Getting to the heart of pleural effusions: A case study

Purpose: To provide nurse practitioners (NPs) with an overview of the physiology, pathophysiology, clinical presentation, and comprehensive assessment, as well as the differential diagnosis process and initial management of patients with unilateral pleural effusions.
Data sources: A review of the scientific literature was performed on pleural effusions, using Pub Med, Medline, and CINAHL. The case study of a patient with a pleural effusion related to heart failure is used to integrate this knowledge into clinical practice.
Conclusions: Pleural effusions are common sequelae of numerous pathophysiological processes.
Implications for practice: Knowledge of the underlying physiological and pathophysiological mechanisms enables the NP to obtain an accurate and comprehensive assessment, establishes a differential diagnosis, and provides the timely initial management necessary to optimize patient care outcomes.     

Determining Critical Incident Nursing Interventions for the Critical Care Setting: A Pilot Study

PURPOSE.  The purpose of this research survey was to determine which Adult Critical Care Core Nursing Interventions (ACCCNIs) in the Nursing Interventions Classification constitutes a critical incident nursing intervention (CINI). A CINI is defined as any indirect or direct care registered nurse (RN)-initiated treatment performed in response to a life-threatening nursing diagnosis.
METHODS.  A list of ACCCNIs were sent to 50 critical care RNs in two survey rounds. Responses >80% for each ACCCNI was determined to be a CINI.
FINDINGS.  Forty-one ACCCNIs were determined to be CINIs.
CONCLUSIONS.  It is recommended that CINIs be included as a separate Nursing Intervention Classification category to reflect current nursing practice.
IMPLICATIONS FOR NURSING PRACTICE.  CINIs can enhance RN competency, education, and vigilance, thereby preventing or decreasing the number of deaths that occur from critical incidents.     

A qualitative study of the experience of oral cancer among Taiwanese men

The incidence and mortality of oral cancer in Taiwanese men have increased over the past decade, primarily associated with a surge in the popularity of betel quid chewing. The aim of this study was to examine the experience of six Taiwanese men with oral cancer, who were aged between 40 and 60 years, using a qualitative approach. The three major themes emerging from the data include: (i) understanding the cancer diagnosis; (ii) the challenges of cancer treatment; and (iii) adapting to difference. Increasing nurses' understanding of the experiential aspects of oral cancer in this population is required if nurses are to develop successful health promotion programmes and nursing interventions to meet these patients' needs.     

Validation of a tool to measure neonatal nursing workload

Aims  To test the validity and reliability of the Winnipeg Assessment of Neonatal Nursing Needs Tool (WANNNT).
Background  Workforce planning is increasingly challenging. Existing tools can be inadequate.
Methods  Nurses provided estimates of patient care time. Charge nurses assessed overall safety of care. Patient levels were compared between two independent assessors. Total nursing needs was compared between the WANNNT and an independent charge nurse.
Results  Mean time estimates for levels 1–5 were not significantly different from the WANNNT. Nurses estimated 50% less time than the tool assigned level 6. The tool was 95% reliable in assigning patient levels between two assessors. The mean difference between the total WANNNT assessment and the charge nurse was one nurse.
Conclusions  The tool provided a reasonable and reliable estimation of the number of nurses required for a given collection of patients in order to provide the highest quality of care.
Implications for nursing management  Nurse managers incorporating this tool need to determine the additional drivers for nursing time that must be considered which may be unique to their unit or hospital. The WANNNT will be a valuable asset for making staffing decisions on a shift to shift and long-term basis.     

Evaluating the role of mentor for advanced practitioners: an example from community matrons in England

This study evaluates the role of mentor for the new community matron role in England and identifies the implications for others in advanced practice roles. With the introduction of 3000 community matrons in England by March 2008, a national pilot education programme was introduced to prepare them for their role. Given the recent requirement by the UK Nursing and Midwifery Council to introduce support at the advanced level of nursing practice, a purposely developed mentorship module was introduced for those supporting the new community matrons.
A mixed-method approach to data collection was used. This involved documentary analysis of a range of sources and, during July 2006, a self-administered postal questionnaire was sent to all community matrons undertaking the pilot education programme ( n  = 70) with a response rate of 67% ( n  = 47). Individual telephone interviews were conducted with 17 students, and 6 mentors on the purposely developed mentor module. A focus group interview was undertaken with the education programme development team ( n  = 5). Quantitative data were analysed using spss and qualitative data analysed using content and thematic analyses.
Despite some initial problems, 96% ( n  = 45) students had access to a mentor during the programme. Overall, the findings reinforce the value placed on individual support for the role and identify the problems associated when support was absent or unsuccessful. For those who had support, there were different expectations of the mentoring role, variation in the quality of their relationship and the perceived value of education to support the mentors in their role.
The study concludes that supporting pioneers to develop new roles when neither party is clear about its strategic direction, nor fully aware of its impact on service, requires risk taking by both parties, and a genuineness, openness and commitment by both in forging the new pathway.     

A supervised land cover classification of a western Kenya lowland endemic for human malaria: associations of land cover with larval Anopheles habitats

Background  

A supervised land cover classification was developed from very high resolution IKONOS satellite data and extensive ground truth sampling of a ca. 10 sq km malaria-endemic lowland in western Kenya. The classification was then applied to an investigation of distribution of larval Anopheles habitats. The hypothesis was that the distribution and abundance of aquatic habitats of larvae of various species of mosquitoes in the genus Anopheles is associated with identifiable landscape features.