Using standardized patients and standardized physicians to improve patient-care quality: results of a pilot study

BACKGROUND: We conducted evaluation research with a sample of registered professional staff nurses in a large, inner-city, tertiary medical center for a pilot study of videotaped case scenarios using standardized patients and standardized physicians to enhance nurses' communication and collaboration skills. METHOD: Change scores from pre-test to post-test on a self-reported rating scale to assess nurse-physician-patient interactions and communications for 28 nurses were compared with a control group of 38 nurses who did not participate in the videotaped sessions. RESULTS: Repeated measures of analysis of variance (ANOVA) detected no statistically significant differences between the intervention and control groups. However, positive changes were noted in some aspects of nurse-physician and nurse-patient interactions in the intervention group. Immediate feedback from the videotaped scenarios heightened nurses' awareness of the impact of their body language. CONCLUSIONS: Nurses must continuously practice and enhance their collaborative and communication skills. This pilot study suggests that it is beneficial to use videotaping with standardized patients and standardized physicians to enhance such nurses' skills.     

The origin and mode of fibroblast migration and proliferation in granulation tissue

The professions of nursing and medicine are committed to interprofessional education, in the belief that through this, patient care and satisfaction will be improved. Most initiatives involving nurses have been at post-qualification level, in primary health care, and concerning interpersonal or information management skills. Much of this collaboration has been with professions allied to medicine or social services. This paper discusses an innovative programme of shared learning in acute care, involving final year medical students and newly qualified staff nurses. The programme, developed in response to the blurring of professional roles between nurses and junior doctors, took place in our interprofessional Clinical Skills Centre. It was based around a developing patient scenario which was pertinent to the participants' area of practice. Each session was led by an experienced nurse lecturer and doctor, supported by specialist contributors. The style of learning was participative, with small interprofessional groups addressing a range of patient management issues. In this way, relevant clinical and communication skills were integrated within the context of holistic patient care. The course was well evaluated by both professional groups of participants and their managers. Subsequent research and curriculum development are leading to the expansion of this successful initiative.     

Cultural assessment in home healthcare

As the nurse becomes adept at performing cultural assessments and culturally competent care, it will become clear that "although it is critical to conduct a cultural assessment with culturally and ethnically diverse groups, it is also important to realize that every client needs a cultural assessment. Every client has values, beliefs, and practices that must be considered when a clinician renders healthcare services. Therefore, cultural assessments are not limited to specific ethnic groups, but rather should be conducted on each individual" (Campinha-Bacote, 1995, p.148). Nurses who have been identified as good transcultural nurses have been found to be empathetic, caring, open, and flexible. They have a positive attitude toward cultural differences and have a genuine interest in learning from the client about the client's culture (Emerson, 1995). Talabere (1996) states that openness, appreciation of another's perspective, holistic communication, genuine interest, and a nonjudgmental attitude are central to cultural sensitivity. When a culturally sensitive nurse develops mutually agreeable goals with a patient from another culture, a kind of cultural synergy occurs, resulting in care that is "meaningful, satisfying and beneficial to clients" (Leininger, 1988, p.155).     

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.     

Response of choriocarcinoma to paclitaxel. Case report and review of resistance

Nurses working in intensive care units may be vulnerable to verbal or physical aggression from relatives. This article explores the principles and skills associated with de-escalating aggression in such scenarios. These nurses may also be exposed to manipulative patterns of behaviour on the part of relatives and the article explores a research technique with which to manage this kind of situation.     

Nursing research 'down under'

1. The major constraints preventing psychiatric nurses from conducting research are lack of time and knowledge. 2. Nurses can be motivated to explore the possibility of conducting research without having necessary skills or knowledge to start. 3. The nursing profession must face its responsibility to support and nurture nurses' interests in conducting and using research.     

