RN to BSN education: what do RNs think?

While most employers want more baccalaureate prepared registered nurses (RNs) in their staffing mix, returning to school is not easy for the RN. This qualitative program evaluation study explores the perceptions of 6 RNs who completed an on-campus, part-time baccalaureate program. Findings reveal that while these RNs originally questioned the value of further education, degree completion had a positive impact on their personal and professional lives. Implications for RN to BSN program design and recruitment into formal education programs are presented.     

Treating individuals according to evidence: why do primary care practitioners do what they do?

Research evidence does not necessarily translate into changed management for individual patients, but that may not mean that the evidence has been ignored. Drawing on accounts from general practitioners, we use a study of non-rheumatic atrial fibrillation (NRAF) to illuminate the processes by which practitioners became aware of and assimilated research evidence. We follow that with an account of how the evidence was incorporated into practice protocols for anticoagulation and then applied to a review of individual patients' records. Practitioners used a range of sources of evidence. They reported difficulties arising from their own skills and circumstances and from the perceived quality of the evidence. Creating a protocol involved overcoming problems of scheduling, resources and managing judgements about the value of the review process. In applying the protocol practitioners drew on their knowledge of the patients' preferences, circumstances and previous specialist consultations. As a result, practitioners made judgements that evidence, combined with prior experience, did not support the initiation of anticoagulation in 52% of an unselected primary care population with NRAF. Our findings have implications for evidence-based practice and for practitioner education.     

Palliative care volunteers: why do they do it?

Two studies were conducted to examine people's motives for joining a palliative care volunteer program. To generate a pool of reasons for becoming a palliative care volunteer, previous studies of motivations relevant to palliative care were reviewed and interviews were conducted with 15 palliative care volunteers (Study 1). Combining the literature review and interviews, a total of 22 distinct reasons for volunteering were identified and used to create an Inventory of Motivations for Palliative Care Voluntarism (IMPCV). In Study 2, 113 palliative care volunteers responded to the IMPCV. "To help ease the pain of those living with a life-threatening illness" was rated as the most influential reason for becoming a palliative care volunteer. A principal components factor analysis was conducted on the IMPCV. It was decided that four factors adequately represented the items: Leisure, Personal Gain, Altruism, and Civic Responsibility.     

Youth with cerebral palsy with differing upper limb abilities: how do they access computers?

Davies TC, Chau T, Fehlings DL, Ameratunga S, Stott NS. Youth with cerebral palsy with differing upper limb abilities: how do they access computers?

Objective

To identify the current level of awareness of different computer access technologies and the choices made regarding mode of access by youth with cerebral palsy (CP) and their families.

Design

Survey.

Setting

Two tertiary-level rehabilitation centers in New Zealand and Canada.

Participants

Youth (N=60) with CP, Manual Ability Classification Scale (MACS) levels I to V, age 13 to 25 years.

Interventions

Not applicable.

Main Outcome Measure

Questionnaire.

Results

Fifty (83%) of the 60 youth were aware of at least 1 available assistive technology (AT), such as touch screens and joysticks. However, only 34 youth (57%) were familiar with the accessibility options currently available in the most common operating systems. Thirty-three (94%) of 35 youth who were MACS I and II used a standard mouse and keyboard, while few chose to use assistive technology or accessibility options. In contrast, 10 (40%) of 25 youth who were MACS III to V used a variety of assistive technologies such as touch screens, joysticks, trackballs, and scanning technologies. This group also had the highest use of accessibility options, although only 15 (60%) of the 25 were aware of them.

Conclusion

Most youth with CP were aware of, and used, assistive technologies to enhance their computer access but were less knowledgeable about accessibility options. Accessibility options allow users to modify their own computer interface and can thus enhance computer access for youth with CP. Clinicians should be knowledgeable enough to give informed advice in this area of computer access, thus ensuring that all youth with CP can benefit from both AT and accessibility options, as required.     

Indigenous nurses and professional education: friends or foes?

While the importance of cultural issues in nursing practices has been recognized, little attention has been directed to evaluating to what extent nursing education respects the cultural norms and values of students from diverse populations. A survey was used to explore the educational experiences of 40 Native American nurses. Respondents indicated that cultural content in their education was quite limited, they wanted more cultural content, and sometimes they obtained it from other sources. Many respondents found no support for their cultural identity during their nursing education. Those who did find support found it mainly through student groups, tribal or Native-specific programs, and through informal peer support. Many respondents identified struggles with culture shock and cultural differences, stereotypes and racist attitudes, isolation, and assumptions about their own cultural identity. This study makes an important contribution by bringing voices of indigenous nurses to the attention of the profession and by moving beyond practice wisdom to join with the growing body of research that is adding an empirical dimension to transcultural nursing literature.     

