Operational definition of the quality of nursing care at an intensive care unit of a teaching hospital

The purpose of this study is the development of valid standards and criteria of nursing care quality for intensive care units (ICUs) based on Donabedian's approach to quality access. Eighteen standards and 219 criteria have been formulated by ICU staff nurses at a school-hospital, according to a protocol. These standards/criteria have then been evaluated by 14 experts in ICU Nursing from 5 other hospitals by means of a written questionnaire. The results indicated a high acceptance thereof and only one criterion was rejected. This showed that staff nurses and the experts involved had similar concepts about quality of ICU practice. The developed operational definition may be a basis to quality access tool. Staff nurses participation in this process is recommended.     

Connecting the research and nursing processes: making a difference in baccalaureate students' attitudes and abilities

Student nurses are often intimidated by the research process. They also frequently have negative attitudes about working with the elderly, especially in long-term care settings. This article describes a clinical project designed to help students improve their attitudes, knowledge, and skills toward research and care of the elderly by connecting the research process and the nursing process. Students implement research-based clinical practice in a long-term care setting. Student evaluations indicate that project goals are achieved. Nursing staff evaluation data indicate that they find student projects interesting and useful in updating resident care plans.     

Do nurses have the information resources and skills for research utilization?

While access to information resources and the skills to use them do not ensure that nurses will use nursing research in their practice, they are important facilitators. Mailed questionnaires to assess existing information resources, the information management skills of nurses, and what additional resources and training are required were returned by 67 of the 71 vice-presidents or directors of nursing in hospitals in two regions of Ontario. The two regions have similar information resources, nursing staff with research expertise, and opportunities for training in research and information management but there is variation among hospitals. Most vice-presidents agreed that nurses need better information resources and skills to access and evaluate professional literature. The rapidly developing field of information technology, including the Internet, provides potential for sharing resources and expertise. Nursing administrators can minimize barriers and help staff nurses recognize that information management skills enhance professional development and improve patient care.     

Results of NAON's Nursing Diagnosis Survey. A contribution to nursing's minimum data set

Use of nursing diagnoses allows nurses to name and classify the judgments nurses apply to analysis of a patient's assessment data. Such classification systems are an important part of the proposed Nursing Minimum Data Set (NMDS) (see sidebar on next page). This article describes the findings of NAON's survey of members' (N = 1500) use of nursing diagnoses in the care of patients undergoing surgery and major invasive procedures. The response rate for this survey was 37.5% (n = 563) and found to be representative of NAON's general membership. Seven nursing diagnoses were reported as primarily used during the care of surgical patients. Six nursing diagnoses were reported to be applied in the care of patients undergoing significant invasive procedures. Findings of this study may be used to contribute orthopaedic nurses' unique perspective to the formation of the Nursing Minimum Data Set (NMDS).     

Continuing education of the intensive care units nursing staff in the city of Sao Paulo]

This study is part of a project about ICU's characteristics in S?o Paulo city. This article describes the continuing education programs for nursing staff. 43 ICUs were analysed and the questionnaire answered by the ICU nurse coordinator was used to collect data. Results showed that 34 (79.1%) of the ICUs have initial program for training each nursing staff category and 18 (41.9%) had regular continuing education program focusing primarily on nursing procedures and routines and the update in pathologies. Continuing education programs are developed primarily by ICU's nurses. 50.2% of the nurses answered that they attended specialisation/extension courses too, in Medical Surgical Nursing or in other areas or in both areas. Due to this result and the development of the ICU's nurses as specialists, some suggestions are presented to improve the continuing education program in these Units.     

Second malignancies in cervical cancer patients in the west of Scotland

A recent focus in health care is to develop a seamless transition for patients between the variety of health care agencies with whom they interact. The continuum of care for patients with stroke is complex and many levels of care are required, from acute intervention through to rehabilitation and reintegration into the community. A group of nurses from a variety of agencies in Southwestern Ontario received funding from the Ontario province Wide Nursing Project to effect a desirable change in the way nurses care for the stroke patient. This article describes the Ontario Province Wide Nursing project and the process of and challenges in developing a nursing model for stroke. The development of a nursing model for stroke patients and their families involved conducting nursing, and patient and family focus groups to identify key issues. Thirty-eight nurses participated in the nursing focus groups, and 8 patients and 18 family members participated in the patient and family focus groups. The common themes were the need for improved communication and the need to better prepare patients and families for the many transitions they experience during their recovery from stroke. A Stroke Education Record, which identifies a comprehensive list of potential learning needs of stroke patients and their families, and a Stroke Education and Resource Guide, which provides a reference for nurses, were developed and will be implemented in September 1998. Implementation of the model included a workshop, staff inservices, a self-learning package, and unit displays. Evaluation of the model will include nursing and patient and family focus groups, a chart review, written nursing evaluations, and patient and family telephone interviews.     

