Research strategies for clinicians.

If there is a story waiting to be told about nurses and research, it is this: research is part of our past, our present, and our future. Research gives "caring" a mental muscle that makes it stronger than caring would be without it. Since the Crimean War, research has been a foundational cornerstone of the profession. Florence Nightingale espoused caring and human touch but not without also observing and measuring important patient outcomes that identified the spread of infection via human contact. As a new generation of nurses emerges, we who have come before might serve them well to role model what we know: that strong research is strong nursing and that obtaining and using evidence in nursing practice results in better outcomes for those patients and families we serve. Is the story waiting to be told your story? Part of the story of nursing waiting to be told is your story. Regardless of why you embarked on your career in nursing and regardless of where your journey has taken you to this point, you are a part of the twenty-first century body of nursing, and your individual contribution is an important one. Listen to your patients with an ear toward measuring and evaluating outcomes. Reflect on the care you provided, the interventions you had to offer, and why. Should something have been different? Could something have been better? Find out ... measure it.     

Imperatives for the future of critical care nursing

In the past, nursing has tended to rely on others to predict the professional future and to suggest specific actions and strategies to make that future a reality. Each of us entered nursing practice with a vision of what the profession of nursing is. Although we may have become distracted in the interim, each of us continues to have a desired vision of the future. Critical care nursing practice can either serve as the basis for innovative leadership in the continuing evolution of autonomous nursing practice or it can continue on an evolutionary track of critical care medical practice implemented by nurses. If your vision of the future is one in which critical care nurses engage in more than the implementation of pharmaceutical and medical treatment regimens, then your vision is worth making a reality. If you believe that critical care nurses make unique and valuable patient care contributions--greater than simply retooling with every technologic advance--you need to help other nurses begin to consider your perspective. Contrary to what many people believe, the future does not just happen. Someone, whether it be a nurse, a physician, or another professional, determines by action or failure to act what the future will hold. Each nurse needs to accept responsibility for the current state of nursing. We each own a piece of nursing's future practice. I want to be sure that my piece of the future matches my vision for critical care nursing. I challenge each of you to acknowledge your vision and to begin to take action to place that vision into critical care nursing's future.     

Chief nursing officer to chief executive officer: lessons learned

As health care in the United States continues to evolve, more chief nursing officers are moving to the role of chief executive officer. This article describes lessons learned from a chief nursing officer who is currently serving as a chief executive officer of an academic medical center. Eight lessons are described followed by reflective questions encouraging the reader to reflect and begin to internalize the experiences of the past role of a chief nursing officer and their applicability to the potential future role of a chief executive officer. The eight lessons explored are as follows: (1) you know more than you think you know; (2) nursing is part of the picture, not the whole picture; (3) relationships matter; (4) trust your gut; (5) if you do not have the right team, change it; (6) simple is better; (7) use your accountability to the board to accomplish your goals; and (8) to serve the organization well, you must keep yourself at your personal best.     

Bringing end-of-life care out of the shadows

Understand what resources are available to help you incorporate palliative and end-of-life care into your nursing practice.     

Bringing end-of-life care out of the shadows

Understand what resources are available to help you incorporate palliative and end-of-life care into your nursing practice.     

Ten commandments of airway management: simple lessons to guide oxygenation & ventilation

Excellent clinicians have a solid knowledge base and use sound principles to guide their practice. Most of us work in dynamic and, at times, uncontrolled settings. To succeed, you must follow some established guidelines. As you grow in your chosen career, also continue to improve your airway knowledge and strive to follow these commandments. Hopefully, they'll empower you to maximize your skills, expand your knowledge base and enhance your problem-solving abilities.     

The new Code of Professional Conduct

The Nursing and Midwifery Council (NMC) has approved a new Code of Professional Conduct (NMC 2002a). This article discusses the main elements of the new code, examines the implications for the profession and encourages you to think about the implications for your own nursing practice. It identifies actions that you should take to comply with the code.     

