Maternal-infant clinical nurse specialist performance assessment: development of an evaluation tool

The Maternal-Infant Clinical Nurse Specialist Performance Evaluation Tool was developed to assist students to enact certain role behaviors of the clinical nurse specialist (CNS) in maternal-infant nursing and to provide faculty with a measurement of such behaviors for the purpose of student clinical evaluation. Items for the behaviorally-anchored, criterion-referenced tool were derived from current standards of CNS practice, expected competencies of the CNS as reported in the literature, and program and course objectives. Initial use of the tool with graduate students in the maternal-infant specialty indicated a valid and reliable rationale for continued use. Since the categories of the tool represent common CNS roles, it should be applicable to other specialties.     

Benchmarking nurse staffing levels: the development of a nationwide feedback tool

Title. Benchmarking nurse staffing levels: the development of a nationwide feedback tool. Aim. This paper is a report of a study to develop a methodology that corrects nurse staffing for nursing care intensity in a way that allows nationwide benchmarking of nurse staffing data. Background. Although nurse workload measurement systems are recognized to be informative in nurse staffing decisions, they are rarely used. When these systems are used, however, it is only possible to compare units within hospitals, because currently available instruments are not standardized for comparisons beyond hospital boundaries. The Belgian Nursing Minimum Dataset (B‐NMDS) contains uniformly measured data about the intensity of nursing care and nurse staffing levels for all hospitals in Belgium. Method. We conducted a retrospective multilevel analysis of the B‐NMDS for the year 2003. The sample included 690,258 inpatient days for 298,691 patients, recorded from 1637 acute care nursing units in 115 hospitals. We corrected the number of nursing staff by using different covariates available in the B‐NMDS: intensity of nursing care, type of day (week vs. weekend), service type (general vs. intensive) and hospital type (academic vs. general). Findings. The multilevel approach allowed us to explain about 70% of the variability in the number of nursing staff per nursing unit using hospital type (P = 0·0053); intensity of nursing care (P < 0·0001) and service type (P < 0·0001) as the only covariates. Conclusion. The feedback tool we developed can inform nurse managers and policymakers about nursing intensity‐adjusted nurse staffing levels according to different benchmarks. Our study demonstrates that investing in large nursing datasets is appropriate for the international nursing community.     

Identifying substance use: an assessment tool for the school nurse.

A nursing assessment tool was developed to identify students who may be using drugs or alcohol. The three-part tool enables the school nurse to identify those students who require immediate medical care, as well as those who are impaired by substance use but medically stable. The use of the tool and implications for school nurses are discussed.     

Mobilization-Observation-Behavior-Intensity-Dementia Pain Scale (MOBID): development and validation of a nurse-administered pain assessment tool for use in dementia

Pain assessment in older persons with severe cognitive impairment (SCI) is a challenge due to reduced self-report capacity and lack of movement-related pain assessment instruments. The purpose of this article was to describe the development of the Mobilization-Observation-Behaviour-Intensity-Dementia Pain Scale (MOBID) and to investigate aspects of reliability and validity. MOBID is a nurse-administered instrument developed for use in patients with SCI, where presence of pain behavior indicators (pain noises, facial expression, and defense) may be observed during standardized active, guided movements, and then inferred to represent pain intensity. Initially, the MOBID contained seven items (observing at rest, mobilization of the hands, arms, legs, turn over in bed, sitting on bedside, and teeth/mouth care). This was tested in 26 nursing home patients with SCI. Their primary caregivers, five registered nurses and six licensed practical nurses (LPNs), rated the patients' pain intensity during regular morning care, and by MOBID, both at bedside and from video uptakes. Three external raters (LPNs), not knowing the patients, also completed the MOBID by rating the videos. Internal consistency of the MOBID indicated high Cronbach's alpha (alpha=0.90) after deleting the items for observation at rest and observation of teeth/mouth care. MOBID disclosed significantly more pain than did pain scorings during regular morning care, and video observation demonstrated higher pain intensity than bedside scoring. Intertester reliability for inferred pain intensity was high to excellent (intraclass correlation coefficient=0.70-0.96), but varied between poor and excellent for pain behavior indicators (kappa=0.05-0.84). These results suggest that registration of pain behavior indicators during active, guided movements, as performed by the MOBID procedure, is useful to disclose reliable and valid pain intensity scores in patients with SCI.     

Using nurse leader development to improve nurse retention and patient outcomes: a framework

With many factors converging, it is critical that nurse leaders have the knowledge and competency to develop outstanding relationships with registered nurses in order to retain them and thus improve patient outcomes. Senior nurse leaders of Methodist Le Bonheur Healthcare, a 7-hospital system based in Memphis is addressing these issues through a comprehensive leader development framework. Through organizational commitment and supported by a federal grant, a program that focuses on creation of individual development plans, provision of development education, and one-to-one on-site coaching has been implemented.     

