Finding the courage to lead: the Oregon experience

A severe nursing shortage has the profession in crisis. The national picture is paralleled in Oregon. The Oregon Nursing Leadership Council (ONLC), through intense dialogue, developed a comprehensive statewide plan to resolve the shortage. From the perspective of group relations and leadership theories, this article describes the issues and events that contributed to the remarkable journey that culminated in this plan. Motivated by our concern for the public welfare and the survival of our profession, individual ONLC members surrendered their own narrow organizational goals to achieve a more effective collective outcome.     

表格式基础护理计划单的设计与应用

目的探讨表格式基础护理计划单在基础护理中的作用。方法制定表格式基础护理计划单,指导护士按计划为病人实施基础护理服务项目,并按计划单追踪病人基础护理落实情况。比较使用表格式基础护理计划单前后基础护理质量情况。结果使用表格式基础护理计划单3个月后基础护理合格率、患者满意率明显高于使用前。结论使用表格式基础护理计划单可有效提高基础护理质量。     

From care plan to concept map: A paradigm shift

Nurses and nursing student must develop and write nursing care plan to provide and organize nursing interventions. Nursing care plans serve as a means of communicating patient care needs between members of the interdisciplinary care team. Traditional linear care plans did not met the educational and functional needs of current nursing students. In an effort to improve nursing students’ clinical reasoning and recognition of interrelatedness of patient data, the traditional care plan format was changed to concept mapping. This article describes the integration of concept mapping in an Associate Degree Nursing program.     

Factors affecting the academic progression of associate degree graduates

The Oregon Consortium for Nursing Education (OCNE) is a coalition of community colleges and the campuses of the Oregon Health & Sciences University (OHSU), created to share a competency-based curriculum by which associate degree graduates from an OCNE campus are eligible to complete requirements for the bachelor's degree after 1 year of additional full-time study. Since 2006, three graduating classes from consortium community college programs have graduated 760 students eligible for direct transfer to OHSU; however, only 228 (30%) have actually transferred. This study aimed to explore the factors that influenced the 208 graduates in the class of 2010 not to transfer. The primary reasons for discontinuing their nursing education, in ranked order, were financial concerns, conflict with time and energy for work, and conflict with time and energy for family. This study has implications for achieving the academic progression goals recommended in the Institute of Medicine's The Future of Nursing report.     

Postoperative patient. Treatment plan

In order to prevent problems and complications which patients who have undergone surgery tend to suffer, it is fundamental to utilize a generic standardized treatment plan due to the preventive dimension which nursing care may then acquire. So that this treatment plan provide greater effectiveness, it should include standardized nursing interventions such as those listed in the Classification of Nursing Interventions since by this method, a common terminology is built up among professionals which provides continuity to treatment and facilitates the selection of adequate interventions for each situation. This report establishes the most frequent nursing diagnoses among post-surgical patients and adapts these to the nursing treatments in the Classification of Nursing Interventions.     

Expanded nursing care for contraceptive use

Nursing actions to promote contraceptive self-care are described. Orem's self-care theory was used to develop assessment tools and to plan nursing actions.     

论护理美学的教学目标

护理人文课程的教学改革亟待深入,无论单门课程的准确定位和在此指导下的教学各环节的实施,还是护理人文课程模块的总体教学目标与教学实践,都需要从护理职业目的和人文课程内容的双向实际出发,制订课程的教学目标和具体的实施方案。本文以护理美学为例,介绍了该课程的总体教学目标和具体教学目标与实施,以此指导实际教学活动。并尝试将这一教学思维模式推广到整个护理人文教育。     

Nursing diagnosis: a strategy for teaching etiologies

In teaching the nursing process, educators ask students to identify nursing diagnoses for patients in the clinical area. Nursing diagnoses provide structure and focus for the student's plan of care. However, beginning nursing students have little or no clinical knowledge upon which to base decisions in the area of etiology determination. A model is presented which limits etiologies to four categories. The four categories can also assist the nurse in practice to assess needs in order to comprehensively plan and implement care. Examples of nursing diagnoses pertaining to the neuroscience patient using the four categories of etiologies are described.     

