Teaching advanced practice nursing students how to use the Internet to support an evidence-based clinical practice.

In the past decade, clinicians have dramatically increased their use of the Internet as an information resource to guide clinical practice. The amount of evidence-based information on the World Wide Web (WWW) is growing at an explosive rate. Although the term "Internet" actually refers to the wires that link computers, and the term "World Wide Web" refers to the linked information, these terms will be used interchangeably in this article. Advanced practice nurses (APNs) need to learn how to locate evidence-based information efficiently on the Internet, how to evaluate the validity and relevance of the information, and how to use the information to support their practice decisions. This article describes a research course that the author teaches to APN students at the University of San Francisco School of Nursing. The course was designed to improve students' skills in using the Internet to support an evidence-based clinical practice (EBCP). The information in this article can assist nurse educators in teaching their APN students how to locate and evaluate evidence-based information on the Internet. It also can assist practicing APNs in using the Internet to facilitate an EBCP.

The use of clinical logs to improve nursing students' metacognition: a pilot study.

The purpose of this study was to examine the effectiveness of the use of a reflective clinical log to improve students' thinking strategies and metacognition (cognitive awareness). Rather than prepare a written nursing care plan prior to entering the clinical setting, students instead were asked to write in a clinical log at the completion of their clinical day, reflecting upon client problems that they had identified, the data that were used to identify these problems, the nursing interventions that were used, and the results of these interventions. The students reported that they preferred the use of a reflective log over writing nursing care plans and they felt that the logs improved their ability to think about their thinking (i.e. their metacognition). The results of this pilot study indicate that reflection in clinical logs assists students to become more active learners, to manage their own thinking, and to improve their metacognition. Additional research in this area is needed to confirm study findings and to provide further understanding regarding the effectiveness of clinical logs as a teaching strategy to improve students' metacognition.

Successful publishing in nursing: debunking some common myths.

Myths can serve useful functions for a group or society. The myths related to success in publishing, however, do not seem to serve a useful function, and may operate as barriers or excuses that unnecessarily hinder success in publishing. In this article, some of the common myths associated with publishing in nursing are examined for their validity and for evidence of support for the myth in the literature.

Thinking in nursing practice.

Despite the fairly extensive body of research describing nurses' thinking in practice, our understanding of this phenomenon remains incomplete. Until we have a full description of nurses' thinking, the component of our practice that is an exercise in clinical judgment will be less precise and scientific. This descriptive study utilized think aloud method to identify and describe the thinking strategies that nurses use in practice. Findings from this study improve our understanding of nurses' thinking in practice and provide information that can facilitate the development of decision support systems to assist nurses in their practice.

The written nursing process: is it still useful to nursing education?

As nursing practice becomes more complex, and patient care more variable, it will be crucial for nurse educators to teach students to think creatively and to develop a repertoire of strategies to resolve patient problems. The written nursing process has been the primary tool that nurse educators use to teach students to identify patient problems and plan for their resolution, but is it still useful? We combined a review of the literature with an informal survey of BSN nursing students to examine the usefulness of the nursing process from three perspectives: as a problem-solving tool, as a means of fostering the art and creativity of nursing, and as a method of individualizing patient care. Current nursing literature and students' comments about the nursing process suggest that this approach may no longer be realistic or germane to current practice needs.

Expert system development in nursing: implications for critical care nursing practice.

OBJECTIVE: To obtain information about how highly experienced critical care nurses reason to plan care and make decisions about a critically ill unstable patient, and to determine the usefulness of this information for expert system development. DESIGN: Descriptive, using think-aloud technique and protocol analysis. SETTING: Laboratory. PATIENT: A simulated patient case whose condition deteriorated over a 12-hour shift. The case depicted an elderly female with congestive heart failure and atrial fibrillation with rapid ventricular response. RESULTS: Protocol analysis revealed the information (data) that subjects used and how they structured that information to plan care and make decisions. Examination of subjects' reasoning processes allowed the investigators to identify "if-then" rules that could be used in expert system design. CONCLUSIONS: The reasoning processes identified would assist in expert system development. An expert system designed to represent experienced critical care nurses' knowledge and reasoning processes would preserve that expertise in a computer system that could then be used to assist less experienced nurses to improve their reasoning skills and strategies.

Expert nurses' clinical reasoning under uncertainty: representation, structure, and process.

How do expert nurses reason when planning care and making clinical decisions for a patient who is at risk, and whose outcome is uncertain? In this study, a case study involving a critically ill elderly woman whose condition deteriorated over time, was presented in segments to ten expert critical care nurses. Think aloud method was used to elicit knowledge from these experts to provide conceptual information about their knowledge and to reveal their reasoning processes and problem-solving strategies. The verbatim transcripts were then analyzed using a systematic three-step method that makes analysis easier and adds creditability to study findings by providing a means of retracing and explaining analysis results. Findings revealed information about how patient problems were represented during reasoning, the manner in which experts subjects structured their plan of care, and the reasoning processes and heuristics they used to formulate solutions for resolving the patient's problems and preventing deterioration in the patient's condition.

A descriptive analysis of experienced nurses' clinical reasoning during a planning task.

A Think Aloud (TA) method was employed to collect verbal data from seven clinical nurses as they reviewed a written case study and formulated a plan of care. Protocol Analysis (PA) of the verbal data resulted in a visual representation of each subject's plan of care and provided information regarding the clinical data that subjects used to plan care. The results demonstrated that frequently problems and interventions were inextricably linked and considered in unison rather than during separate steps of a planning process. This finding has implications relative to the current practice within both nursing education and nursing service of focusing on problems and interventions separately when planning care.