When CPR is not an option

What is to be learned from this situation? First, although Mr. Lockwood's consent for the DNR order is not needed, there is an obligation to communicate openly and clearly with the family and ensure that Mrs. Lockwood's advance directive is respected. This might mean a DNR order needs to be written. Also, there is an obligation to discuss goals of care with the family. The second lesson is that you should reflect on your employer's CPR policies and practice, and ask the following questions: Do the policy and/or practices support saying "no" in a situation such as Mrs. Lockwood's? Also, how does the policy support staff when there is a request for futile CPR, either from a competent patient or from a patient's family? What are the expectations about communication with the family when there is an advance directive and/or when CPR is found to be futile? Knowing what you ought to do for patients is not sufficient. Often you cannot act on these decisions because of the environment. If the policies are not in accord with the CNA Statement on Resuscitative Interventions, you should collaborate with colleagues to revise the CPR policy and practices. By doing so, you will be meeting your obligation to help foster and support a practice environment that promotes ethical, competent and compassionate nursing care.     

A letter to fellows: transitioning from training into practice in uncertain times

The end of training marks the beginning of learning. Moving into practice is exciting, and there are good opportunities. Although there is still a great deal of uncertainty with the economy, you have a skill set that is in demand. By understanding your real priorities, being deliberate and organized in your search, and being willing to extend outside your comfort zone, you will find a practice that fits you. Each person has an ideal practice. Choose your new practice setting with your eyes wide open, especially regarding new changes that are expected with health care reform.     

Choosing a master's program in critical care

This article has presented information to assist you in selecting a master's program that best suits your interests and needs. You should plan your education and career with the above information in mind. Regardless of which program you select, graduate school is an exciting experience that will provide you with numerous opportunities as you continue in your nursing career.     

Writing for professional publication. Part 3: following journal guidelines

Recognizing your motivation and identifying the content of your potential article are the first two steps in writing for publication. However, you will almost certainly receive a rejection letter if you do not plan and structure your article to meet the style of the specific journal you intend submitting to. In the third part of a series of articles, John Fowler, an experienced nursing lecturer and author, highlights the importance of downloading and reading carefully the author instructions which are found on the websites of nearly all professional journals.     

Revision cheats – How to maximise your learning to achieve exam success

Whether you are a student veterinary nurse or a registered veterinary nurse completing advanced qualifications, you need to get the most out of often brief study time between busy shifts in practice. Unfortunately there are no shortcuts to exam success. There are, however, ways to learn more effectively to get the most from your study time, helping you to feel better prepared for exams. Focusing on two key factors will ensure you are maximising your learning: taking control and keeping the learning active!     

Creating healthy workplaces: what every nurse can do

Strong, proactive people focus their efforts, time, and energy on that which they control. Your co-workers' behavior can influence you, but never control you. Neither do you control your colleagues. No matter what your role or practice setting, or your level of power or experience, you do control your own behavior, and can thereby influence others in your workplace. Focus on yourself and how you behave at work. By choosing constructive, collaborative, respectful ways of interacting, every nurse can be instrumental in creating healthy workplaces.     

Question time

Choosing to train as a nurse is a major decision, rife with different emotions and considerations. Regardless of what point you have reached in your studies, whether you are studying towards a degree or diploma, whatever your age and whether you are from the UK or overseas, you face common challenges. These include surviving financially, juggling study and clinical placements, learning new information and addressing patients' needs. While the profession certainly offers exciting opportunities, nursing students in 2006 face a range of uncertainties. There have been cuts and freezes to existing and vacant posts across NHS trusts, while students from overseas face the additional problem that band 5 and 6 nursing posts have been removed from the Home Office's shortage occupation list. Will there be enough mentors to teach students? Will there be jobs when they qualify? How can students survive financially? Will overseas students be able to stay once qualified? NT put students' key questions to a panel of experts and influential figures.     

Understanding and using teleradiology.

In 1972, Webber and his coauthors closed their landmark paper with some visionary remarks that have proved to be remarkably perceptive. They hypothesized that special telephone circuits or radiofrequency channels could be used to yield "images whose grey scale and resolution are satisfactory enough to be virtually indistinguishable from the original." Speaking of transmitting still-frame images in a reasonable length of time and at a reasonable cost, they were limited by the current state of technology, but not by failing to use available technology creatively. We now have the tools they lacked; we must analyze alternatives and apply them. First, define the clinical problem. Determine the minimum acceptable function level of the proposed teleradiology system. Then use your best judgement to sort our convenience, reliability, cost, and various other considerations in light of the needs of your practice. As you develop the scenario, frequently refocus on the problem to be solved. Very likely you will find, as you look closer at current options, that by using teleradiology you could increase the quality of service to your patients by extending your presence electronically to areas where constant physical presence is simply not possible, affordable, or convenient.     