Development of a bariatric patient readiness assessment tool for the emergency department

Morbidly obese patients present safe patient handling challenges to emergency department (ED) personnel. Emergency departments are often ill-equipped to safely manage the patient of this size. The purpose of this study was to develop an assessment tool to determine ED readiness to safely manage the morbidly obese patient. Published guidelines by the Facility Guidelines Institute and the National Association of Bariatric Nurses were used for tool development. The tool assesses policy, equipment, space/structural requirements, and patient handling and -moving tasks. A 2-phase, nonexperimental, exploratory study in a convenience sample of 5 EDs was conducted, applying a usability testing model to determine the usability and utility of the tool. Four of 5 hospital EDs agreed that the tool was easy to use and helpful in determining their readiness to safely manage the morbidly obese patient. The tool was found to be usable on a limited basis. Additional application of the tool on a larger scale is recommended.     

Genogram: a useful tool for nurse practitioners

This paper presents the genogram, originated by family therapists and utilized in the psychosocial field, as a valuable tool to be used by the nurse practitioner. The nurse practitioner from any area of practice, primary care, women's health, paediatrics, geriatrics, psychiatry, in any setting (hospital, clinic, school, industry, community and home), requires a tool that provides a comprehensive assessment of the client and the factors that affect their health. The theoretical background of Bowen's family systems theory and of systems theory is reviewed as the genogram evolved from the theories. Two hypothetical case illustrations utilizing the genogram are presented, one presenting only medical problems, the other presenting medical, psychiatric and family relationships. The usefulness of the genogram is not new, but it is reviewed here for its value to the nurse practitioner. Evidence leads to the conclusion that the genogram is an assessment tool that enhances intervention strategy and communication in the client's record. It augments treatment planning, care provision, health promotion and prevention, as well as cost management.     

The development of a respiratory assessment tool

Patient-controlled analgesia uses an infusion pump to administer analgesia to the patient intravenously in small bolus doses. Administration of the doses is controlled by the patient up to a prescribed maximum dose (Pasero and McCaffrey, 1994). The use of PCA is increasing in hospitals, partly due to the range of reported benefits it has for patients (Thomas, 1993). It is particularly useful in the control of postoperative pain (Thomas, 1993), and avoids the need for other pain relief methods such as intramuscular injections.     

The Pain and Movement Reasoning Model: Introduction to a simple tool for integrated pain assessment

Pain is no longer considered to be simply the transmission of nociception, but rather an output subsequent to the complex interactions of homeostatic systems. Manual therapists' clinical reasoning needs to incorporate this complexity in order to develop individualised effective treatment plans.Pain classification strategies attempting to assist clinical reasoning traditionally define multiple types of pain – nociceptive, neuropathic, centrally sensitised – potentially fitting elements of the pain experience to linear independent systems, rather than embracing the multiple dimensions. It is our contention that pain should not be classified unidimensionally. In all pain states consideration should be given to the combined influence of physiological, cognitive, emotional and social inputs, all of which have the potential to influence nociception.The Pain and Movement Reasoning Model presented in this paper attempts to capture the complexity of the human pain experience by integrating these multiple dimensions into a decision making process. Three categories have been created to facilitate this – central modulation, regional influences, and local stimulation. The Model allows for the identification of a predominant element to become the focus of treatment but also for the identification of changes to clinical presentation, where new treatment targets can emerge.     

Preparing the patient for a barium enema: a comparison of nurse and patient opinions

The purpose of this research was to explore possible differences in nurse versus patient opinions about patient education information appropriate for the barium enema procedure. Twenty-eight nurses and 30 patients participated in the study. Findings showed that nurses believed a patient should have more information than the patients believed a patient needs, and that patients wanted only minimal detailed information about events that will happen during the procedure. Rather, patients were interested in knowing the benefits and purpose of the procedure while nurses believed that this information should be provided by the physician and not the nurse. Finally, nurses were dissatisfied, in general, about their patient education information that they have given to patients in the past for a barium enema procedure.     

The use of a customized training needs analysis tool for nurse practitioner development

The role and professional boundaries of the nurse practitioner (NP) in the UK have not yet been unequivocally defined. This confusion has served to limit the expansion of the NP in both the acute and primary care sectors, despite a mounting body of evidence that attests to their value. This lack of coherence has necessarily impacted upon the educational provision currently available for NP development, with a range of courses of variable nature and standards being provided. The lack of nationally agreed educational criteria and the importance of taking account of local needs, together suggest that a formal training needs analysis might be valuable in systematizing and unifying the present position. Such a survey would have the function of informing both the definition and regional training requirements of NPs, provided the data were obtained through the use of a reliable assessment instrument. To this end a total population survey of all nurses employed in general practice within a large regional health authority was undertaken, using a psychometrically valid and reliable training needs analysis questionnaire. The information obtained provided a preliminary definition of the NP role and a clear index of the content and level of prospective educational provision. In addition, the survey offered an estimate of the numbers of potential participants on NP courses, by FHSA and preferred educational institution. In this way, the use of a scientifically constructed and specifically customized training needs analysis tool may have the potential to inform precise educational commissioning, thereby rationalizing resources and enhancing the quality of both training and ultimate care provision.