es. @e)-)"se# sur(e' 1 . Data anal&sis method identified .es. !"ctors "ssoci"te# $it% potenti"ll' pre(ent")le %ospit"li+"tion inclu#e# presence o0 nursin, st"00 tr"ine# to co--unic"te e00ecti(el' $it% p%'sici"ns 6&L .0018> e"s' "ccess to ur,ent l")or"tor' results in less t%"n 4 %ours on $eeken#s 6&9.038> t%"t p%'sici"ns "tte-pt to tre"t p"tients $it%in t%e nursin, %o-e "n# "#-it to t%e %ospit"l "s " l"st resort 6&L.0018> %i,%er reporte# proportion o0 resi#ents enrolle# in -"n",e# c"re pl"ns 0or re,ul"r -e#ic"l c"re 6& 9.048> %i,%er percei(e# likeli%oo# t%"t illness $ill c"use #e"t% 6&9.038> percei(e# in"#equ"te "ccess )' p%'sici"ns to resi#entsD "n# prior -e#ic"l %istor', l")or"tor' results, "n# electroc"r#io,r"-s 64CGs8 6&9.028, "s reporte# )' 1?Ns.2 6p,. 7018 1". Research interpretation of the findings a. Findings in (eeping %ith those e+pected So-e$%"t. Al-ost "ll o0 t%e 1?Ns ",ree# or stron,l' ",ree# t%"t -e#ic"l pro)le-s $ere i#enti0ie# in " ti-el' -"nner 67:J8, t%"t p%'sici"ns %"# speci"l interest "n# skills in nursin, %o-e c"re 6B2J8, "n# t%"t p%'sici"ns consi#ere# %ospit"li+"tion "s " l"st resort 6;BJ8. Al-ost %"l0 o0 t%e 1?Ns "lso ",ree# or stron,l' ",ree# t%"t 0"-il' -e-)ers usu"ll' pre0erre# t%"t "cute con#itions )e tre"te# in t%e %ospit"l 647J8, "n# 0e$er t%"n one-0i0t% reporte# t%"t %ospit"li+"tion s%oul# )e t%e 0irst response to "n' resi#entDs serious -e#ic"l pro)le61;J8. !"-il' pre0erence t%"t "cute con#itions )e tre"te# in t%e %ospit"l 6&9 .028 "n# p%'sici"nDs pr"ctice 6&9 .018 "n# speci"l interest "n# skills 6&9 .058 in nursin, %o-e c"re $ere si,ni0ic"ntl' "ssoci"te# $it% potenti"ll' pre(ent")le %ospit"li+"tions.2 6p,. 704-7058 1espite st"te re,ul"tions requirin, t%"t p%'sici"ns )e noti0ie# o0 "n' c%"n,e in " p"tientDs con#ition 6e.,., " s-"ll )ruise8, " pre(ious stu#' 0oun# t%"t nursin, st"00 reporte# t%"t p%'sici"ns $ere 0requentl' #i00icult to re"c%, o0ten #i# not return c"lls pro-ptl', "n# $ere so-eti-es irrit"te# )' telep%one c"lls reportin, $%"t t%e' percei(e# to )e insi,ni0ic"nt s'-pto-s "n# si,ns. !"ilure o0 t%e nurse to "rticul"te t%e p"tientDs con#ition -"' co-pro-ise t%e p%'sici"nDs #ecision--"kin, process. 4(entu"ll', p%'sici"ns -"' lose con0i#ence in t%e nursin, st"00 "n# "#-it p"tients -ore re"#il'.2 6p,. 705-70:8 !e$ resi#ents $ere enrolle# in *=?s 0or t%eir re,ul"r -e#ic"l c"re. 5%e ("st -"Horit' o0 %o-es reporte# t%"t 0e$er t%"n 25J o0 resi#ents $ere enrolle# in -"n",e# c"re pl"ns or *=?s 6B:J8 or lon,-ter- c"re insur"nce pro- ,r"-s 6ne"rl' 70J8.26p,. 7038 b. Findings related bac( to the stud& frame%or( Step$ise -ulti("ri"te line"r re,ression i#enti0ie# siF pre#ictors $it% " si,ni0ic"nt rel"tions%ip to potenti"ll' pre(ent")le %ospit"li+"tion2 6p,. 