Perceived importance of teaching characteristics in clinical nurse specialist preceptors.

UNLABELLED: Advanced practice nursing education includes a minimum of 500 hours of supervised clinical practicum, with practicing clinicians serving as preceptors providing the bulk of the supervision. Preceptor behaviors and teaching skills can significantly impact student learning, however, no empirical evidence exists that identifies or evaluates effective clinical teaching characteristics in clinical nurse specialist (CNS) preceptors. PURPOSE: The purpose of this study was to explore and compare CNS student and preceptor perceptions of the importance of clinical teaching characteristics in CNS preceptors. METHODS/SAMPLE: Data was obtained from CNS preceptors (n = 278) and CNS students (n = 78) through a web-based questionnaire instrument. Twenty-one previously identified effective clinical teaching characteristics served as the questionnaire items and participants were asked to rate their importance and identify the most and least important characteristic. Statistical tests including calculation of mean scores and independent t-tests for each characteristic were completed. FINDINGS: The CNS preceptors and students rated all effective teaching characteristics as important. Clinical competence/judgment was identified as the most important characteristic among participants. The findings demonstrated congruence between students' and preceptors' ratings except for the characteristics calm during times of stress and flexibility. CONCLUSIONS: These findings can help CNS faculty and practicing CNSs better prepare and evaluate preceptors for supporting advanced practice students in clinical practicum experiences.

The effectiveness of a brief intervention for emotion-focused nurse-parent communication.

OBJECTIVE: A child's hospitalization is stressful for both the children and their parents. Nurse-parent communication during stressful hospitalizations requires skilled nurse communicators. Brief methods of training emotion-focused communication for newly licensed nurses are needed, but as yet are rare. The purpose of this study was to evaluate the effectiveness of a validated brief communication training (Four Habits Model) session using simulation for newly licensed pediatric nurses. METHODS: Quantitative and qualitative methods provided data for this experimental study, using a group-by-trials repeated measures ANOVA design. The intervention group participated in a 1-h three-part education simulation session and the control group observed a 1-h video. RESULTS: Compared with the controls, the intervention group improved significantly in four of five areas: preparation, communication skills, relationships, and confidence. Experience level had minimal effect. Over half of the nurses in the intervention group reported using one or more of the Four Habits in clinical practice. CONCLUSIONS: The findings of this study suggest that a 1-h Four Habits communication-training program improves newly licensed nurses' self-perception of their preparation for emotion-focused conversations with parents. PRACTICE IMPLICATIONS: The findings of this study suggest that the Four Habits Model can be useful in communication training with nurses.

Relationship between occurrence of falls and fall-risk scores in an acute care setting using the Hendrich II fall risk model.

INTRODUCTION: Falls are a common clinical problem in the acute care setting, and fall-related injuries can include fractures, subdural hematomas, excessive bleeding, and even death (Hitcho et al., 2004). Several instruments are used clinically to estimate a patient's risk of falling. The STRATIFY (Oliver, Britton, Seed, Martin, & Hopper, 1997), the Morse Fall Scale (Morse, Black, Oberle, & Donahue, 1989), and the Hendrich II Fall Risk Model (Hendrich, Bender, & Nyhuis, 2003) are three instruments widely used in clinical practice by nurses. To be clinically useful, a fall risk assessment instrument should be easy to use with only a small number of items, perform consistently across target populations, and have evidence-based scoring and good inter-rater reliability. Oliver (2008), author of the STRATIFY tool, questioned the merits of any instrument used to assess fall risk in hospital inpatients in the absence of interventions to modify the risk factors. Too often, patient assessment and assignment of a score become required tasks and resulting data do not drive interventions. PURPOSE: The purpose of this study was to explore the relationship between scores on the Hendrich II Fall Risk Model (HIIFRM) and fall occurrence as recorded in the medical record for patients diagnosed with diabetes mellitus, stroke, or heart failure in an acute care inpatient setting. METHOD: To determine if a relationship existed between the occurrence of a fall and the HIIFRM score, the study used a random sample of patients who fell during admission and a matched control group of patients who did not fall. Fall cases were identified based on an admission Medical Severity-Diagnosis Related Group (MS-DRG) (Schmidt & Stegman, 2008) of stroke or secondary International Classification of Diseases (9th revision) (ICD-9) code (Hart, Stegman, & Ford, 2009) of heart failure or diabetes. Non-faller matched controls were selected at random from the same admission MS-DRG or secondary ICD-9 code as the fall case and matched for admission month/year. DISCUSSION: This study found HIIFRM scores to be related significantly to falls in the sample of patients with diabetes, but not in the sample of patients with heart failure. Although the HIIFRM demonstrated statistically significant mean differences in scores between patients who fell and those who did not, clinically the instrument failed to identify 44% of patients who did fall as being at high risk for falling. Given the negative consequences associated with falling, not identifying 44% of high-risk patients can have significant clinical implications. CONCLUSIONS: In this study, HIIFRM scores were related to falls among inpatients in an acute care hospital who had a diabetes diagnosis, but not a heart failure diagnosis. The differ ences between patient groups based on medical diagnoses suggest the instrument does not perform equally across patient groups, nursing skill levels, or clinical units. Though the findings are statistically significant, the clinical concemrn remains that a large percentage of patients who fell were scored as low risk using the HIIFRM instrument. At some level, every patient admitted to an acute care hospital is at risk for falls. Patients sick enough to be in the hospital have underlying disease, are receiving physiologically altering medications and treatments, and are likely experiencing pain, fatigue, anxiety, sleep disturbance, and other symptoms that interfere with cognitive and physical functioning. The key to preventing falls among hospitalized patients may lie in addressing how the hospital environment creates risk. Nurses should continue to improve the ability to assess fall risk and implement interventions that modify or eliminate risk when possible.