Best practices initiative: nurturing partnerships that promote change

As the science of nursing continues to evolve, efforts to develop strategies to integrate nursing research into clinical practice are increasing. To address the gap between research findings and the use of these findings to improve practice, Oregon Health & Science University School of Nursing established the Best Practices Initiative in conjunction with three clinical partners, all in the Pacific Northwest: a large Veterans Affairs medical center, a large health maintenance organization, and a state agency that oversees health care for older adults. This article presents the Best Practices Initiative Partnership Model, some of the lessons learned about partnering with clinical agencies, and an overview of the projects that involved each partner.     

A nursing information system. The outcome of implementing nursing diagnoses

The use of nursing diagnosis, as the focus for care planning and as a role expectation for professional nursing practice, has evolved throughout the years into a concept that has permeated all other systems in the Department of Nursing. Systems that were previously mutually exclusive were organized through the use of nursing diagnosis-based care planning and were integrated to improve both nursing efficiency and efficacy. Full computerization of the Nursing Information System Model (Fig. 1) will have the nursing diagnosis-based patient care plan and the medical orders for nursing intervention as the source of all clinical nursing data and will provide the majority of nursing administrative management data.     

Acuity and staffing under prospective payment

Nursing administrators are debating the desirable mix of professional (RN) and paraprofessional (LPN) nursing staff under the prospective payment system (DRGs). The staffing mix reflects the cost and quality of nursing care provided by an acute care hospital. Based on a reliable and valid acuity/care plan system, standards of care and nursing diagnoses, several DRGs were analyzed on an eight-bed medical/surgical intensive care unit with regard to intensity of care and staffing mix. This study showed nursing administrators that the staffing mix on an intensive care unit varies according to the acuity/care plan rather than DRGs or nursing diagnoses.     

The Oregon Consortium for Nursing Education: a response to the nursing shortage

The Oregon Consortium for Nursing Education (OCNE) is a statewide coalition designed as a long-term solution to the nursing shortage and in response to the need for a new kind of nurse to care for Oregon's aging and increasingly diverse population. It is an effort to increase capacity in schools of nursing by making the best use of scarce faculty, classrooms, and clinical training resources in the delivery of a standard curriculum on 13 campuses, including 8 community colleges and the 5 campuses of the OHSU School of Nursing. This article describes the development of OCNE, including infrastructure development, creation of the shared curriculum, redesign of clinical education, faculty development, and plans for evaluation. If OCNE is successful in achieving its goals, it holds substantial policy implications for the development of nursing education systems, design of curricula, use of simulation as a component of clinical education, and delivery of clinical education.     

Massage therapy as a nursing practice

Nursing is a profession that can be practiced in many unique ways. Nursing care can be provided through conventional means in traditional settings or practiced in domains labeled as alternative or complementary. This article describes massotherapy as an alternative therapy of a holistic nursing practice. The elements of a business plan, including planning and marketing are addressed.     

A statewide strategy for nursing workforce development through partnerships in Texas

Statewide efforts and partnerships were used for nursing workforce development to address the nursing shortage in Texas. A statewide strategic action plan was developed where partnerships and collaboration were the key components. One of the most important outcomes of these statewide partnerships was the passage of the Nursing Shortage Reduction Act 2001. Through this legislation, the Texas Center for Nursing Workforce Studies and its advisory committee were established. This article describes how a statewide infrastructure for nursing workforce policy and legislative and regulatory processes were further developed. An overview is provided on the contributions made by the organizations involved with these strategic partnerships. The ingredients for establishing successful, strategic partnerships are also identified. It is hoped that nursing and health care leaders striving to address the nursing shortage could consider statewide efforts such as those used in Texas to develop nursing workforce policy and legislation.     

