Accelerating the Development of Higher-Level Clinical Thinking in Novice Nurses.

Enhancing clinical expertise of novice nurses is a challenge for nursing professional development practitioners. Time and availability of expert preceptors are limited. This article describes a process evaluation project using a specific method of cognitive skills training to expose inexperienced nurses to expert thinking and help them develop more advanced cognitive skills. Development of scenarios, decision points, and expert rationale is described along with project outcomes and lessons learned. Nursing professional development practitioners and inexperienced nurses may benefit from using this method.

Patient Education and Discharge Planning to Prevent Functional Decline in the Older Adult.

The population in the United States is aging, and persons older than 65 years account for over 50% of healthcare costs. Preventing functional decline in older adults through patient education and optimal discharge planning is one way we can succeed in decreasing healthcare costs, readmissions, and mortality in this population. The aim of this article is to present viable healthcare policy options to prevent or minimize functional decline in the older adult, regardless of what health-related facility the person enters. Policy objectives include mandating functional screening tests on all persons 65 years and older, addressing functional status as a required element of discharge planning, tracking and reporting patient outcomes, and utilizing advanced practice nurses to the full extent of their education and scope of practice. Three policy options are presented, analyzed, and compared. The summary concludes with a recommended policy option.

Back to basics: importance of nursing interventions in the elderly critical care patient.

The global population is aging, and with that comes new challenges. Optimal care must be delivered to minimize the time spent in the acute care setting. Avoiding costly complications and focusing on health promotion rather than disease management will be key. Geriatrics is a complex patient population and basic nursing care is essential to prevent unnecessary complications if our health care system is to survive. Our profession is ill prepared to optimally care for this patient population.

Incidence and prevention of delirium in critical care patients.

Delirium in the intensive care unit is prevalent and a topic of high interest. Although it has been studied a great deal, screening, prevention, and management remain difficult. There are many causes of delirium and equally as many approaches to prevention and treatment. Two case studies sharing the challenges and successes of education, prevention, and treatment of delirium are presented in the context of complex adaptive systems.

Pulmonary issues in acute and critical care: pulmonary embolism and ventilator-induced lung injury.

Many patients admitted to acute care hospitals are at risk for VTE. Nurses play a pivotal role in prevention of VTE events by assessing risk and implementing prophylactic interventions, promptly recognizing and reacting to signs and symptoms of DVT and PE, and collaborating with other team members to ensure rapid treatment ensues. When patients require mechanical ventilation, nurses need to remain alert for complications indicative of VILI, effectively communicate assessment findings to other team members and confidently implement nursing and ordered medical interventions to promote the best possible patient outcomes.