Virginia Henderson International Nursing Library

AN OBESITY INTERVENTION PROGRAM FOR HISPANIC ADOLESCENTS

Mon, 20 Feb 2012 12:11:41 GMT

Title: AN OBESITY INTERVENTION PROGRAM FOR HISPANIC ADOLESCENTS

Abstract: Purpose/Aims: The purpose of the study was to evaluate the feasibility, acceptability and preliminary efficacy of a theory-based healthy eating and activity intervention (Sabor con Salud Latino para los Niños [SSLN]). Relationships between self-efficacy, peer and parent social support and acculturation as key factors associated with eating and activity behaviors in Hispanic youth were explored. Background: Obesity in Hispanic youth has reached alarmingly high levels, increasing the risk of type 2 diabetes, hyperlipidemia, hypertension, and cardiovascular disease. In Mexican American children ages 6-11 years, 41.7% are overweight and obese, 24.7% are obese and 19.6% have a Body Mass Index (BMI) greater than the 97th percentile (Ogden et al., 2010). While personal, behavioral, and environmental factors contribute to these high rates, emerging literature suggests acculturation, self-efficacy and social support are key influences. Methods: The one-group, pre- and post-test, quasi-experimental design used a community-based participatory research (CBPR) method to test the feasibility, acceptability, and preliminary efficacy of the 8-week intervention. Social Cognitive Theory (SCT) was used to guide the intervention. Measurements included an analysis of recruitment, retention, participant satisfaction, observation of intervention sessions, paired t-tests, effect sizes, and bivariate correlations between study variables (acculturation, nutrition and physical activity [PA] knowledge, attitude and behaviors, perceived confidence and social support) and outcome variables (BMI z-score, waist circumference and BP percentile). Results: Findings showed the SSLN program was feasible and acceptable. Seventeen participants (10 females and 7 males) aged 11-14 years enrolled in the study. SSLN completers (n=16) attended 88.1% of the sessions. Retention strategies such as texting reminders for class, raffle prizes and phone calls to parents increased attendance and strengthened communication between parents, adolescents and the SSLN Instructors. Participants reported that the curriculum was fun (M = 4.63, SD = .72) and they learned about nutrition (M = 3.81, SD = 1.42) and PA (M = 4.25, SD = 1.13). The preliminary effects on adolescent nutrition and PA behaviors showed mixed results with small-to-medium effect sizes for nutrition knowledge and attitude, PA and sedentary behavior. Correlation analysis among acculturation and study variables was not significant. Positive associations were found between perceived confidence in eating and nutrition attitude (r = .61, p < .05) and nutrition behavior (r = .62, p < .05), perceived confidence in exercise and nutrition behavior (r = .66, p < .05), social support from family for exercise and PA behavior (r = .67, p < .01) and social support from friends for exercise and PA behavior (r = .56, p < .05). Implications: These findings suggest a culturally specific healthy eating and activity program for adolescents was feasible and acceptable and warrants further investigation, since it may fill a gap in existing obesity programs designed for Hispanic youth. The positive correlations suggest further development and testing of the theoretical model.

