Generic nursing outcome objectives for use in long-term care facilities

Twenty-two registered nurses employed in four long-term care facilities generated data for a study about nursing diagnoses in long-term care (N = 360). Generic outcome objectives were developed as an integral part of the project. The research team also specified exceptions to the outcomes: instances where meeting outcome objectives might not be possible. The outcome objectives and exceptions for the sample's 20 most frequently occurring nursing diagnoses are presented as working statements. The authors expect that these outcome objectives and exceptions will be revised by nurses who use them in practice, basic and continuing education, and research.     

Unit-based acute confusion resource nurse: an educational program to train staff nurses

Despite the high prevalence of acute confusion among elders and the importance of its early detection, there are few reports of systematic efforts to increase staff competence. This article describes the development and evaluation of an 8-hour educational program designed to prepare staff nurses to perform in a new role, the unit-based acute confusion Resource Nurse (ACRN). Pre- and posttest scores were obtained for the 80 registered nurses who participated in the program. Paired t tests showed that knowledge and confidence significantly increased for participants as a result of their participation in the educational program. This program can serve as an effective model for geriatric staff education.     

The roller coaster supply of registered nurses: lessons from the eighties

The strong labor demand of the eighties for nurses has evaporated under reform proposals and cost constraints. In this study, the 1984 and 1988 National Sample Surveys of Registered Nurses (NSSRN) were used to examine the labor supply of nurses. Ordinary least squares and logistic regression analyses indicated that the responsiveness of registered nurses to the wage was greater than previous research has indicated. If wage growth is slow relative to other occupations due to a decreased demand for nurses, registered nurses will in turn reduce their supply of labor more than previous research has indicated. Whether the response by nurses will balance the reduction of demand by employers remains to be seen.     

Ratings of the performances of practicing internists by hospital-based registered nurses

PURPOSE: To examine the feasibility and reliability of ratings completed by hospital-based registered nurses of the humanistic qualities, communication skills, and selected aspects of the clinical skills of practicing internists. METHOD: In 1988-1989, registered nurses who worked in the same 175 hospitals as 232 internists with admitting privileges at these hospitals rated the internists' performances. The nurses were selected from medicine floors, specialty floors, and intensive care units and/or critical care units, using lists provided by head nurses. A total of 1,877 rating questionnaires with 13 performance categories were collected (with a mean of 8.01 nurses per internist). The ratings were analyzed to determine measurement characteristics and the relationships of the nurses' demographic characteristics to the ratings. In addition, for each of ten performance categories for 152 of the internists, the average rating each internist received from nurses was compared with the average rating each internist received from peer physicians. Statistical analysis used Pearson correlations, canonical correlations, factor analyses, Student's t-tests, analysis of variance, and stepwise multiple regression. Finally, the internists themselves, including physicians who were not actually rated by the nurses, were asked to complete a brief questionnaire that included questions about their opinions of the use of nurses' ratings. RESULTS: The nurses' ratings correlated moderately strongly with the peer physicians' ratings and had a common structure. However, the nurses' ratings were lower for several humanistic qualities, including respect, integrity, and responsibility, and their ratings were higher for medical knowledge and verbal communications. Across the 13 performance categories, approximately 10-15 ratings from nurses were needed to obtain a reliable assessment of an internist's humanistic qualities and communication skills. Many internists felt that nurses' ratings should be used equally with, or at least as a lesser contribution to, ratings by peer physicians of humanistic qualities and communication skills. CONCLUSION: Nurses' ratings appear to provide a feasible and reliable method of evaluating the internists' communication skills and humanistic qualities, when used in conjunction with ratings by peer physicians.     