Improving quality and safety in graduate education using an electronic student tracking system.

TOPIC: The Institute of Medicine report on the future of nursing, the Quality and Safety Education for Nurses initiative, and the Technology Informatics Guiding Education Reform movement are among the most prominent forces guiding change related to information technology and informatics in nursing to improve quality and safety in practice. Informatics competencies are essential for psychiatric nurses to leverage and integrate information technology into education, practice, and research. PURPOSE: This article examines informatics and information technology from the perspective of educational preparation of the psychiatric mental health nurse practitioner. SOURCES OF INFORMATION: Literature related to informatics, information technology, and quality and safety in advanced practice psychiatric nursing. CONCLUSION: Strategies for integration of information technology in educating psychiatric mental health nurse practitioner students are described. Informatics competency will result in safer and higher quality care.

Reproducibility of radiographic measurements in assessment of congenital talipes equinovarus.

Six commonly measured parameters in the assessment of congenital clubfoot were retrospectively assessed from standardized preoperative and intraoperative radiographs taken during operative complete subtalar release. These radiographic parameters were measured in 30 feet by 6 observers at 2 separate readings. The observers were orthopedic residents in different stages of training. Between-observers intraclass correlation coefficients (ICCs) were computed for each parameter. All radiographic parameters were found to be reproducible across time and observers (range of preoperative intraobserver ICCs, 0.84-0.99; range of preoperative interobserver ICCs, 0.93-0.99), except for intraoperative anteroposterior (AP) talar-first metatarsal angle (intraoperative intraobserver ICC, 0.79) and lateral talocalcaneal angle (intraoperative interobserver ICC, 0.81). Differences in mean preoperative measurements between observers and time were tested by analysis of variance. There were no significant differences between observers and time in the 6 preoperative measurements (P<.05), except for intraoperative AP talar-first metatarsal angle, AP talocalcaneal angle, and degree of AP calcaneocuboid subluxation, which were significantly different (P<.05). Our results support use of radiographs as a reliable method for guiding care in patients with clubfoot and as a reproducible method that physicians can use for comparisons.

Fatigue and depression in patients with lymphoma undergoing autologous peripheral blood stem cell transplantation.

PURPOSE/OBJECTIVES: To describe the patterns of depression and fatigue, including its dimensions, and the relationship between these two variables in patients with lymphoma undergoing autologous peripheral blood stem cell transplantation (PBSCT). DESIGN: Prospective, descriptive, correlational, repeated measures. SETTING: Midwestern university National Cancer Institute-designated clinical cancer center. SAMPLE: 27 patients with lymphoma aged 19 to 71 undergoing autologous PBSCT. METHODS: The revised Piper Fatigue Scale was used to measure fatigue and its dimensions. The Center for Epidemiologic Studies' Depression Scale was used to measure depression on selected days at baseline and during chemotherapy and recovery. MAIN RESEARCH VARIABLES: Fatigue and its four dimensions (behavioral/severity, sensory, cognitive/mood, and affective meaning) and depression. FINDINGS: Total fatigue, fatigues four dimension scores, and depression scores changed significantly over time, with the highest scores at day + 7 after transplant. Total fatigue and the four dimension scores were highly and positively correlated with depression, with the highest correlation reported between the affective fatigue dimension and depression. CONCLUSIONS: The findings support the importance of assessing fatigue and depression in patients undergoing autologous PBSCT at baseline, during chemotherapy, and throughout recovery. IMPLICATIONS FOR NURSING: Routine clinical assessment with close observation around day +7 after transplant and patient education about the patterns of fatigue and depression will help the healthcare team to intervene at the appropriate time and may help patients to better manage these symptoms.