The role of the clinical nurse specialist in acute pain management

The role of nursing in infusional cancer chemotherapy (ICC) may vary depending on the practice setting. Nurses in free-standing centers and office practices perform many duties that nurses in other facilities may not, because of the lack of many of the supports that benefit hospitals with their multidepartmental and hierarchical structures. Nurses function collaboratively with physicians in the planning and the implementation of patient treatment. Patient-related nursing responsibilities include patient/family education, drug preparation and administration, patient assessment for treatment toxicity, recognition and management of complications related to the catheter or infusion device, and telephone triage. Other duties more removed from patient care might include inventory management, research data collection and management, quality assurance and improvement, compliance with regulatory issues, and a myriad of other responsibilities. The transition of patient care to the outpatient setting has broadened the scope of nursing to include nonpatient care responsibilities due to financial constraints brought about by health care reform, changes in reimbursement patterns, and overhead required to maintain and deliver quality patient care. As a result of nursing responsibilities, it becomes paramount that the aforementioned constructs for program support are in place and that all nurses are consistently trained and have a template to follow for patient treatment and management. Nursing ability to perform patient-related tasks should be proven by formal written and practical competencies repeated annually and as procedural changes are implemented. The paragraphs to follow suggest nursing management of patients receiving ICC using a model developed at The Cancer Center of Boston (TCC).     

Onychomycosis: strategies to reduce failure and recurrence

Nursing students often do not get the chance to practice the skills they need as nurses prior to graduation. Many of the required skills are difficult to teach using traditional classroom or clinical teaching methods. Peer leadership is one teaching method that may provide alternative learning opportunities for enhancing these professional nursing skills, and it encompasses the notions of peer teaching and peer supervision simultaneously. The purpose of this study was to describe what junior baccalaureate nursing students perceived as the benefits of a peer leadership experience, using Loving's Competence Validation Model as the theoretical framework. Twelve junior nursing students participated during their adult medical-surgical rotation and completed self-evaluations following the peer leadership experience. From analysis of these self-evaluations, responses were categorized into five perceived benefits: practice in prioritizing, enhancement of critical thinking skills, enhancement of technical skills, realization of peers as resources, and development of management skills.     

Role orientation in novice home healthcare nurses

The focus of healthcare delivery continues to shift from hospital-based nursing practice to care in the community, which includes home health care. Many basic nursing education programs provide home healthcare clinical experiences for students. However, this may not be enough to assist nurses in achieving home health nursing competency. Most nurses recruited into home health care worked exclusively in hospitals. Many nurses are employed in a practice environment for which they lack the necessary education and skills. As the practice environment for the nurse changes, so does the role of the nurse. Nurses are having difficulty adjusting to changing roles and responsibilities. This cross-sectional research study was conducted to evaluate the extent that new home healthcare nurses understand their role. This study reveals that nurses employed in home health care for 24 months or less continue to have only a moderate degree of understanding of their new role. These data suggest that educators critically evaluate the effectiveness of orientation programs for novice home healthcare nurses.     

The growth and development of an Intravenous Nurses Society chapter PICC council

Growing interest in peripherally inserted intravenous catheters led to the development of the PICC Council. This council was established to provide a resource of information for the area nurses involved in peripherally inserted intravenous catheters use and care. The group went through various developmental stages as they sought to establish cohesiveness and professional collaboration across a variety of practice settings. The outcome was the development of recommendations for vocabulary, communication, and care/maintenance activities, that could be used by intravenous nurses to enhance patient care coordination.     

Perioperative nursing interventions for intravascular stent placements

Keeping abreast of changing surgical technologies is among the more challenging aspects of perioperative nursing. Because peripheral vascular disease is a leading cause of lower extremity disabilities that require surgical interventions, new procedures and techniques are being developed continually. These procedures involve the insertion of intraluminal structural supports into patients who have had mixed or unsuccessful results from angioplasty. Perioperative nurses are an integral part of vascular surgery teams performing the insertion of intravascular stents. To function effectively, perioperative nurses must understand the concepts of intravascular stent procedures, nursing diagnoses, and nursing interventions that promote optimal patient outcomes.     

The place of humour in chronic or terminal illness

The literature supports the use of humour as a therapeutic intervention. The ability to apply and comprehend humour is associated with coping skills and is particularly relevant to people with chronic or terminal illness. Whether or not the application of humour is therapeutic will depend on the nature of the communication and the relationship established between nurse and patient.     

Developing a patient education program: overcoming physician resistance

Scientific expertise in the management of diabetes was an important factor in overcoming physician resistance to the education program. Nurses have expertise, and their expertise must be acknowledged for them to be viewed as leaders. Not only are nurses responsible for sharing their expertise with other nurses, it is equally important for them to share their expertise with the physicians, who may appreciate receiving any information that can help them improve their patients' outcomes. The components that are essential for success in pioneering a new program are good listening skills, a willingness to cooperate, self-confidence, scientific knowledge, vigilance, determination, and a clear vision. Patient outcomes will improve when nurses use their scientific knowledge base and leadership skills through patient-centered nursing practice, planned change strategies, and advanced practice nursing.     

