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Over the last decade, investor-owned hospital corporations have grown primarily by acquiring other for-profit hospital chains or stand-alone for-profit institutions. Between 1990 and 1995, however, these corporations also acquired nearly 50 not-for-profit hospitals and converted them to for-profit status. An examination of the long-term financial condition of 39 not-for-profit hospitals acquired by various investor-owned hospital corporations between 1992 and 1996 was conducted using free-cash-flow accounting valuation. The results suggest that, initially, only not-for-profit hospitals in dire financial straits were candidates for acquisition and conversion to for-profit status. More recent acquisitions increasingly have involved more successful not-for-profit hospitals.

Increasingly, grandmothers are parenting grandchildren in homes where parental presence is sporadic or nonexistent. A disproportionate percentage of African American grandparents fall in this category. The author reviews the literature on the African American grandmother in the context of the African American family and describes a practice model for service provision to those women who seek support as they “parent again.”

Mental health professionals and researchers have emphasized the importance of conducting outreach to locate homeless persons with mental illness, and of creatively engaging these persons into a therapeutic relationship. These outreach and engagement activities raise challenging issues in the areas of client-staff boundaries, professional ethics, and staff safety. While several issues in each of these three key areas have received attention in the growing literature on homelessness, certain issues within each area remain unexplored. The authors draw from the street experiences of outreach staff in a federally funded homeless outreach project to further explore each of these areas, and suggest that experiences of outreach workers are essential in shaping and redefining work activities in these, and other important areas.

Pigeons were presented with a concurrent-chains schedule in which terminal-link entries were assigned to two response keys on a percentage basis. The terminal links were fixed delays that sometimes ended with food and sometimes did not. In most conditions, 80% of the terminal links were assigned to one key, but a smaller percentage of the terminal links ended with food for this key, so the number of food reinforcers delivered by the two alternatives was equal. When the same terminal-link stimuli (orange houselights) were used for both alternatives, the pigeons showed a preference for whichever alternative delivered more frequent terminal links. When different terminal-link stimuli (green vs. red houselights) were used for the two alternatives, the pigeons showed a preference for whichever alternative delivered fewer terminal links when terminal-link durations were long, and no systematic preferences when terminal-link durations were short. This pattern of results was consistent with the predictions of Grace's (1994) contextual choice model. Preference for the alternative that delivered more frequent terminal links was usually stronger in the first few sessions of a condition than at the end of a condition, suggesting that the conditioned reinforcing effect of the additional terminal-link presentations was, in part, transitory.

The present study compared compliance, noncompliance strategies, and the correlates in 5-year old Japanese and American children were observed during three standardized laboratory procedures. Compliance, noncompliance strategies, and negative affect were coded during Toy Pick Up procedure. Maternal directiveness and mother-directed behaviors were coded during Mother-Child play and Free-play procedures, respectively. A baseline level of play was also obtained during the Free Play procedures to ensure that the children's willingness to engage in the Toy Pick Up procedure would not be confounded with their level of involvement with the toys. Consistent with predictions derived from a review of cross-cultural research on socialization practices, Japanese children showed longer latencies to begin picking up toys in response to maternal requests and were also more likely to engage in the `less skilled' noncompliance strategies of direct defiance and passive noncompliance than American children. The two groups of children did not, however, differ in their level of negative affect during the Toy Pick Up procedure. Contrary to expectations, maternal directiveness was not associated with compliance in either group of children. However, approach behavior to mother during Free Play was inversely correlated with compliance in Japanese, but not American children.

Direct behavioral observation and motility monitoring procedures provide reliable data, and both are appropriate for sleep/wake state measurements starting immediately after birth. Using these procedures, newborn rats, rabbits, and humans were found to have a greater amount of quiet sleep on the day of birth rather than 24 hr later. Changes in active sleep and wake were inconsistent across the 2 days. The quiet sleep findings are contrary to the developmental course which increases with age. The findings are interpreted as a temporary adaptive response to the stress of the birth process.

Most nurse educators would agree that critical thinking is an essential competency for the professional nurse in today's ever-changing health care environment. In fact, critical thinking has been identified as an integral component of professional nursing practice and has been incorporated in accreditation guidelines (1-3). As a result of this imperative, professional programs of nursing must explicate a clear definition of critical thinking, identify specific learning outcomes reflective of critical thinking abilities, and select appropriate ways to measure the achievement of these outcomes in graduating students. Although much has been written about the need for critical thinking skills, the concept and measurement of critical thinking within the context of nursing education has not yet been clearly defined (4-6). As a result, nursing programs are developing their own conceptual definitions of critical thinking and using a variety of methods to measure outcomes (5). The authors caution that to ensure validity of findings, the instruments used must reflect the individual program's definition of the concept. In most cases, outcomes have been assessed using a cross-sectional design that compares students at different levels or types of programs or are measured as an end-of-program outcome. While such designs can provide educators with knowledge of students' critical thinking abilities at a particular point in the educational process, longitudinal data are needed to assess the effects of the educational program.

In response to public criticisms about the outcomes of higher education, colleges and universities have implemented comprehensive assessment programs. In nursing education, outcomes assessment has become a criteria for accreditation. Yet, currently no guidelines exist describing “best practices” in nursing education outcomes assessment. Experts in educational assessment provide helpful guidelines for nurse educators as they establish comprehensive assessment plans. The authors provide a review of the literature in the field of assessment and offer strategies for developing successful assessment programs in nursing education.

Nurses are challenged to advance the theoretical foundations of community practice. This paper offers ideas on what-has been done and what needs to be done to meet this challenge. Within a community health nursing perspective, the paper defines community, proposes an integrated knowledge development framework that focuses on community, analyses contemporary theoretical and philosophical foundations of community in nursing, considers three worldviews in which nursing can be framed, and examines parameters for knowledge development for the future.

A presentation of case studies forms the focus for an exploration of the discovery of an abortion or adoption used as the management of an unwelcome pregnancy which occurred in the context of the marital system. Managing an impasse in the middle phase of therapy in each case led to the emergence of information which then allowed the therapist to work with the couple system to alleviate the core situation out of which presenting problems emanated. In these cases the unwelcome pregnancy had the potential to be cataclysmic to the couple system. Therefore, the possibility that a couple is concealing an abortion or an adoption should be considered by couples' therapists when there is little or no response to usual strategies for change. The reason for concealment is immaterial. What is paramount is that the therapist bring the event to the fore of treatment and work with a couple to put closure on what is generally an unresolved issue. © 1999, by The Haworth Press, Inc. All rights reserved.