The demise of nursing education at a major research university

The Department of Nursing at the University of Southern California closed in June 2004 after a series of attempts to restructure nursing education programs to adhere to the vision and mission of the parent institution. From a review of the Department's history and strategic plan, it is clear that Nursing did not recognize the University's political and academic plan to strengthen undergraduate education evidenced by increased selectivity of students and showcasing research. This case study analyzes the Department's demise and the contribution of internal and external factors including isolation from the rest of the University by its physical location, the administrative structure within the academic health center, economic constraints, and a lack of continuing permanent leadership. Nursing leaders can learn from this experience that nursing faculty must be scholars and researchers at a comparable level to other disciplines and that the educational programs must be strategically aligned with the University's vision and mission.     

Licensed nurses disciplined in Oregon between September 1996 and June 2008

This study is undertaken to better identify the types of errors being made by nurses in Oregon, to have a more thorough understanding of who is making the errors, and to examine how the Board is sanctioning nurses through Board (Board of Nursing) discipline. Results show that older nurses, and a disproportionately high number of male nurses, are being disciplined. RNs tend to be disciplined more for substance abuse and LPNs for substandard or inadequate care or for unprofessional conduct. RNs tend to be reprimanded more often than other licensure types, and LPNs receive more licensure suspensions. It may be helpful for administrators and nurse managers to use the information for staff education and development decisions. It may also inform Oregon nursing regulators, charged with protecting the public, when developing strategies aimed at ensuring equity and consistency in Board actions.     

COE Final Report: Chiba University

Background: The Center of Excellence (COE) program for the Creation and Dissemination of a New Japanese Nursing Science at the Chiba University School of Nursing aims to develop nursing science that is appropriate for Japanese culture and to internationally disseminate the importance of culturally based care. The object of this culturally appropriate nursing is not only clients/families but also nurses themselves, because although the cultural aspect of a nurse is tacit, it has deep influence on nursing care. Method: We organized our research subprojects from the viewpoint of “Interpersonal Helping,” which is different from the former approach of nursing, and we conducted research study on these subprojects. We conducted our research studies to clarify culturally appropriate nursing by the qualitative meta‐synthesis method. We performed international comparative research study on culturally appropriate nursing and conducted international conferences to elaborate and disseminate our outcomes. Results: Fourteen outcomes of meta‐synthesis studies have already been published until now, and more than 200 primary research studies have been conducted. We developed mainly 2 education programs and adopted them practically. From the inductive analysis of all our primary researches, we derived 4 viewpoints that clarify cultural aspect in nursing. The Cultural Nursing Society was established in 2007. Conclusions: We finally named this culturally appropriate nursing which respected the difference of individual culture “Cultural Nursing”. The importance of Cultural Nursing will further increase in the near future. We plan to establish and systematize this Cultural Nursing Science, which is based on the outcome of our program, and enroll researchers and nurses who have the ability to study and practice Cultural Nursing from both interdisciplinary and international aspects.     

不同学历层次护士临床护理的比较

目的探讨不同学历层次的护士对临床护理质量的影响。方法2012年10月,便利抽样法选择哈尔滨医科大学附属第一临床医院工作年限〈5年的临床护士100名作为研究对象,按照学历不同将其分为本科组、大专组、中专组。以《全国卫生系统护师岗位技能训练和竞赛活动护理技术项目考核要点》为依据,对三组护士的临床护理质量水平进行考核评估,比较三组护士的临床护理水平差异。结果护理评估、护理诊断、制定护理计划、护理评价等方面的成绩,三组护士的差异有统计学意义（P〈O．05或P〈0．01）。结论必须加强对护士队伍的继续教育,提高护士的学历层次,从而提高整体护理质量。     

Use of physician-hired nurses. A survey

The results of a survey conducted on the practice of using physician-hired nurses in hospitals are reported. Nursing administrators need information on the nursing services that are being provided in direct association with the medical practice of physicians, particularly when those services influence the quality and cost-effectiveness of patient care. The information can be used to plan more effective approaches to the delivery of nursing health care services.     

The Neuman Systems Model: application to a patient with a cervical spinal cord injury

Neuman's Systems Model provides a framework for holistic neuroscience nursing practice. Utilizing Neuman's assessment format, results are presented for a patient who sustained a cervical spinal cord injury. Nursing diagnoses are identified and a sample plan of care is included.