Handicap questionnaires: what do they assess?

Background and purpose: There is an increasing need to get insight into the social and societal impact of chronic conditions on a person's life, i.e. person-perceived handicap. The purpose of this study is to report how current handicap questionnaires assess handicap. Method: A literature search using both Medline and the database of the Dutch Institute of Allied Health Professions (NPi) was conducted for handicap questionnaires. Questionnaires were included if addressing handicaps or life roles, environmental influences and social consequences of a disease. Excluded were questionnaires focusing on only impairments, disabilities or quality of life. Results and conclusion: 20 questionnaires were identified. Handicap is not uniformly defined in these questionnaires. Based on different concepts, the various questionnaires encompass different domains and different aspects are emphasized in similar domains. Fourteen questionnaires assess societyperceived handicaps, and do not address the life roles, care needs or individual problem-experience. Six questionnaires are to some extent person-perceived, but a generic person-perceived handicap questionnaire could not be identified. It is concluded that development of a generic person-perceived handicap questionnaire is essential for adequate assessment of needs, outcome, and relevance of rehabilitation interventions from the individual's point of view.     

Mandatory continuing professional education: what is the prognosis?

Each year registered nurses apply for registration renewal. The Nursing and Midwifery Board of Australia stipulate all nurses and midwives are expected to take responsibility and accountability for participating in continuing professional development (CPD) as a declaration that their practice is current, safe and competent. The code of professional conduct and Australian Nursing and Midwifery Council (ANMC) competencies governing registered nurses and midwives, outline the professional and personal responsibility nurses hold in order to maintain clinical competence; which may be achieved through continuing nurse education and professional development. As the health care industry shifts focus to keep up with changes in technology, economics, demographics and culture, the nursing profession must respond accordingly.With the implementation of a national registration scheme in Australia, this paper provides a review of the literature relating to mandatory CPD and how CPD may assist nurses to respond to the changing needs of the health care system and its consumers, to ensure the best possible health outcomes. Suggestions of possible avenues of research into the concept of CPD are also offered.     

Individual delirium symptoms: do they matter?

OBJECTIVES: To evaluate the impact of individual manifestations of delirium on outcome, describe them in critically ill adults, and validate nurses' bedside item assessments from the Intensive Care Delirium Screening Checklist (ICDSC). DESIGN: Prospective study. SETTING: Single 16-bed medical/surgical university hospital intensive care unit. PATIENTS: Six hundred consecutive patients admitted to the intensive care unit for >24 hrs. INTERVENTIONS: All patients were evaluated with the eight-item ICDSC throughout their intensive care unit stay. In all patients scoring positive on any ICDSC item, individual checklist items were tallied throughout the intensive care unit stay and assessed for impact on mortality. In addition, when the ICDSC score indicated delirium (> or = 4 of 8), the subsequent overall frequency of each item was also independently documented to describe delirious patient symptoms. ICDSC items were tested for discrimination between delirious and nondelirious patients. Throughout the study, the validity of bedside delirium assessments was assessed in 30 nurses. MEASUREMENTS AND MAIN RESULTS: We were able to assess 537 patients. In nondelirious patients, psychomotor agitation by ICDSC assessment was associated with a higher risk of mortality after adjustment for Acute Physiology and Chronic Health Evaluation, age, and the presence of coma. One hundred eight-nine patients (35.1%) developed delirium (i.e., ICDSC score > or = 4). On presentation (and throughout the intensive care unit stay), the most frequent features of delirium were inattention, disorientation, and psychomotor agitation. Each ICDSC item was highly discriminating between delirious vs. nondelirious patients. Correlation between gold standard adjudicators and nurses for the overall bedside evaluations of delirium were excellent (Pearson's correlation R = 0.924, p < .0005). Individual symptom evaluation by nurses varied: Alteration in level of consciousness was poorest (R = 0.681, p < .0005), and both disorientation and hallucinations evaluated best (R = 1.000). CONCLUSIONS: In nondelirious patients, agitation was associated with a higher risk of mortality. Each of the eight ICDSC items is highly discriminating for the diagnosis of delirium, suggesting that any screening or diagnostic scales should incorporate them. Quality assurance and educational efforts should, therefore, emphasize independent assessment of the individual features of delirium.