Disaster preparedness: institutional capacity building in the Americas

Latin American and Caribbean countries are prone to natural, technological and "complex" disasters. This vulnerability to catastrophic events led the region to undertake the long journey away from an ad hoc response towards institutional preparedness and, more recently, to disaster prevention and mitigation. This article attempts to outline the definitions and basic principles of institutional emergency preparedness, including reliance on the more effective use of existing resources, rather than establishment of special stockpiles and equipment; the critical importance of general participation and awareness; and the interrelationship of the health sector with others and the potential for leadership. How to assess the level of preparedness is discussed. Stress is placed on the fact that preparedness is traditionally confused with the existence of a written disaster plan. Preparedness should be seen as a never-ending, complex process that can only be assessed through an in-depth review of coordination, planning, training and logistic elements. There is also a fundamental distinction between preparedness, i.e., "getting ready to respond" and disaster prevention/mitigation, which aims to reduce the health impact. The latter calls for the collaboration of engineers, architects, planners and economists with the health sector. It is illustrated by the regional initiative in the Americas to reduce the physical vulnerability of hospitals to earthquakes and hurricanes. In spite of the encouraging achievements, much remains to be done. Weak areas include preparedness for technological disasters, and a true inter-country preventive approach to common disasters across borders. Electronic communications through the Internet will also help to suppress borders and boundaries, contributing to a truly collective approach to emergency preparedness and disaster relief coordination.     

Service unit management and nurses' satisfaction

Nurses' satisfaction was compared in 55 patient units, 32 with service unit management (SUM) and 23 without. Satisfaction of licensed practical nurses was unrelated to SUM, but intrinsic task satisfaction of registered nurses (and of head nurses, who were considered separately) was positively related to the presence of SUM. Transfer of nonprofessional tasks out of nursing and reduction of tension arising from reduced responsibility of nurses for coordinating activities with ancillary departments are possible explanations for the positive relation between the presence of SUM and professional nurses' satisfaction.     

Power or the lack of it in nursing care

Power is required to obtain professional goals. The aim of this study is to clarify the significance of power and the lack of it in the opinions of nurses and in prevailing nursing practice. The power of the nurse was measured by the nurse's own assessment of her/his capability to improve the quality of nursing care. The data were collected from all the registered nurses (n = 179) of five hospitals. The response was 70%. The powerful nurses had more knowledge, were better motivated, implemented policies more often, acted consciously towards nursing goals and collaborated better than the powerless nurses. The results demonstrated that nurses who had enough power possessed both wider and deeper cognitive and moral dimensions and had better skills in human interaction than did the powerless nurses.     

The registered nurse: perceptions about advance directives

The driving force behind mandates from both the American Nurses' Association and the American Medical Association is an expectation that doctors and nurses will act as advocates for the participation of the patient in end-of-life treatment decisions. This mandate assumes that both groups are knowledgeable about advance directives and can advise patients on these. Both groups are enjoined not only to facilitate the expression of the patient's wishes but also scrupulously to honor these. The literature suggests that, despite their professional mandate, nurses may feel uncertain about the legal, moral, and ethical obligations surrounding their participation in this enormously significant aspect of patient care. This study focuses on the perception of the dilemma by a sample of registered nurses at a large southeastern university medical center.     

Nursing in prisons. Career opportunities in the nursing service for prisoners

This paper looks at the organisation and recent transformation of the nursing service for prisoners. Formerly the majority of health care within the prison service was provided by discipline officers, who had had training in first aid and basic nursing duties. However, the service is now increasingly employing registered nurses.     

Retaining registered nurses in rural community hospitals

In rural practice settings where the task of recruiting new employees is exceedingly difficult, the first step in surviving the nursing shortage should begin with maintaining existing resources. Based on a survey of 2,488 staff registered nurses working in rural community hospitals, the authors compare personal, demographic, and practice characteristics of nurses by their self-reported intentions to stay in their present positions. Specific areas of job dissatisfaction that best distinguish those who anticipate leaving in 1 year from those committed to remaining in their present job for 5 years or more are identified.     

Where are career ladders going in the 90s?

