Outcomes evaluation: measuring critical thinking

Nursing education, along with higher education in general, is increasingly focusing on educational outcomes; critical thinking is one of these outcomes. This study examined the impact of a baccalaureate registered nurse programme on the critical thinking skills of students. Students were tested upon entry and exit of the programme and a significant (0.05) difference was found. Subtest gains were significant (0.05) on Recognition of Assumptions, and Deductions. A significant relationship (0.05) between the nursing grade point average (GPA) and the post-test total score existed, accounting for a variance of 4%. No relationship was found between the post-test total score and the general education GPA. The two GPA correlation coefficients were significantly different from one another (0.05). Since one goal of professional nursing education is to prepare nurses who engage in complex problem solving and critical thinking, both the curriculum and teaching strategies need to enhance these skills.     

Case Study: The Challenges of Self‐Management of Exacerbation of Pulmonary Symptoms

PURPOSE. This case study demonstrates the signs and symptoms of pulmonary exacerbation and the challenges of self‐management for a female veteran. DATA SOURCES. Data were obtained through the author's clinical practice in primary care nursing and research literature sources. DATA SYNTHESIS. The appropriate nursing diagnosis, nursing interventions, and patient outcomes were identified through the use of NANDA‐International, the Nursing Interventions Classification, and the Nursing Outcomes Classification. CONCLUSIONS. This case study illustrates the appropriate nursing diagnosis, interventions, and outcomes pertinent to an individual with pulmonary exacerbations. It provides a framework for nurses in primary care when caring for individuals with pulmonary exacerbations. IMPLICATIONS FOR NURSING PRACTICE. Employing the NANDA‐International standardized nursing diagnoses, the Nursing Interventions Classification and the Nursing Outcomes Classification provided the needed constructs for improving care for a patient that had pulmonary issues in a primary care setting.     

Nutritional status and delirium in long-term care elderly individuals

Delirium is physiologically plausible in elderly individuals with a poor nutritional status. We explored body composition, serum protein levels, and delirium in a multicenter long-term care study using bioelectrical impedance analysis (BIA). Estimates from the BIA procedure included the body cell mass and fat-free mass (FFM) of nursing home elderly residents (N = 312). Increased delirium was identified in men and women who were leaner and had lower FFM. Clinical surveillance for delirium in frail elderly individuals with low serum albumin levels and polypharmacy is recommended because of their increased likelihood of having drug toxicities for medications with protein-binding properties.     

Comparison of QTc Interval Prolongation for Patients in Methadone Versus Buprenorphine Maintenance Treatment: A 5-Year Follow-Up

The authors investigated whether patients receiving buprenorphine maintenance treatment (BMT) will have corrected QT (QTc) prolongation after taking buprenorphine for an extended period of time. They also compared QTc prolongation for patients in methadone maintenance treatment (MMT) versus BMT to determine which medication is the better option for patients with heart disease. A retrospective chart review study of 73 patients in BMT and 55 patients in MMT was performed. A linear regression model with a one-sided P value was used for data analysis. The MMT group had statistically significant prolongation of QTc compared with the BMT group (F = 3.94, P = .0001). Being diagnosed with congestive heart failure and taking methadone were the only individual variables that showed a statistically significant association with a QTc prolongation > 500 ms. The model as a whole showed statistical significance (F = 5.203, P = .007). Being diagnosed with congestive heart failure was the only individual variable that showed a statistically significant association with mortality. The model as a whole also showed statistical significance (F = 17.15, P = .000). This study supports previous findings that methadone may be associated with QTc prolongation, whereas buprenorphine may not. This study has the advantage of confirming that QTc prolongation persists in patients in MMT but not in those in BMT over an extended period of time (i.e., 5 years). Buprenorphine might a better first-line opioid maintenance treatment for patients with heart disease because buprenorphine was not associated with QTc prolongation. Patients in BMT may not need to be screened routinely for QTc prolongation.