7058 c. ;hich findings %ere not e+pected ;;J reporte# "("il")ilit' o0 tr"inin, 0or nursin, st"00 to reco,ni+e c%"n,es in resi#ent 0unction or )e%"(ior"l st"tus t%"t -"' si,n"l t%e onset o0 "cute illness2 6p,. 7038 B4J reporte# pro(i#in, st"00 tr"inin, on e00ecti(e co--unic"tion $it% p%'sici"ns2 6p,. 7038 70J o0 t%e nursin, %o-es %"# %"# less t%"n 25J M&N "n# RN turno(er #urin, t%e p"st 'e"r. Nursin, "i#e turno(er $"s " )it %i,%er, $it% ne"rl' ;1J o0 %o-es reportin, less t%"n 25J turno(er.2 6p,. 7038 B:J o0 nursin, "i#es spoke 4n,lis% "s t%eir 0irst l"n,u",e2 6p,. 7038

?n $eeken#s, 4BJ o0 %o-es coul# ,et st"t l")or"tor' results in less t%"n 4 %ours> 35J coul# ,et st"t r"#iolo,' results, "n# 3BJ coul# ,et 4CG tr"cin, "n# interpret"tion.2 6p,. 7038 24J o0 t%e nursin, %o-es %"# e"s' "ccess to on-site p%'sici"n or nurse pr"ctitioner e("lu"tion in less t%"n 4 %ours.2 6p,. 7038

1). Implications of the findings for nurses pro$ided .es. 3n ,ener"l, t%e selecte# c%"r"cteristics o0 nursin, %o-es in Ne$ .ork St"te "re si-il"r to t%ose o0 ot%er nursin, %o-es in t%e countr'. 3n co-p"rison $it% " pre(ious n"tion$i#e nursin, %o-e sur(e',11 t%e 0in#in,s o0 t%e current stu#' s%o$ si-il"r results in resource "("il")ilit' 6e.,., e"s' "ccess to st"t l")or"tor' 6-e"n 1.5 (s. 1.38, r"#iolo,' 6-e"n 1.: (s. 1.48, "n# nursin, %o-e pr"ctice 6e.,., 0"-il' -e-)ers usu"ll' pre0er t%"t "cute con#ition )e tre"te# in t%e %ospit"l, -e"n 3.4 (s. 3.38, "lt%ou,% t%ere "re so-e ("ri"tions in percei(e# #eter-in"nts o0 pre(ent")le %ospit"li+"tion> 0or eF"-ple, t%e percent",e o0 1?Ns in Ne$ .ork St"te reportin, t%e likeli%oo# t%"t illness $ill c"use #e"t% "s t%e -ost i-port"nt or "n i-port"nt 0"ctor $%en #eci#in, to %ospit"li+e " resi#ent $"s 1:.5J, co-p"re# $it% :.BJ in Buc%"n"nDs stu#'.2 6p,. 7058 1.. Clinical significance of findings stated .es. Reporte# presence o0 tr"inin, pro(i#e# to nursin, st"00 on %o$ to co--unic"te e00ecti(el' $it% p%'sici"ns ")out " resi#entDs con#ition $"s si,ni0ic"ntl' "ssoci"te# $it% " lo$er r"te o0 ACS %ospit"li+"tion 6)9 -20.2, & 9.00B8> speci0ic"ll', nursin, st"00 $%o recei(e# co--unic"tion e00ecti(eness tr"inin, %"# 20.2 0e$er ACS %ospit"li+"tions per 100,000 resi#ent-#"'s 6or 20.2 %ospit"li+"tions per 3,2B; resi#ent--ont%s8 t%"n t%ose $%o #i# not recei(e tr"inin,. 5%e o(er"ll ACS %ospit"li+"tions per 100,000 resi#ent-#"'s in Ne$ .ork St"te $"s :54, $it% "n "pproFi-"te tot"l cost o0 K223.B -illion> t%is tr"nsl"tes to 3J 0e$er potenti"ll' pre(ent")le %ospit"li+"tions "n# K:,;14,000 cost s"(in,s $%en tr"inin, on e00ecti(e co--unic"tion )et$een nursin, st"00 "n# p%'sici"n $"s pro- (i#e#. Si-il"rl', e"s' "ccess to ur,ent l")or"tor' results in less t%"n 4 %ours on $eeken#s le# to 7.3 0e$er ACS %ospit"li+"tions> t%is tr"nsl"tes to " 1.4J re#uction in potenti"ll' pre(ent")le %ospit"li+"tions "n# "n "pproFi-"tel' K3.1 -illion cost s"(in,s. !"