Information from 543 hospitals and 200,000 RNs was obtained through a National Nursing Compensation Survey. Analysis of the data showed that 239 hospitals had clinical nurse ladders and many others were planning to initiate some form of ladder program soon. Although the theoretical framework, the process and the compensation packages varied, it is clear that clinical ladders are quite effective in recruitment and retention of registered nurses.     

The disaster preparedness concerning personnel at the hospitals in the Disaster Preparedness Region II: Viborg, Ringkj?bing and Aarhus counties

The aim of this investigation was to describe the disaster preparedness concerning hospital staff members in Viborg, Ringkj?bing and Arhus county, and to describe the outcome of the disaster medicine-courses given in the region--in theory as well as practice. In the region a questionnaire was sent to the chief doctor and chief nurse for the involved departments, and a personal questionnaire was sent to all the doctors and nurses in the region, who had participated in one or more courses in disaster medicine during the period 1990-1995. Of the total number of doctors at the involved departments, 7% of the residents, 29% of the senior residents and 56% of the consultants had taken a course in disaster medicine, as had 33% of the nurses. Only 15% had taken more than one course, and as few as 2% had had a follow-up course to the primary one given in the region. Forty-one percent had used their acquired knowledge either in theory or practice: 55% for educational purposes, 11% for disaster planning and 12% for buying equipment for the hospital. In general an easier access to follow-up is desired, and there seems to be a need to give more consideration to the priorities of the individual departments concerning the selection of participants to the courses in disaster medicine.     

Roles of advanced practice nurses in oncology

Managed care is a process of health-care management that integrates financing, cost-containment strategies, and business principles with the delivery of health care. Managed care's rapid transformation of specialty practices, such as oncology, is redirecting classic nursing functions toward market initiatives that value the design of care/case management systems and the implementation of multidisciplinary "patient-centered" care models. As health-care systems continue to evolve, advanced practice nurses (APNs) are redefining their roles and enhancing their skills to meet the demands of the marketplace. Advanced practice nurses are defined as registered nurses who have met advanced educational and practice requirements and are prepared at the graduate level. This paper will identify the four established APN roles: nurse practitioner (NP), nurse anesthetist, nurse midwife, and clinical nurse specialist (CNS), as well as highlight the nurse practitioner and clinical nurse specialist as the leadership APN roles within oncology practice. The adaption to managed care has identified new functions and created opportunities for these APN specialties that are being viewed both competitively by other oncology health-care providers and creatively by managed-care organizations. The integration of these emerging roles within the new advanced nursing market and their contributions to oncology care are also discussed.     

When the severely ill elderly patient refuses food. Ethical reasoning among nurses

Forty registered nurses (RNs) regarded as "good and experienced" in either cancer or dementia care, were asked about their decision to feed or not feed a severely ill elderly woman (a hypothetical case). In order to compare ethical reasoning in the two groups of nurses and to illuminate what it means to RNs to face a situation where the patients can/cannot decide for themselves, a phenomenological hermeneutic approach was used for the analysis. Both groups saw themselves as the advocate for their patients but in different ways. The RNs who talked about a mentally alert patient emphasized that they encouraged their patient to speak up for herself, while the RNs who talked about a severely demented patient emphasized that they tried very hard to interpret their patient's vague and unclear communicative cues and to act as her advocate, especially in relation to physicians. Transcending experiences of dying relatives and patients as well as role models helped them to achieve their ambition of putting themselves in the patient's shoes in order to respect and understand her or his wish and/or what was best for them. The majority of RNs strongly rejected active euthanasia.     

Forensic responsibilities of the legal nurse consultant

1. Legal nurse consultants are registered nurses who use their clinical knowledge and expertise to assist attorneys with their cases in any context where law and medicine overlap. 2. A working knowledge of the four elements that constitute negligence is essential for a legal nurse consultant who works on medical and dental malpractice cases. 3. The ultimate goal of the legal nurse consultant is to provide the attorney with answers to questions relating to medical issues that may arise in a court of law. 4. The greatest challenge and opportunity the legal nurse consultant faces is the task of educating attorneys on the medical issues of their cases so that they are as knowledgeable and comfortable with these issues as they are with the liability issues.     