A CASE STUDY OF MIDWIFERY in MANITOBA

Mon, 20 Feb 2012 12:11:38 GMT

Title: A CASE STUDY OF MIDWIFERY in MANITOBA

Abstract: Background. In 2000, midwifery was regulated in the Canadian province of Manitoba. Since the inception of the midwifery program, little research has been done to analyze the utilization of regulated midwifery services. Currently, many women are denied access to midwifery care due to the shortage of midwives in Manitoba. Key components of the original implementation plan for midwifery have not met projected targets, including a lower than projected number of midwives and midwifery births. Furthermore, a lack of successful educational programs and lack of funded positions have contributed to the shortage of midwives. Purpose. The purpose of this study is (1) To describe the utilization of midwifery health care services in Manitoba from 2000/2001 to 2009/2010 and; (2) To explore factors influencing the utilization of regulated midwifery services in Manitoba. Conceptual Model. The Behavioral Model of Health Services will be used to conceptualize factors that impact the utilization of midwifery services in Manitoba. The goal of this framework is to demonstrate how predisposing, enabling, and need factors are interrelated in regards to health care utilization. A feminist framework will be applied in this study to draw on the insights and struggles of the midwifery profession in Manitoba. The relevance of a feminist framework in midwifery is to examine the issues and practices of a situation in relation to how they influence women’s lives and experiences. Methods. This study will use a case study design. The unit for analysis or the single case to be studied is regulated midwifery services in Manitoba. Both qualitative and quantitative methods of data collection will be used. The case study evidence will be derived from three sources; documents, administrative data and interviews. The quantitative analysis will be done using population-based administrative data from the Manitoba Centre for Health Policy, to study the utilization of midwifery care in Manitoba between 2001/02 to 2009/10 (e.g., trends in number of midwives, proportion of births attended by midwives, geographic distribution of midwifery services). Document analysis (e.g., reports, minutes, archived documents) and the long interview method with key informants will be used to gather the qualitative data in this case study. Interviews will be audiotaped and transcribed; content analysis will be used to identify themes arising from the data. Implications. In spite of scientific evidence that supports the midwifery model of care, there remains an inherent struggle to justify and sustain the profession globally. Although Canada has implemented a direct entry midwifery model, other areas of the world including the U.S. also have a nurse midwifery model. The findings will have implications for maternal/child health professionals to work at improving collaborative efforts to facilitate access to midwifery services for women who would like the choice of midwifery care.

NOVEL METHODS EXAMINING STRESS, REST AND GROWTH IN NICU VULNERABLE INFANT POPULATIONS

Mon, 20 Feb 2012 12:11:34 GMT

Title: NOVEL METHODS EXAMINING STRESS, REST AND GROWTH IN NICU VULNERABLE INFANT POPULATIONS

Abstract: Purpose: To describe novel methods used to investigate stress reactivity, growth and rest in preterm infants randomized to a music intervention while quantifying noise levels in the neonatal intensive care unit (NICU). Background: Innovative techniques are available to study the sensitive balance of the hypothalamic-pituitary-adrenal axis and neuroendocrine system function among infants in NICU who are at risk for increased stress, poor rest and decreased growth. Music has the unique ability to reduce stress, enhance rest and promote growth. Due to characteristic challenges of these babies, minimal research has been conducted in these areas as it is impractical to obtain large quantities of blood commonly needed to test biomarkers for stress and growth. Further, equipment for evaluating rest and noise is often cumbersome around the tubes, wires and monitors attached to tiny babies. Methods: We conducted a randomized controlled blinded multi-center pilot study to examine a structured music intervention over a seven day period. Using Urn Randomization, eligible preterm infants (N=19) were randomized to: 1) a music or 2) sham intervention based on high versus low degree of perinatal stress identified on standardized instruments, namely, the Perceived Stress Scale (PSS) reported by mothers and the Clinical Risk Index for Babies (CRIB). The Neurobiologic Risk Score (NBRS) was used to score infant biophysiologic stress over the NICU stay. Growth variables of weight gain in grams and serum insulin and IGF-1 were obtained before and after the one week study period. Hours of rest were quantified by actigraphy and validated with the Newborn Behavioral Observation (NBO) tool. NICU environmental noise decibels and frequencies were analyzed with portable noise dosimeters. Stress reactivity was examined at timed intervals before and after a stressor blood stick with salivary cortisol strips collected pre and post the one week intervention. Analyses: Descriptive statistics and two-sample independent t-tests were used to examine the data and determine group differences in stress, weight gain, rest, Insulin, and IGF-1. Results: The data suggests that stress scores (PSS, CRIB, and NBRS) were similar between the two groups. Compared to the controls, the music group was found to have lower salivary cortisol levels during the stress reactivity tests, a higher number of sleep bouts, lower activity counts, increased Insulin and IGF-1, and lower lengths of stay. Implications: Lingual cortisol strips offered a non-invasive method of obtaining cortisol levels to examine stress reactivity. Actigraphy provided a means of quantifying rest that was validated by the NBO tool and nurses notes. Noise dosimeters were shown to be useful for assessing NICU noise. In sum, clinical scientists need innovative ways to examine variables that impact health outcomes of at-risk infants cared for in the NICU. Funding: 1) NIH/NINR-T32 NR007077 Health Disparities and Vulnerable Populations Research Training Program. 2) Oppenheimer Complimentary Alternative, Integrative Medicine Grant. 3) American Association of Critical Care Nurses Clinical Care Grant.

