The author elicited the lived experience of 19 oldest-old adults (13 women, all White, mean age 90.7 years, range 85-98 years) who lived alone in the rural Midwest to describe their everyday activities, concerns and struggles, and adaptive strategies. In-depth interviews (59 total) were audiotaped, transcribed, and analyzed in an interpretive phenomenological tradition of thematic analysis, interpretation of paradigm cases, and interpretation of exemplars. Participants described how historical, cultural, and environmental contexts shaped their everyday thoughts, activities, and what was meaningful to them. Findings can guide health care professionals to evaluate and develop community services and help significant others (family, friends, neighbors) understand what oldest-old rural adults need to remain at home.

The theoretical definition of the concept of self-mutilation offers the basis for nurses to develop interventions to provide competent care when discovering injuries that are self-inflicted.

No abstract

The upper arm is the primary site used to obtain a blood pressure measurement (BPM); however, when it is not possible to use the upper arm, the forearm is a commonly used alternate site. This study determines if there is a significant difference between upper arm and forearm BPMs among adults and examines the relationship of participant characteristics to the BPM difference. A convenience sample was recruited from a low-income, independent-living, 104-apartment complex in the Midwest. Of the 106 participants, 64% were female and 89% were White. Ages ranged from 20 to 85 years (M = 50.7). The investigators calculated the BMIs (range = 18 to 42, M = 29.3, SD = 5.4) for the 89% (n = 94) of participants who reported their weight. The forearm tended to have higher BPMs than the upper arm (M difference = 4.0 mm Hg systolic, 2.3 mm Hg diastolic). However, site differences were greatest for men, obese adults, and middle aged (36 to 65) adults.

The purpose of this article is to discuss the five levels of skill acquisition (novice, advanced beginner, competent, proficient, and expert) developed by Patricia Benner and colleagues, within the unique context of home health nursing. Descriptions of practice at each level are provided and can help nurses have reasonable expectations of performance. Recommendations are made for competence-based clinical support programs such as orientation, mentoring, and clinical ladders that identify, measure, and reward clinical knowledge and skill.