A framework to support preceptors’ evaluation and development of new nurses’ clinical judgment

In today’s complex, fast-paced world of hospital nursing, new graduate nurses do not have well-developed clinical judgment skills. Nurse preceptors are charged with bridging the gap between new graduates’ learning in school and their autonomous practice as RNs. In one large, urban medical center in the U.S., a clinical judgment model and rubric were used as a framework for a new evaluation and orientation process. Preceptors of new graduate nurses who had used the former and new processes described their experiences using the framework. The findings indicated that having a structured framework provided objective ways to evaluate and help develop new graduate nurses’ clinical judgment. It is hypothesized that academic clinical supervisors may find such a framework useful to prepare students for transition to practice.     

The experience of ‘treatment-resistant’ depression: A qualitative meta-synthesis

While antidepressants may be effective in treating depression for some people, a third of people do not have an improvement in mood after a trial of two different antidepressants for an adequate duration. These people are diagnosed as having ‘treatment-resistant’ depression which situates the problem as part of their biological or psychological makeup. We conducted a search of studies that examined this problem from the perspective of people whose depression did not improve on antidepressants. Nine studies were included in a qualitative meta-synthesis that identified four themes across these studies: feeling trapped, disconnection, loss of self, and questioning. The participants experienced considerable distress associated with the constant presence of depression in their lives. While antidepressants may help some people, there is a need for more innovative approaches to the treatment of depression. There is a strong argument for trialling appropriate evidence-based psychotherapy before a person is categorized as having treatment-resistant depression. It is perhaps better to describe the issue as inadequate efficacy of antidepressants to situate the problem with the treatment provided rather than with the person.     

The adolescent’s experience of cancer: An integrative literature review

AimThis integrative review appraises the literature that explores the experiences of the adolescent diagnosed with cancer.BackgroundThe cancer experience has an impact on the way the adolescent lives their life, their future hopes dreams and fears, their health and wellbeing. Healthcare professionals require an understanding of what the adolescent experiences after a diagnosis of cancer and during the treatment experience to be able to provide optimal age appropriate care.MethodsThe review was conducted following Whittemore and Knafl’s (2005) framework. A comprehensive search using the following four databases, CINAHL, MEDLINE, PyschINFO, Embase was undertaken for the period of 2005–2016. Google scholar, healthcare policies and guidelines reference lists were also searched. Screening and appraisal of 911 articles resulted in 22 articles being included in this review.FindingsThree themes were identified: ‘Losing what I know - this is what makes me different’, ‘Communication and information sharing - the need to know’, and ‘The importance of friends, peers and relationships’.ConclusionThis review reports that healthcare providers should be aware of the changing self-perceptions the adolescent experiences throughout the cancer journey. Accessing this information will enable healthcare providers to determine more appropriate care when these adolescents are feeling most vulnerable. The review identified there is limited information about the experience of the younger adolescent (11–15 years) with cancer. Future research may benefit from focusing on the stage of development of the adolescent with cancer.     

Expectations and experiences of group supervision: Swedish and Norwegian preceptors’ perspectives

Aim The aim of the present study was to describe preceptors’ expectations and experiences of participating in group supervision (GS). Background The challenging role of preceptors and their need for support is well known. Therefore, a collaborative project was carried out, providing GS to preceptors to strengthen them in their role. Method Data were collected from 48 preceptors by means of study-specific forms and field notes, and analysed using qualitative content analysis. Results Both positive and negative expectations and experiences of group supervision were found, but the positive experiences exceeded the expectations. The group in itself had a significant meaning for the preceptors; their pedagogical and personal competence increased and they became aware of their role as ‘bridge-builders’. Conclusions Using GS to strengthen preceptors in their role was found to be successful. The findings provided new arguments for this model as a reflection tool. Implications for nursing management Strengthened preceptors can have an impact on nursing students’ learning, and thereby also on future nurses’ competence, which is a great concern of nurse managers. By using nurse lecturers as group leaders, the collaboration between the clinical placements and the nursing faculties can be improved.     

Evaluation of VITEK 2 for discriminating Trichosporon species: misidentification of Trichosporon non–T. asahii

The VITEK 2 system was evaluated for the identification of 74 Trichosporon invasive and non-invasive clinical isolates, comparing its results with the IGS1 sequencing. The system correctly identified Trichosporon asahii but not non–T. asahii isolates, which represented nearly 50% of the invasive infections in our nosocomial setting.     