RISKING UNINTENDED PREGNANCY, HIV AND STIs AMONG METHAMPHETAMINE-USING WOMEN

Mon, 20 Feb 2012 12:11:31 GMT

Title: RISKING UNINTENDED PREGNANCY, HIV AND STIs AMONG METHAMPHETAMINE-USING WOMEN

Abstract: Purpose: To describe the contextual factors and perceptions of methamphetamine-related behaviors that influence sexual risk for unintended pregnancy, HIV and sexually transmitted infections (STI) among methamphetamine-using women. Background: Among methamphetamine users, the gender ratio is equal between women and men, but women start using at a slightly younger age and have more complex psychosocial problems due to childhood traumas. As a potent long-acting stimulant, methamphetamine's neurobiological effects last for eight to twelve hours, during which users describe euphoria, increased energy, decreased appetite, and enhanced sexual desire. Research has identified an independent association of the drug and sexual activity and likelihood for sexual encounters to occur while under the influence of methamphetamine. Descriptive studies report high frequency of risky sexual behaviors that are practiced by heterosexual users, including: unprotected vaginal intercourse, receptive anal intercourse, and sexual encounters with multiple intimate or anonymous partners. Methamphetamine use poses gender-specific risks for women who become regular users of the drug, especially related to sexual risk for pregnancy, HIV, and sexually transmitted infections. Method: Passive recruitment was conducted by flyer placement in southern California drug treatment facilities, WIC sites, and a maternal-fetal medicine practice seeking participation by pregnant or postpartum women who used methamphetamine during a portion of their pregnancy. Eligible candidates were 18 years of age or older, English speaking, and claimed methamphetamine was their primary drug of choice. A sample of 17 participants self-identified as White, Hispanic, mixed race Hispanic and Asian, ranged in age from 18 to 37 years of age; four were married, and all were unemployed. Under the protection of a Certificate of Confidentiality, one or two audio taped, semi-structured interviews were conducted regarding their lives before pregnancy, methamphetamine use, and their experience of pregnancy. Using Constructivist Grounded Theory and the symbolic interactionism for understanding meaning-making, simultaneous data collection and analysis was conducted. Findings: The women reported initiation to methamphetamine averaging at 15.8 years of age and half of the sample had a first pregnancy by the age of 16. They had minimal knowledge of and exposure to reproductive education or services; thus, they chose not to use contraception and voiced no concern for sexual risk with multiple partners. From their description of sexual behaviors surrounding methamphetamine use, a core category, Risking unintended pregnancy, HIV, and STI emerged with four categories of factors that contribute to understanding the participants’ sexual risk-taking: seeking sexual satisfaction, gambling with sexuality, fulfilling intrapersonal needs, and using sex as a commodity. Implications: The process contributes to understanding the complex relationship between methamphetamine and sexuality among female users. The findings point to the need for early timing of supportive interventions, including psychological counseling with adolescents regarding adverse childhood traumas, introduction to reproductive services, contraceptive education, and ongoing availability of appropriate resources into adulthood. Further research with a broader population of methamphetamine users remains critical.

