Evidence-based practice and the advanced practice nurse: a curriculum for the future.

The concept of evidence-based practice has gained increased attention throughout the 1990s as a strategy for linking the best scientific findings with clinical judgment to improve health outcomes. Because the concept implies finding, evaluating, summarizing, and using research results, a high level of clinical reasoning skills is required. Effective evidence-based practice also requires the incorporation of new practices into clinical and organizational settings, thereby demanding advanced leadership skills. Competencies in clinical reasoning, leadership, and clinical practice are critical for advanced practice nurses. This article describes a master's-level curriculum supportive of evidence-based practice and includes recommendations for developing curricula of this type.

Communication of sexual risk behavior among late adolescents.

A grounded theory approach was used to describe how males and females in late adolescence communicate with their sexual partners about sexual risk behaviors. Interviews were audiotaped with 18 women and 15 men from a university in the southeastern United States. Verbatim transcripts were analyzed using constant comparative analysis. Building trust was identified as the core variable for both men and women. For women, prerequisites for building trust were being involved in caring relationships and indirectly gathering information about potential sexual partners. For men, prerequisites were being involved in caring relationships and using their instincts. Women usually initiated safe-sex talk, but men were willing to discuss it, once the conversation was initiated. Findings can serve as a guide for developing nursing strategies that promote more effective communication about sexual risk behavior in this age group.

PIP: The characteristics of communication about sexual risk behaviors between adolescent sexual partners were investigated in interviews with 14 sexually active females and 18 males attending a public university in southeastern US. Mean age at first intercourse was 17 years; respondents had had an average of 3 sexual partners. A review of the interview transcripts led to development of a model of the communication process. Building trust in one's partner emerged as the core variable for both males and females. A prerequisite for building trust was being involved in a caring relationship. Women built trust by indirectly gathering information about potential sexual partners, while men tended to rely on their instincts about their partners' appearance and demeanor. Once trust was established, both men and women were more likely to talk about sexual risk issues. Although males were willing to engage in safe sex talk if their female partner raised the topic, they rarely initiated such discussions. Alcohol use, previous sexual experience, knowledge about reproduction and contraception, conversations with friends, and the media were intervening conditions for safe sex conversations. Some participants believed that discussing safer sex practices indicated a lack of trust. Moreover, many participants demonstrated trust in their partners by engaging in high-risk sexual practices. This model can serve as a guide for developing strategies for promoting more effective communication about sexuality in late adolescence. For example, the finding that women tend to initiate discussions of safer sex practices suggests a need to empower women with the skills needed to negotiate risk-reduction behaviors.

Women's expectations of the labor and delivery nurse.

Sixty-one, Lamaze-prepared, married multigravidae identified their expectations of the labor and delivery nurse in semistructured interviews conducted at 36 to 38 weeks' gestation. Findings indicate variations in the amount of involvement women expected from the nurses during labor and delivery: limited (n = 17), moderate (n = 22), or extensive (n = 22). Women varied in the amount of time they wanted nurses present, who they expected to make caregiving decisions, and whether or not they wanted nurses to assist them in managing labor and delivery.