An examination of learning processes during critical incident training: Implications for the development of adaptable trainees.

Three experiments are reported that examined the process by which trainees learn decision-making skills during a critical incident training program. Formal theories of category learning were used to identify two processes that may be responsible for the acquisition of decision-making skills: rule learning and exemplar learning. Experiments 1 and 2 used the process dissociation procedure (L. L. Jacoby, 1998) to evaluate the contribution of these processes to performance. The results suggest that trainees used a mixture of rule and exemplar learning. Furthermore, these learning processes were influenced by different aspects of training structure and design. The goal of Experiment 3 was to develop training techniques that enable trainees to use a rule adaptively. Trainees were tested on cases that represented exceptions to the rule. Unexpectedly, the results suggest that providing general instruction regarding the kinds of conditions in which a decision rule does not apply caused them to fixate on the specific conditions mentioned and impaired their ability to identify other conditions in which the rule might not apply. The theoretical, methodological, and practical implications of the results are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Co-amplification of nuclear pseudogenes and assessment of heteroplasmy of mitochondrial DNA mutations

As nurses begin to develop the sensitivities and skills necessary to preserve the integrity of clinical care and professional life, they must recognize the legitimacy of their perspectives and the value and consequences they have for the well-being of patient and family care. Nurses have much to contribute to the development of ethical practice environments for patients, families, multidisciplinary team members, and themselves. The frenzied, and at times anesthetized, culture of clinical settings can mitigate against the kind of deliberate reflection that is necessary if nurses are to act with ethical integrity. Knowing the rules of the road for end-of-life care and being attentive to common warning signs and addressing them proactively, enables nurses to provide patients and families with the highest quality care at the end of life.     

Computer-assisted communication and team decision-making performance: The moderating effect of openness to experience.

This study examined the effects of computer-assisted communication on team decision-making performance as a function of the team's openness to experience. 79 teams performing a multiple-cue probability learning task were randomly assigned to 1 of 2 experimental conditions: (a) verbal communication or (b) computer-assisted communication (which combined verbal and computerized communication). The results indicated that access to computer-assisted communication improved the decision-making performance of teams, but only when the teams were high in openness to experience. This effect was observed using both global openness and more specific openness facets, as well as a variety of team-level aggregation strategies. Moreover, the beneficial effects of openness in computer-assisted conditions were mediated by the efficiency with which teams integrated verbal and computerized forms of communication. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Legal and ethical considerations of informed consent

The law of informed consent remains ineffective at resolving patient comprehension issues primarily because differing interpretations exist regarding who is responsible for the duty to inform. Court cases continue to set precedents for practicing physicians and other health care providers; however, other measures can be applied for effectual patient advocacy. Health care personnel should rewrite typical consent forms in simpler terms, use larger print, and create duplicate copies. If patients are given copies of the permits they sign, the can reread the forms at home when they are more comfortable. For true autonomy to exist in informed consent for surgical procedures, consent forms should contain patients' primary languages whenever possible, or an adequate interpreter should be made available. Surgeons, nurses, and other health care providers must become aware of their responsibilities related to informed consent for treatment. It is necessary for health care personnel to develop and use effective communication techniques and remember that although some patients are more visually attuned to new information, other patients may benefit more from listening or reading. The cases in this article show that a patient's autonomy is part of the informed consent process and the duty to inform the patient lies with the person performing the procedure. A more important issue, however, involves the patient's comprehension of the information given, because without it, the patient cannot achieve true autonomy in making decisions. Ensuring that all elements of informed consent are met to obtain informed consent will result in fewer malpractice claims, greater patient satisfaction, and an improved professional image. Nevertheless, nurses should make themselves aware of the state laws in which they practice, including their nurse practice acts. They then should advocate for patient rights by encompassing all elements of informed consent.     

Formal measurement of pain by nurses

How often have we heard nurses complain because doctors have not prescribed adequate pain relief for patients? Nurses, however, are just as guilty as doctors of not managing patients with acute and chronic pain adequately. Concern that nurses in her district were not using, or were using inappropriately, pain assessment tools prompted the author to undertake a small survey of current practice. The results confirmed her suspicions, but subsequent continuing education programmes on pain management seem to be helping to raise nurses' awareness of their responsibilities in this crucial area of care.