IMPACT OF AN INTERVENTION TO IMPROVE ART ADHERENCE AMONG RURAL INDIAN WOMEN WITH AIDS

Mon, 20 Feb 2012 12:11:28 GMT

Title: IMPACT OF AN INTERVENTION TO IMPROVE ART ADHERENCE AMONG RURAL INDIAN WOMEN WITH AIDS

Abstract: Purpose: To assess the impact of an innovative intervention delivered by lay village women in India, Ashas, on improving antiretroviral therapy (ART) compliance and psychological and physical health of rural women living with AIDS (WLA) in India. Background: WLA in India continue to face profound challenges in accessing and following treatment regimens, caring for family members, and maintaining positive mental health. In 2005, the Government of India launched a National Rural Health Mission to address the health needs of the rural population by engaging Ashas, lay village women who interface with nurse midwives and physicians at local primary health centers. Ashas in India have predominantly focused on reproductive health for pregnant and postpartum women and infant wellbeing; however, the investigators trained Ashas to improve the adherence of rural WLA and enhance their physical and psychological health. Method: A prospective, randomized clinical trial was utilized to assess the outcomes of an innovative theoretically-based Asha Life intervention on ART compliance and physical and psychological health among 68 WLA. These WLA, residing in one of two villages, were randomized into Asha Life (AL) or usual care (UC) groups. Ashas worked closely with nurses and other health care providers, focused on providing supportive care and overcoming the barriers to compliance of ART. These included illness, difficulty in transportation, etc. WLA were eligible if they were between the ages of 18-45; and 2) screened as receiving ART for a minimum of three months. Structured instruments assessed ART adherence, depressive symptoms and body composition. Additionally, percent body fat, fat and lean mass were measured with a 310e Bioimpedance analyzer. Findings: At six-month follow-up, findings revealed that adherence was significantly improved ranging from 93% -100% for the AL group (mean 99%; 0.02) and 60% - 95% for the UC group (mean 67%, 0.22). In multivariate analyses, the AL participants also had significantly greater odds of reducing depressive symptoms, improving CD4 levels and weight, BMI, percent fat, fat weight, and lean weight significantly higher in the AL group compared to the UC group. Implications: The findings provide a basis for addressing the challenges which rural WLA face and support the AL intervention which focuses on supportive care, education, overcoming barriers to care. As a package, the AL intervention was significant in impacting the outcomes assessed.