Self-coherence, emotional arousal and perceived health of adult children caring for a brain-impaired parent

An important concern for nurses is the ability of adult children to provide effective care to a dependent parent without sacrificing their own health and well-being. The purpose of the study was to examine 'sense of self-coherence' as an inner resource for the attenuation of distress in a sample of 168 adult children who were involved with the care of a brain-impaired parent. Subjects were interviewed twice in their homes in order to obtain data on variables for: self-coherence, emotional arousal, perceived health, and crisis. Findings from the study indicate that adult children with crisis experience in the previous 6 months of caregiving had higher scores for emotional arousal, lower scores for self-coherence, and lower ratings of perceived health than did adult children with no crisis experience. In addition, there was a negative relationship between self-coherence and emotional arousal and a positive relationship between self-coherence and perceived health. Both of these relationships were significantly stronger in the presence of crisis experience than in the absence of crisis experience. Finally, there was a negative relationship between emotional arousal and perceived health that was equally apparent in both the presence and absence of crisis experience. The findings suggest that self-coherence is an inner resource that emerges in filial crisis to modulate the emotional impact of the situation. The implication is that measures of self-coherence could be used to assess an adult child's preparedness to appraise and cope with emotional responses to filial crisis events. This information could help nurses anticipate and target resources for vulnerable adult children so that they are less adversely affected by the demands of parent care.     

Effectiveness of computer-assisted instruction in increasing the rate of universal precautions--related behaviors

BACKGROUND: With widespread noncompliance to universal precautions well established, an experimental study was designed to compare the rate of universal precautions--related behaviors between nurses who participate in computer-assisted instruction. This study also explored the relationship between rates of universal precautions--related behaviors and subjects' demographic and experiential characteristics and history of occupational blood-borne exposure. METHODS: Data were collected by using a questionnaire to elicit information as to subjects' demographic and experiential characteristics and history of occupational blood-borne exposure. The Universal Precautions Assessment Tool was used to gather data on rates of universal precautions--related behaviors on two groups of registered nurses with 30 subjects per group. RESULTS: By using analysis of variance, the null hypothesis was rejected. The intervention used in this study did increase universal precautions--related behaviors. Multiple regression was used to analyze the research question and none of the variables were significant. Forty (67.8%) subjects reported receiving a needlestick or cut caused by a needle or sharp that was actually or potentially contaminated with blood or body fluids. Of these exposures, only one patient was known to be HIV antibody positive. CONCLUSION: Replication studies using computer-assisted instruction interventions are needed as are studies aimed at exploring other potentially effective interventions.     

A clinical advancement program: creating an environment for professional growth

Clinical ladders help maintain expert, motivated, and effective nurses in direct patient care roles. While many institutions were phasing out clinical ladders for registered nurses, Miami Valley Hospital was proactively evaluating the original version. The authors describe their clinical advancement program, based on Benner's model, with program evaluation results. The program participation rate has increased overall. Participants perceive their work and environment more positively than nonparticipants.     

Youth suicide

Despite these recognised constraints, increased knowledge of individual and family health problems in Australia will enable nurses to make a valuable contribution to this important Australian public health issue. However, the use of primary care or public health approach alone cannot ensure patient or community involvement in changing the various social structures that cause certain groups to be at high risk for a particular health problem. The world today needs nurses who can diagnose community health problems and institute measures to protect, advance, and monitor the health of populations as a whole, nurses who can care for the sick or the disabled, nurses who can teach people to care for themselves. By understanding and integrating these concepts with the illness prevention/ health promotional tenets of primary health care. Australian nurses will become the future leaders in individual, family, and community health and also have a substantial impact on the problem of adolescent suicide in Australia.