-il' -e-)er pre0erence t%"t " resi#entDs "cute con#ition )e tre"te# in t%e %ospit"l incre"se# 5 ACS %ospit"li+"tions "n# percei(e# in"#equ"te "ccess to prior -e#ic"l %istor' incre"se# 5.: ACS %ospit"li+"tions.2 6p,. 7058 5%e stu#' results in#ic"te t%"t, $%en #eci#in, to %ospit"li+e " resi#ent, t%e likeli%oo# t%"t illness $ill c"use #e"t% is positi(el' "ssoci"te# $it% %i,%er %ospit"li+"tion r"tes. 5%e rel"tions%ip )et$een t%is perception "n# t%e tr"ns0er #ecision is co-pleF.2 6p,. 70:8 Gre"ter st"00 #e-"n# require# to c"re 0or ter-in"ll' ill resi#ents, couple# $it% t%e tr",ic n"ture o0 #e"t%, -"kes it "ppe"lin, to tr"ns0er p"tients to " %ospit"l 0or en#-o0-li0e c"re.2 6p,. 70:8 13. Suggestions for further studies pro$ided .es. Socio#e-o,r"p%ic #"t" "n# Nt%eO %e"lt% st"tus o0 nursin, %o-es resi#entsP s%oul# )e inclu#e# in 0uture -ulti("ri"te "n"l'ses to re#uce )i"s "n# re0ine t%e esti-"tes pro(i#e# %erein.2 6p,. 70:8 14. 8issing elements of the stud& noted .es. 5%is stu#' %"s se(er"l s%ortco-in,s t%"t li-it its ,ener"li+")ilit' "n# -"' in0luence interpret"tion. !irst, socio- #e-o,r"p%ic #"t" "n# %e"lt% st"tus o0 nursin, %o-e resi#ents $ere not "("il")le to t%e rese"rc% te"-. 5%is in- 0or-"tion s%oul# )e inclu#e# in 0uture -ulti("ri"te "n"l'ses to re#uce )i"s "n# re0ine t%e esti-"tes pro(i#e# %erein. So-e o0 t%e non-si,ni0ic"nt "ssoci"tions -"' )e #ue to l"ck o0 st"tistic"l po$er. Secon#,

t%e @e)-)"se# sur(e' response r"te 0or t%e stu#' $"s 53J, "lt%ou,% t%is response r"te $"s co-p"r")le $it% t%ose o0 si-il"r %e"lt% sur(e's. &ro)le-s co--on to @e)-)"se# sur(e's $ere 0"ce#, suc% "s )ounce# e--"ils "n# p"rticip"nt un0"-ili"rit' $it% co-puters. 5%ir#, t%e stu#' $"s )"se# on in0or-"tion reporte# )' Ne$ .ork St"te 1?Ns, $%o -"' %"(e )een )i"se# in t%eir responses in 0"(or o0 t%eir institutions, "lt%ou,% t%is )i"s is pro)")l' e(enl' #istri)ute#. 5%e turno(er r"tes o0 nursin, st"00 in t%e nursin, %o-es un#er stu#' see-e# lo$. 3t $"s not possi)le to per0or- " %o-o,eneit' test )ec"use #"t" rel"tin, to turno(er r"tes in nonp"rticip"tin, nursin, %o-es $ere not "("il")le. !ourt%, "lt%ou,% t%e stu#' $"s li-ite# to nursin, %o-es loc"te# in Ne$ .ork St"te, results -"' )e ,ener"li+")le onl' to nursin, %o-es s%"rin, si-il"r c%"r"cteristics.2 6p,. 70:8 17. <our recommendations for usefulness of the stud& in practice 3 0eel t%is stu#' is use0ul 0or nursin, %o-es to e("lu"te %o$ t%e' -e"sure co-p"re# to nursin, %o-es in t%e st"te o0 Ne$ .ork. 5%e' c"n use t%e #"t" collecte# "n# su,,estions -"#e in t%is sur(e' to -"ke c%"n,es to t%eir o$n policies.