QIGONG AS A NOVEL INTERVENTION FOR SERVICE MEMBERS WITH MILD TRAUMATIC BRAIN INJURY

Mon, 20 Feb 2012 12:11:24 GMT

Title: QIGONG AS A NOVEL INTERVENTION FOR SERVICE MEMBERS WITH MILD TRAUMATIC BRAIN INJURY

Abstract: Purpose/Aims: The purpose of this study was to explore the interest in and utility of an 8-week internal qigong intervention in service members diagnosed with mild traumatic brain injury (mTBI). Gaining insight into the interest, effects of, and adherence to a qigong intervention from the service member’s perspective is a first step toward the long-term goal of establishing a program of research using non-pharmacologic interventions such as qigong for management of symptoms related to mTBI. Background: Over the past decade, traumatic brain injury (TBI) has evolved into the signature injury for service members returning from the wars in Iraq and Afghanistan. The attention being given to mTBI is greater than it has ever been when compared to previous conflicts. Because of the nature of the blast injuries occurring on the battlefields in Iraq and Afghanistan, diagnosis, treatment, and rehabilitation of service members with mTBI have proven to be challenging and often incomplete, leading the military medical community to seek new and innovative approaches to the long-term management of mTBI. One novel therapy that has shown potential in reducing stress and improving quality of life issues similar to those seen in service members with mTBI is qigong, an ancient Chinese healing art that involves focusing the individual’s internal energy towards balance and wellness through the use of slow, deliberate movements, diaphragmatic breathing, and meditation. Methods: This study used a qualitative descriptive phenomenological analysis. A total of six service members with mTBI who were receiving outpatient neuro-rehabilitation at the Defense and Veterans Brain Injury Centers–Charlottesville Rehabilitation Program (DVBIC–Charlottesville) were interviewed halfway through the qigong intervention, then again at the end of the 8 weeks of formal instruction. The interviews focused on the service members’ interest in and the utility of this ancient art. Interview data were analyzed using methods originally described by Husserl and later refined by Giorgi. Results: Findings from the interviews revealed a dramatic change in the attitudes of the participants following the practice of qigong over the 8 weeks. Four themes emerged and included, “the physical experience of qigong,” “regaining control,” “no pain, a lot of gain,” and “barriers to practice of qigong.” Participants offered profound examples of how qigong enabled them to take control of their symptoms and their general outlook on the future. Their perceptions were that qigong was conducive to the highly disciplined mindset of military service members. They also believed that the simplicity of qigong, when compared to similar modalities such as tai chi and yoga, was well suited to individuals with symptoms related to mTBI who may be limited by decreased balance, cognition and memory. Implications: This pilot study strongly supports additional research into the effects of the practice of qigong in service members with mTBI. Specifically, research could be directed not just at overall well-being associated with practice, but to the phenomenon of using qigong to address symptom management through promotion of empowerment and control in a population for whom elements of control have been lost following a brain injury.

VALIDATION OF A NURSING PRESENCE SCALE USING DATA TRIANGULATION

Mon, 20 Feb 2012 12:11:21 GMT

Title: VALIDATION OF A NURSING PRESENCE SCALE USING DATA TRIANGULATION

Abstract: Background: Nursing presence is defined as the intentional use of self by the expert nurse who encounters patients from an existential view with a desire to understand and respond to the individual patient’s healthcare needs. While nursing presence is posited to be an essential element of nursing practice and a strong factor in promoting enhanced patient satisfaction, little documentation exists regarding the quantification of perceived nursing presence. Purpose: The purpose of this mixed methods study was to utilize data triangulation to validate the Presence of Nursing Scale (PONS) developed by Kostovich (2001) administered to a group of 75 adult patients in an acute care setting. Methods: Seventy-five adult patients (38 females, 37 males) in a medical-surgical unit in a large university medical center were recruited, with a mean age of 49.1 years. The majority of participants had a primary diagnosis of non life-threatening, orthopedic injuries (63.9%). A mixed methods design was used in which both quantitative and qualitative data were collected. Respondents were asked to rate their perception of nursing presence using PONS, a 25-item Likert-type survey designed to measure perception of nursing presence. In previous work, the construct validity of PONS was established using a biserial correlation comparing the construct of nursing presence (as measured using the PONS) to patient satisfaction with nursing care (dichotomous variable), resulting in correlation of 0.801. A Cronbach’s alpha reliability coefficient of 0.95 supported internal consistency of the tool. In the current study, all respondents completed PONS and then participated in an individual qualitative interview consisting of open-ended questions exploring the patient’s perceptions of the nurse-patient relationship and work manner of the nurse. Content analysis of themes from qualitative interviews was performed, followed by data triangulation using multiple triangulation methodology described by Mitchell (1986.) Results: Data triangulation of quantitative and qualitative results revealed that PONS appears to be a valid measure of nursing presence. Respondents who scored on the lower quartile of PONS scores reported qualitatively that they felt like “objects” of the nurses’ work, attended to only when they called for help. In participants scoring toward the middle of the PONS scale, qualitative themes included perceiving a “professional” relationship with their nurse and having confidence in the nurse’s skill and knowledge. In those participants who scored at the higher end of the PONS scale, recurrent themes included feeling “watched over,” experiencing reduced stress, and perceiving enhanced encouragement. Implications: The PONS appears to be a valid measure of nursing presence in the context of the daily work of the bedside nurse. In qualitative interviews, participants reported that specific nursing behaviors were associated with certain levels of nurse presence, suggesting it is possible to teach behaviors that promote an enhanced sense of nurse presence. Considering the posited relationship between the PONS scores and patient satisfaction with nursing care, future intervention studies in which nursing presence behaviors are taught in a structured manner are suggested as a means of ultimately enhancing patient satisfaction scores.