Study of the relation between transformational leadership of the head nurse and supplementary efforts of nursing personnel

The present study proposes to show that the ethos of the Head Nursing staff is related to the practice of transformational leadership, and to additional efforts displayed by the treatment staff. Using a sampling of 57 nurses, it was established that transformational leadership presented a positive influence on additional efforts which were superior to that produced by transactional leadership. Contrary to transactional leadership, transformational leadership was shown to exert a positive effect on the ethos of the leader who in turn, had a positive influence on the extra care supplied by the nursing staff.     

Introducing primary nursing: nurses' opinions

This article reports on one aspect of a research project carried out to monitor and evaluate the introduction of primary nursing on four demonstration wards in one health authority. Nursing staff working on the wards were interviewed to identify how the changes were affecting them and their work. Stress questionnaires were also completed by a sample of nurses on the wards. Responsibility and communication--key concepts emerging from the data--are discussed and related to the literature on primary nursing.     

Evidence for healing of interproximal intrabony defects after conventional and regenerative therapy: digital radiography and clinical measurements

Competencies have been formulated for entry level nurses. Specialist and generic advanced nursing competencies are also being developed. This paper describes exploratory groundwork on aged and extended care nursing competencies derived from interviews with nurses, allied health staff, residents and their families from one setting. Critical Incident Technique1 was used to guide semistructured interviews with 29 participants. A thematic analysis of the data suggests that the Australian Nursing Council Inc.2 competencies make a useful but incomplete contribution to understanding the perceived role of nursing in aged and extended care. A conceptual framework developed from the data illustrates the interdependence of competencies with the context in which they are observed. The framework proposes a number of elements which have the potential to offer a means to better interpret nursing competence (critical aspects) in aged and extended care contexts.     

The influence of clinical relapses and steroid therapy on the development of Gd-enhancing lesions: a longitudinal MRI study in relapsing-remitting multiple sclerosis patients

A two-round Delphi study was performed in Pediatric Nursing at a large midwestern teaching hospital. The purpose of the study was to identify research priorities for the Pediatric Research committee for future projects. The initial survey was sent to all pediatric nursing staff. Sixty-two staff (19%) responded to the first round. Forty-five separate research topics/themes of interest were identified. The second round survey was sent to the 62 staff who responded to Round 1. Forty-eight staff (76%) responded. Participants were given a list of the 45 topics identified in Round 1, and asked to identify their top five priorities. Results were analyzed by unit and by Division. The identified priorities for the Division are described here.     

Where do I begin? Writing for publication

Nursing is changing. All nurses, clinical and management, are being encouraged to write. Some educators are under considerable pressure to write as part of their jobs. The university system has always insisted that teaching staff publish and many nursing colleges and schools are now joining the higher educational system. This article is about getting started in writing. It describes what to write, who to write it for and how to write for publication.     

Thinking about thinking

BACKGROUND: The nursing leadership at a 900-bed tertiary-care facility in the southeast believed an opportunity existed to improve the critical thinking abilities of the professional nursing staff. METHOD: A team, consisting of a diversified group of nurse educators and managers, had the opportunity to gain understanding of the critical thinking process of the nursing staff as well as to develop a plan designed to improve critical thinking skills. RESULTS: Outputs of the team included development of a critical thinking model and process as well as an action plan that specifically outlined how it would implement the model within the organization using a preceptor-based educational process. CONCLUSION: Nursing leadership within this facility believes that nurturing critical thinking in the staff will have a positive impact on care delivery outcomes. Creating shared visions through the assumptions that the staff and organization hold is important to improving care provided. Assisting staff with using a critical thinking process in order to construct, tear down, and then reconstruct clinical incidents as encouraged by this model is one key to problem-solving.     

DNA mismatch repair deficient mice in cancer research

Because the phenomena of managing and therapeutically responding to confused elderly hospitalized patients is complex and difficult, a group of advanced practice nurses, supported by a pharmacist, nursing administration, and a School of Nursing professor, was commissioned to explore the research-based literature and provide practice recommendations for these patients. This article identifies one process undertaken for synthesizing and grounding an immense body of literature related to confused elderly patients. The literature review served to begin clarifying the differences between the diagnosis and required interventions for managing either acute or chronic confusion. These interventions were articulated within a protocol format (Marker model) familiar to staff members at our institution. The development, implementation, and evaluation of the protocol is presented, as well as suggestions for further research.     

The correspondence of patient satisfaction and nurse burnout

This study examined the relationships of nurse burnout, intention to quit, and meaningfulness of work as assessed on a staff survey with patient satisfaction with nursing care, physician care, information provided and coordination of care, and outcomes of the hospital stay assessed post-discharge. Sixteen inpatient units from two hospital sites formed the data base and included 605 patients and 711 nurses. Patients' perceptions of the quality of each of the four care dimensions corresponded to the relationships nurses had with their work. Patients on units where nurses found their work meaningful were more satisfied with all aspects of their hospital stay. Patients who stayed on units where nursing staff felt more exhausted or more frequently expressed the intention to quit were less satisfied with the various components of their care. Although nurse cynicism was reflected in lower patient satisfaction with interactions with nursing staff, the correlations between cynicism and other aspects of care fell below statistical significance. No significant correlations were found between nurse professional efficacy and any of the patient satisfaction components measured. The implications of the relationship between patient satisfaction and nurses' perception of their work is discussed.     

