This longitudinal descriptive study retrospectively profiled the acutely ill patient in home health care and explored the utility of using patient record data in predicting agency resource use and patient outcome. The findings suggest that those variables traditionally relied on for reimbursement qualification and as components of patient-classification schemes may not be wholly adequate to explain resource use and patient outcome in the home health setting. Professional nursing judgment of the patient's prognosis was found to be the most sensitive variable predicting outcome. Selected diagnoses and self-care capacity of the patient were the major predictors of resource use. Suggestions are offered for further studies that may move public health nursing more quickly toward the development of consistent and accurate home health care case mix measures.

This paper traces the evolution of a broader environmental health role for nursing by focusing on the health effects of exposure to environmental pollutants and of global environmental change. This evolving role is reviewed through the examination of selected community health nursing texts published during the last several decades. Key role strategies based on this expanded and evolving environmental role are proposed. Finally, a survey is described that is intended to heighten awareness of personal and professional attitudes and behaviors related to the environment.

Forty-five subjects including community health nurses with baccalaureate nursing degrees, senior-level generic nursing students, and registered nurses in a baccalaureate nursing program were compared on age, years of employment in nursing, and three variables 6 f professional autonomy: nurses' rights and responsibilities, the nurse-patient relationship, and nurses' role in health care delivey. It was predicted that nurses from baccalaureate programs and those practicing in community health nursing would perceive themselves as more autonomous and that age and years of employment in nursing would not appreciably alter perceptions of autonomy. An analysis of variance confirmed the initial prediction at the 0.01 level of significance or better for nurses' rights and responsibilities and their role in health care delivey. A significant negative correlation was obtained between age and nurses' rights and responsibilities for the community health nurses; a significant positive correlation was obtained between years of work experience and nurses' rights and responsibilities for only the registered nurses. This study is perceived as an initial step in a lengthy process aimed at identifying factors that influence nurses' perceptions about professional autonomy.Autonomy is of considerable personal and professional relevance to nurses. Autonomous nurses are not only autonomous pers o n s , but advocates for c l i e n t s a n d professionals able to function independently yet collaboratively in a complex health care environment The foundational ideas for this study were ( 1 the development of persona1 and professional autonomy and (2) the imAddress correwondence to: Joan E. R.N.g M.P.H., College of Nursing, Michigan State University,