FEASIBILITY OF A TARGETED BREAST HEALTH INTERVENTION FOR CHINESES IMMIGRANT WOMEN

Mon, 20 Feb 2012 12:11:18 GMT

Title: FEASIBILITY OF A TARGETED BREAST HEALTH INTERVENTION FOR CHINESES IMMIGRANT WOMEN

Abstract: Background: The Asian American and Pacific Islander (AAPI) population is the fastest-growing racial/ethnic population in the U.S. It is predicted that AAPIs will comprise 9 to 10% of the U.S. population by the year 2050. Breast cancer continues to be the most commonly diagnosed cancer among AAPI women. Despite the known benefits of early detection, mammography screening rates among AAPI women are the lowest among all ethnic groups. Aims: Assess the feasibility and acceptability of a theory-based, targeted educational intervention to increase mammography screening among Chinese American women, the largest AAPI subgroups in the U.S. The secondary aims were to assess preliminary effect sizes and to assess the influence of demographics and beliefs on mammogram completion. Feasibility was measured by response rate and intervention completion rate. Acceptability was assessed by process questions related to cultural appropriateness of the content, participants’ response to the content, and intent to change screening behavior. We also assessed changes in the theoretical variables (knowledge, beliefs, and stage of readiness) that were manipulated in the educational program. Methods: Single group (N=44) pre- and post-test pilot study. The 2-part targeted intervention comprised group teaching with targeted messages followed by an individual counseling session. Results: Study response and completion rates were high at 71% and 95%, respectively. The intervention content and setting were well received by the participants. Awareness and knowledge of breast cancer risk and post-treatment survival were low. Colors, graphics and contents were considered very culturally appropriate. The mother, daughter, and grandmother dialogue interactions in the presentation were appreciated. Twelve weeks post intervention, 21 (50%) of the 42 women who completed the study had a mammogram. Seven participants moved two stages from pre-contemplation to action stage. For those in contemplation stage at baseline, twelve moved one stage to action. The top three reasons for not completing a mammogram at the end of the study were “no need/no symptom”, “busy”, and “reliance on family for assistance”. Mean breast cancer susceptibility scores increased significantly at posttest as theorized (t(40)=-2.88, p <.01). Participants were more likely to obtain a mammogram when they had been in the U.S. between 3 and 15 years, and less likely to obtain a mammogram if they had been here less than 3 or greater than 15 years. Implications: Efficacy of this promising intervention is currently being tested using a randomized controlled design, and can be adapted to other AAPI subgroups. A targeted program that aims to increase breast health knowledge, improve access, and remove barriers may promote mammography screening among Chinese and other immigrant women.