The poster session: an overlooked management tool

One approach to addressing recruitment and retention, image, and staff morale issues is through poster sessions held by local, state, and national organizations. When you and your staff communicate your projects through a poster session, you increase the visibility of your institution and nursing department, as well as your staff's professional development and morale. The authors discuss guidelines for developing poster presentations that will effectively and professionally communicate your ideas.     

Demystifying nursing research: defining the problem to be studied

Determining potential areas to examine for researchable nursing practice problems, stating the problem/question for study, and areas to consider after tentatively selecting a problem for study are all fundamental elements of sound research study design. At this point, if you have a problem in mind, write it in a declarative sentence beginning with: "The purpose of this study is to...". After the word "to" place an active verb such as examine, describe, determine, compare, or explore. This is only a suggested short list, but after writing the verb, go on to say what will be compared, explored, etc. Now you have declared how to begin your research "journey" and where you expect it to lead. It may take several tries before clearly capturing and stating the study problem. After you are satisfied with the problem statement, you are ready to conduct a focused literature review on the topic. Suggestions for efficient ways to do this will be covered in the next article in this series.     

帕金森病患者对疼痛认知体验质性研究

目的 了解帕金森病患者的疼痛体验及认知,为采取针对性疼痛护理措施提供依据。方法 运用质性研究中的现象学分析方法,对17例伴有疼痛的帕金森病患者进行半结构式访谈。访谈提纲包括6个问题：（1）您对帕金森病相关的疼痛了解吗?请您具体说说 （2）如果根据数字评分表(NRS)对疼痛进行评分,您觉得最高评分是多少? 可以谈谈您疼痛的感受吗?（3）当您感到疼痛时,您是如何应对的?（4）您是否向亲人或者医护人员主动说起您的疼痛经历?（5）您认为亲人和朋友的关心和支持对您重要吗?（6）针对帕金森病疼痛,您希望得到什么帮助呢?结果 共析出3个主题：疼痛体验深刻;对疼痛的应对不足;外源性支持不足。结论 疼痛严重影响帕金森病患者的生活质量,应重视患者的疼痛体验,加强知识宣教;关注居家照护,增加社会支持;立足评估治疗,加强疼痛管理,从而建立规范的疼痛管理模式,提高帕金森病患者的生活质量。     

Selected Internet Sites for Transcultural Health Questions

Are you new to the Internet and want some tips on findings sites that will help you in clinical practice? Maybe you are Internet savvy, but don't have the time to go searching for sites on transcultural health. Want the work done for you? This is a handy guide that discusses some selected Internet sites on questions you may have about your patients' health beliefs and their culture. Here are tips for improving communication and assessment of your ethnically and culturally diverse patients.     

Use of the Watson-Glaser Critical Thinking Appraisal with BSN students

The complexity and changing nature of nursing today requires proficiency in thinking skills to ensure knowledgeable, confident, creative, and sensitive decisions regarding client care. Nurse educators are faced with the task of promoting educational strategies to develop the abilities of nursing students to think critically in all health care settings (1). However, a lack of consensus on what characterizes critical thinking leads to difficulty in the development of instruments for adequate measurement. It is important to decide on a definition of critical thinking that faculty support and are willing to use in practice. The term is diversely defined in the literature. For example, Alfaro-LeFevre states that critical thinking in nursing "entails purposeful, goal directed thinking; aims to make judgments based on evidence (fact) rather than conjecture (guesswork); is based on principles of science and scientific method; requires strategies that maximize human potential and compensate for problems caused by human nature" (2). The authors of this study use a definition by Paul: "thinking about your thinking while you are thinking in order to make your thinking better, more clear, more accurate, more defensible" (3). The authors believe that the development and/or enhancement of critical thinking ability must be the result of conscious, deliberate activity throughout the nursing program. As the student matures, the ability to think critically will be manifested in decision making that reflects accurate assessment and resolution of problems. The nursing faculty selected an instrument to evaluate the critical thinking abilities of baccalaureate nursing students that had strong reliability and validity documented in the nursing literature: the total and subtest scores of the Watson-Glaser Critical Thinking Appraisal (WGCTA), Form A (4). The instrument was deemed to be congruent with the definition of critical thinking supported by the faculty.