The Supportive Care Task Force at the University of L’Aquila: 2-years experience

The Supportive Care Task Force (SCTF) was established within the Medical Oncology Department at the University of LAquila in May 2002. The missions of the SCTF were to allow systematic evaluation and treatment of symptoms, to warrant continuity of care in all phases of disease and to provide medical oncology residents with training in the treatment of symptoms. A medical oncologist, two senior residents in medical oncology and a registered nurse comprised the SCTF. A psychiatrist, two neurologists, a dietician, and two physiotherapists served as consultants or on a part-time basis. Four beds in two-bedded rooms inside the Medical Oncology Department were reserved to SCTF. A close integration with the physicians of the Medical Oncology Department was realised. The only criterion to admission was the presence of uncontrolled symptoms. Patients were evaluated and monitored with the visual analogue scale for pain and with the Edmonton Symptom Assessment Scale (ESAS). The Palliative Prognostic Score (PaP Score) was employed to assess the prognosis. Non-clinical needs were evaluated with the Need Evaluation Questionnaire (NEQ). Protocols for the treatment of common symptoms were available in written form for consultation by physicians, residents and nurses. From 1 May 2002 to 31 May 2004, we observed 208 patients: 111 women and 97 men. The median age was 64.7 (range 28–90) years. Fifty-four patients (25.9%) were admitted more than once, for a total of 285 admissions. One hundred ninety-nine admissions (69.5%) were for supportive care while 86 admissions (30.5%) were for supportive care and active treatment. The most frequent symptoms were asthenia and anorexia. We registered excellent results regarding the treatment of pain, nausea and dyspnea while psychological symptoms, anorexia and asthenia proved more difficult to treat.Two hundred twenty patients were discharged: 142 (49.8%) home; 76 (26.7%) to the Home Care Service and two (0.7%) to others units of the hospital. Sixty-five (22.8%) died in our unit.     

The validity and reliability study of Turkish version of the fathers’ support scale: Neonatal intensive care unit

BackgroundFathers whose infants are cared for in the neonatal intensive care unit have negative experiences and thus require support.AimThis study was carried out with the aim of performing a validity and reliability study of the Turkish version of the “Father’s Support Scale: Neonatal Intensive Care Unit” (FSS: NICU).MethodThe study included 165 fathers whose infants were hospitalised in the neonatal intensive care units of a university hospital and a state hospital in the west of Turkey.FindingsThe item-total score correlation values of the scale were between 0.26 and 0.73 and the Cronbach’s alpha coefficient was 0.91. It was found out that the test-retest reliability coefficients were between 0.78 and 0.92. The scale accounted for 48.38% of the total variance in three factors, as in the original version of the scale.ConclusionIt was found that the Turkish version of the FSS: NICU was a valid and reliable measurement tool.     

The patient lock model©: a continuum of care

Nursing as a profession has the responsibility to society to protect and promote the health of individuals and communities. The intent of this conceptual model is to center the patient in his or her environment while allowing qualified, expert health professionals to provide timely, effective, cost-efficient care within their levels of competence and expertise. Significant shortages of registered nurses and other health professionals delay timely provision of quality care and affect the effectiveness of care. Care management issues are due to the complexity of individual patient's health care needs, limited access to providers, inability to afford treatment, and delay in seeking care. These challenges to the system slow efficiency in the provision of care across all settings. In presenting this conceptual model, there will be a review of nursing and the internal and external forces that affect the profession. This is an initial development phase of the model: The Patient Lock Model.     

ABUS examination time: An observational study of operators’ experience

ObjectiveIn this study we aimed to evaluate the operation times of ABUS by technologists during the learning time course and share the learning experience.Materials and methodThe first consequent 400 examinations after the installation of an ABUS unit in the breast clinic between August 2017 and December 2017 were included. Total examination time was measured for each procedure. The initial and final examination times during the learning period were compared. Data were analyzed with the Mann-Whitney Test.ResultsThe acquisition times for routine six position examination ranged between eight and 36 minutes with an average of 13.2 ± 3.58 min. The examination time for the eight position examination ranged between 18 and 32 min, with an average of 22.9 ± 3.93 min. The overall average examination time was 13.3 ± 3.98 min. There was a significant difference (p = 0.00) between the average initial and final examination times of the learning period with an average decrease of 10.6 min.ConclusionThe average time of an ABUS examination for an average breast is less than 15 min. ABUS examination time reduced as technologists became familiar with the sonographic anatomy of the breast and experienced in positioning technique during the learning curve.