ENSURING ETHNIC REPRESENTATION IN THE NATIONAL CHILDREN'S STUDY, GRANT COUNTY SAMPLE

Mon, 20 Feb 2012 12:11:14 GMT

Title: ENSURING ETHNIC REPRESENTATION IN THE NATIONAL CHILDREN'S STUDY, GRANT COUNTY SAMPLE

Abstract: Purpose: The Pacific Northwest Center for the National Children’s Study (NCS) recruited participants from Grant County, WA into the NCS using an Enhanced Household‐Based Recruitment (EHBR) strategy. Ensuring ethnic representation in the sample was a primary goal of recruitment. Background: Grant County is a large (over 2,600 mi2), diverse rural region with low population density (30.8 persons/sq mi). The county has experienced large population growth, with a 19% increase in the overall population and a 51% increase in the Hispanic population. To ensure sample representativeness, specific outreach and engagement strategies were implemented based on cultural responsiveness theory. Methods: Outreach staff was hired locally. A cultural liaison was employed who spoke Spanish and was familiar with organizations serving the Hispanic community. The community advisory committee included representatives from Hispanic organizations. Outreach materials, media, and marketing were personalized and presented in English and Spanish. Targeted outreach events focused on areas with large Hispanic populations. Results: These activities were successful in recruiting Hispanic participants. Current data indicate that 38% of the women who completed the pregnancy screening instrument were Hispanic (expected value is 33%). Consents indicate a higher rate of Hispanic women in the sample (49%) than expected, with the percent of consented women ranging from 3% to over 20% higher than expected over eight segments. When Hispanic women were asked “How did you hear about the NCS?” most respondents replied that they had heard about the NCS through outreach activities, with 29% from media and events. Implications: Employing a conceptual approach to outreach and engagement has led to the successful inclusion of Hispanic women into the NCS. While personalized encounters between researcher and participant can be difficult to implement on a community-wide scale, choices made in outreach, marketing, and media can leverage existing trust and shared values between potential participants and local intermediaries to enhance recruitment. Funding support: Eunice Kennedy Shriver National Institute of Child Health and Human Development (HHSN275200800015C)

COMPARISON OF EXPERT AND NOVICE RURAL NURSE DAILY PRACTICE ACTIVITIES

Mon, 20 Feb 2012 12:11:11 GMT

Title: COMPARISON OF EXPERT AND NOVICE RURAL NURSE DAILY PRACTICE ACTIVITIES

Abstract: Purpose/Aims: The purpose was to compare rural novice and expert work activities and medication errors in order to better understand the workplace. Rationale: The literature is mixed about the rural nursing quality and safety. Some studies report novice nurses commit more medication errors than experts while others do not. Some authors state novices perform the same duties as expert nurses and without transition support. As turnover of new rural nurses ranges from 35-65% during the first year of practice, responsibilities and pressures of practice need to be understood. Understanding novice rural nurses practice is foundational to program improvement. Methods: Participants of a national residency program participated in tracking and reporting daily work activities and medication errors. Novice and expert nurses reported one week’s shifts three times during a year. The Medication Error Survey was also completed three times. During the first reporting period 217 novices’ (163) and experts’ (64) reports were averaged and compared using Spearman’s Correlations, Kruskal-Wallis and Mann-Whitney tests. Results: Novices cared for significantly more patients per shift (f 1.690, .06) than experts. Experts did not report workload reductions while teaching new employees. Expert nurses supervised more people during a shift (f 17.460, .001). Novices found more patient errors (f 5.563, .019). Expert nurses also spent more time on more committees than did novice nurses (f 3.764, .054). Using the Medication Error Survey, there was not significant differences between novice and experts other than in reporting/documenting errors found. Experts made significantly more reports. Experts reported making fewer errors than novices but this was due to a lack of rating the questions about making errors rather than a difference in error commission. Although responses could have been-no errors, nearly one third of expert participants refused to answer the question at all. Implications: Medication error Safety issues need further examination, systems organization, and nurse education. Future research questions include: Why do expert nurses avoid answering medication error questions when they could affirm or deny commission of an error anonymously? Was personal safety an issue? Which organizational systems produce professional safety concerns? What occurs and when for socializing novices to report errors? How do nurses define professional advancement? If advancement means more supervision and committee work in addition to patient care, is this satisfying? Were experts given workload accommodations for committee work and supervision? How often are expert nurses pulled from patient care? Comparison among groups over time needs reporting. Since novices reported finding more patient errors than experts, an understanding of who commits errors is needed. Do experts and novices perceive errors differently? Are there socialization issues involved in not reporting errors? Differences in practice impact job expectations of novices and experts. More information is needed in order to develop effective transition to practice programs.