Chiral separations by capillary electrophoresis in process chemistry

BACKGROUND: Conducting research in clinical settings can be problematic for many nurses in practice due to lack of experience and support. METHOD: Research collaboration between clinical nurse specialists and staff nurses in clinical settings can promote development of their research process skills. RESULTS: Strategies identified can be applied by clinical nurse specialists involved in continuing education and staff development in clinical practice through further research development. CONCLUSION: Collaboration among clinical nurse specialists and staff nurses provides a unique and strong link that transcends degrees and roles to make substantial contributions to professional nursing practice.     

Nurses helping nurses. Development of internal specialists in long-term care

The prevalence of psychiatric disorders and behavioral disturbances among nursing home residents, combined with observed deficits in geriatric mental health/illness expertise among LTC staff, supports the need for creative approaches to improve the knowledge, understanding, and management of such problems among LTC providers. The train-the-trainer model described in this article proved to be a viable method to providing geriatric mental health consultation and training that targets both improved quality of life for residents and quality of work life for the staff in charge of residents' care. More collaborative efforts among nursing specialists, subspecialists, and generalists are needed to empower those who work in LTC to utilize strengths and abilities inherent to their positions. Nursing homes nurses, who are all too familiar with the problems and challenges of their patient population, may act not only as mental health trainers but also as resource persons, role models, liaisons with geropsychiatric specialists, and leaders in the application of geropsychiatric care principles to residents within their facility, thus promoting improved resident and staff care alike.     

Effects of clozapine and haloperidol on baseline levels of vacuous jaw movements in aged rats

BACKGROUND: IgE-mediated hypersensitivity to latex proteins has become a significant clinical problem over the last decade. Nursing and medical staff are at risk because of their occupational exposure to latex. AIMS: To determine the prevalence of type I hypersensitivity to latex allergens in the nursing staff of an Australian hospital. METHODS: A questionnaire which asked about symptoms associated with the use of latex gloves was completed by 140 nurses working in the Alfred Hospital (72 in general medical wards, 68 in intensive care units). Skin prick tests with eluates of five different types of latex glove as well as common aeroallergens (rye pollen and house dust mite) and banana extract were performed. RESULTS: Thirty-one nurses (22%) were skin prick test positive to at least one of the five latex glove eluates. All of these nurses were atopic, having positive skin prick tests to rye pollen or house dust mite. Symptoms of local dryness, itch and erythema associated with glove use were reported by more than half the study group, but not more frequently by those who were skin prick test positive to latex. Urticaria associated with glove use was reported more frequently by those with positive latex skin prick tests (13% vs 4%, p = 0.05). Eighty-seven per cent of the nurses who were latex skin test positive were also positive to banana extract. CONCLUSIONS: IgE-mediated hypersensitivity to latex is common in nurses working in an Australian hospital. Glove associated symptoms were frequently reported, but in most cases the symptoms were more typical of irritant or contact dermatitis rather than type I hypersensitivity reactions. However, the extent of subclinical sensitisation to latex found in this study suggests that symptomatic latex allergy is likely to emerge as an increasing problem for nursing staff in this country.     

The Research Nurse Intern program. A model for research dissemination and utilization

The Research Nurse Intern program at the University of Nebraska Medical Center is designed to support the development of research-based nursing practice and to foster the professional development of staff nurses. The activities of the 2-year program are based on a model that blends research dissemination and utilization with the change process. The authors' purpose is to describe a staff nurse-focused program and its successes in accomplishing these two standards of clinical nursing practice.     

Relevance of pharmacokinetics and pharmacodynamics

This ex post facto study investigated the relationship of social support from two workplace sources, unit managers and registered nurse (RNs) coworkers, to work-related stress among staff nurses. Sample participants included 51 full-time RNs from a variety of clinical specialties in one nursing organization. The three theoretical components--affect, affirmation, and aid--were measured by the Norbeck Social Support Questionnaire. The Nursing Stress Scale was used to quantify the levels of perceived work-related stress. Statistically significant negative correlations were found between affect from unit managers (r = -299; P = 0.15) and aid from coworkers (r = -.294; P = .036) on levels of perceived work-related stress. Additionally, the increased age of the subjects (r = -.342; P = .007), years of nursing experience (r = -252; P = .037), and length of employment (r = -329; P = .009) had a negative relationship with work stress. The results of this research demonstrated that two components of social support--affect (emotional support) from unit managers and aid (services, information, materials) from coworkers--were linked to lower stress scores in this sample of staff nurses.