Meaningful moments

Rituals provide meaning and order to transitions, and symbolically connect people and events. Despite the prevalence of perinatal loss (miscarriage, stillbirth, and newborn death) and pediatric deaths, little has been written about the use of rituals surrounding these losses. The purpose of this article is to define the dimensions of a ritual as each pertains to perinatal and pediatric death, and provide concrete applications for use in clinical practice. Intention, participation, and meaning-making are the key dimensions of rituals that arise from clinical encounters. Initiating the discussion about ritual and the timing of the ritual itself are critical elements for the nurse who is caring for a bereaved family. Because of the paucity of research on using rituals in perinatal and pediatric death, nurse researchers should design studies that explore the outcomes of using rituals, both in the short- and long-term, following the death.     

Meaningful nursing research

Dr. Fawcett's editorial (Western Journal of Nursing Research, August 2000), staunchly criticizes research journals and researchers for their lack of attentiveness to nursing discipline-specific knowledge. She suggests that this lack of attentiveness posits nursing for extinction; in doing so, she raises fundamental questions about the relationship between nursing and nursing science. Despite a plethora of nursing literature, professional nursing remains an intangible concept for many nurses. The author addresses this issue from the perspective of her sense of self as a nurse.     

Meaningful Use of Electronic Health Records

The concerns on patient safety and quality improvement in health care are increasing. There is growing use of technology in health care, particularly use of the electronic health record (EHR). As this occurs, the health care system is transforming. The federal government has become involved in EHR implementation, encouraging improved health care. The Centers for Medicare & Medicaid Services are implementing the Meaningful Use (MU) Incentive Program for Medicare- and Medicaid-eligible providers. As EHR implementation and MU Programs grow, it is important for the nurse practitioner (NP) to be aware of the MU Program. As NPs become engaged in using EHRs, MU will have an impact on changing health care systems and implications related to clinical practice and improved outcomes.     

Guidelines for Creating Meaningful Meeting Minutes

In academia, documentation of meaningful minutes ensures quality and integrity of education practice and serves as evidence in accreditation reviews. Nurse faculty often share responsibility for minute taking during various academic meetings, but frequently lack mentorship and learn by trial and error. The article provides guidelines for formulating meaningful meeting minutes. It offers concrete strategies for ease and facilitation of comprehensive documentation of minutes.     

Meaningful design and contrast estimability in FMRI

Optimising the efficiency of an experimental design is known to be of great importance. However, existing methods for calculating design rank deficiency and contrast estimability (an important aspect of experimental design) relate to computational precision rather than image noise and are therefore not very meaningful. For example, a contrast between two experimental conditions may be mathematically "estimable" while requiring a huge differential BOLD response for statistical significance to be reached. In this paper we formulate standard efficiency equations in terms of required BOLD effect, and use this to generate measures of rank/estimability which are meaningful. This takes into account the strength and smoothness of the timeseries noise and is applicable to complex contrasts; we show how to re-express several regressors and an associated contrast vector as a single equivalent regressor, so that we can calculate the contrast's effective peak-peak height unambiguously. We also present some example results on typical designs, and characterise noise results from a range of typical FMRI acquisitions, in order to allow experimenters to apply efficiency estimation in advance of acquiring data.     

Meaningful lives: elders in treatment for depression

This study used a qualitative approach and was conducted to gain insights into the lives of elders with depression that could eventually lead to improvements in treatment strategies for this population. Twenty elders described a typical day in their lives. Using a multistep analysis of the interviews, six themes emerged: independence, spirituality, family relationships, depression, medical comorbidities, and motivation. A perspective of the process of elders finding meaning in their lives was explicated such that characteristics of independence, motivation, and spirituality enabled these elders to identify their need for treatment and to cope with their comorbidities. During treatment, these elders began to appreciate their experiences of social and family relationships and began to be able to appreciate the meaning inherent in their lived experience. Developing the role of the clinician as coordinator of health care and the appropriateness of MI as a treatment strategy were presented as possible avenues to improving treatment for elders with depression.     

Clinically Meaningful Changes in Quantitative Measures of Asthma Severity

OBJECTIVE: To determine minimum clinically meaningful improvements in peak expiratory flow rate (PEFR) and dyspnea visual analog score (VAS) in patients with acute asthma exacerbation. METHODS: Patients presenting to the emergency department (ED) with acute asthma exacerbation were eligible. The PEFR and VAS were assessed at presentation and after initial asthma therapy. During reassessment, subjects were asked to describe their asthma symptoms as "much better," "a little better," "no change," "a little worse," or "much worse." Correspondence between self-reported improvement and changes in PEFR and VAS was assessed. The "minimum clinically significant change" in either index was defined as the difference between pre- and posttreatment measures in subjects reporting their symptoms "a little better." RESULTS: One hundred fifty-six subjects were included. Asthma symptoms were "much better" in 99 (64%), "a little better" in 41 (26%), and "unimproved" (composed of patients describing symptoms as "no change," "a little worse," or "much worse") in 16 (10%). The mean VAS change among the "a little better" subjects was 2.2 cm (95% CI = 1.1 to 3.4), significantly greater than the -0.4 cm (95% CI = -2.1 to 1.4) change in the "unimproved" subjects. The mean change in percent predicted PEFR among the "a little better" subjects was 11.9 (95% CI = 7.3 to 16.1), not statistically different from the change of 6.1 (95% CI = 1.1 to 11.3) in the "no change" subjects. The "much better" group showed significantly greater changes in both measures than either of the other groups. A VAS change of > or =0.5 cm reliably discriminated between subjects with and without symptom improvement. CONCLUSIONS: Improvements in VAS of 2.2 cm and in predicted PEFR of about 12 percentage points are minimal clinically significant improvements during ED asthma therapy. The dyspnea VAS is valid in assessing symptomatic changes and may detect small subjective improvements better than the PEFR.     

Nurse Practitioners and Meaningful Use: Transforming Health Care

This article describes how the adoption of electronic health records (EHRs) and the achievement of Meaningful Use requirements by nurse practitioners (NPs) can transform patient care. By implementing EHRs, NPs can improve the quality and consistency of care while simultaneously reducing health-care costs. This article provides insight into considerations for NP participation in the EHR Incentive Program. It includes a case study focusing on one NP’s experience with the program, who sought to improve the quality of patient care, safety, and satisfaction through health information technology, along with the challenging yet rewarding journey to practice transformation.