Examining pedagogical practices in family systems nursing: intentionality, complexity, and doing well by families.

Teaching graduate family nursing students the important and delicate practice of entering into and mitigating families' illness suffering signifies an educational practice that is rigorous, intense, and contextual, yet not articulated as expounded knowledge. This study examined the pedagogical practices of the advanced practice of Family Systems Nursing (FSN) as taught to master's and doctoral nursing students at the Family Nursing Unit, University of Calgary, using observation of expert and novice clinical practice, live supervision, videotape review, presession hypothesizing, clinical documentation, and the writing of therapeutic letters to families. A triangulation of research methods and data collection strategies, interpretive ethnography, autoethnography, and hermeneutics, were used. Students reported an intensity of learning that had both useful and limiting consequences as they developed skills in therapeutic conversations with families experiencing illness. Faculty used an intentional pedagogical process to encourage growth in perceptual, conceptual, and executive knowledge and skills of working with families.

Design and synthesis of pyridone inhibitors of non-nucleoside reverse transcriptase.

Next generation NNRTIs are sought which possess both broad spectrum antiviral activity against key mutant strains and a high genetic barrier to the selection of new mutant viral strains. Pyridones were evaluated as an acyclic conformational constraint to replace the aryl ether core of MK-4965 (1) and the more rigid indazole constraint of MK-6186 (2). The resulting pyridone compounds are potent inhibitors of HIV RT and have antiviral activity in cell culture that is superior to other next generation NNRTI's.

Design and synthesis of conformationally constrained inhibitors of non-nucleoside reverse transcriptase.

Highly active antiretroviral therapy (HAART) significantly reduces human immunodeficiency virus (HIV) viral load and has led to a dramatic decrease in acquired immunodeficiency syndrome (AIDS) related mortality. Despite this success, there remains a critical need for new HIV therapies to address the emergence of drug resistant viral strains. Next generation NNRTIs are sought that are effective against these mutant forms of the HIV virus. The bound conformations of our lead inhibitors, MK-1107 (1) and MK-4965 (2), were divergent about the oxymethylene linker, and each of these conformations was rigidified using two isomeric cyclic constraints. The constraint derived from the bioactive conformation of 2provided novel, highly potent NNRTIs that possess broad spectrum antiviral activity and good pharmacokinetic profiles. Systematic SAR led to the identification of indazole as the optimal conformational constraint to provide MK-6186 (3) and MK-7445 (6). Despite their reduced flexibility, these compounds had potency comparable to that of the corresponding acyclic ethers in both recombinant enzyme and cell based assays against both the wild-type and the clinically relevant mutant strains.

The professional practice knowledge of nurse preceptors.

Significant research has been conducted and disseminated on preceptorship as an essential component in teaching and evaluating student learning in the final clinical practicum. The preceptorship triad-formally defined as an equilateral relationship among a nurse preceptor, faculty member, and undergraduate nursing student-overlooks the contextual challenges preceptors encounter. Preceptors develop relationships in the clinical setting to enhance teaching, and more importantly, to ensure student practice reflects the depth of clinical reasoning and skill acquisition necessary for safe and competent practice. Using descriptive surveys and qualitative focus groups, a research collaborative among academia, practice, and professional regulating bodies was established in southern Alberta, Canada, to research the types of knowledge nurses acquire and integrate to successfully assess, evaluate, and teach undergraduate nursing students in the clinical environment. This article describes the research findings and highlights the professional practice knowledge of nurse preceptors.

Preceptors matter: an evolving framework.

Preceptors teach students within complex, unpredictable, and often chaotic environments. The teaching expertise that preceptors acquire as they guide, facilitate, and evaluate student learning often is overlooked by both academia and service. The purpose of this triangulated research was to create a profile of nurse preceptors and reveal teaching expertise through the interpretation of preceptors' everyday experiences and challenges. The findings of this research are brought forward through the three main understandings of discovering, learning, and engaging. Dissemination occurred through the development of a collaborative Centralized Preceptorship Education Project that included three health regions, seven academic institutions, and professional regulating bodies, as well as the development of a preceptor educational framework, entitled Preceptors Matter. Our intent throughout the research and dissemination process was to legitimize the preceptor role by revealing expertise, connecting conversations, and offering opportunities for extension.

Keeping the center of nursing alive: a framework for preceptor discernment and accountability.

This research served to explicate the profile of the nurse preceptor and illuminate the knowledge that nurse preceptors accrue while teaching students in the final clinical practicum. The analysis of the descriptive survey, sent to approximately 770 preceptors, along with the interpretive analysis of 16 focus groups and 5 interviews, revealed understandings of discovering, learning, and engaging as central to the relational elements of professional discernment and accountability. Preceptor discernment is essential to ensuring competent nursing practice for student nurses preparing for entry-level practice. Dissemination of the findings is suggested through the creation of an educational framework reflective of, relevant to, and used by nurse preceptors that may be used in both practice and academic settings.

Knowing within: practice wisdom of clinical nurse educators.

The challenges nurse educators encounter and respond to while teaching undergraduate students in the clinical area require a unique set of skills and teaching expertise, different from those acquired through classroom teaching. As these educators encounter, make sense of, and move beyond these interruptions, a unique set of understandings and wisdom is acquired. In explicating this wisdom, philosophical literature on practical wisdom, tacit knowledge, smooth activity, and Unready to Hand immersions was accessed. Two layers of interviews were conducted with 9 educators (32 total interviews). An interpretive analysis of these stories elucidated the metaphor of Unready to Hand as Adventure, revealing three domains of practice: Preserving the Ideal, Salvaging Learning, and Sustaining Self. These domains clarify the professional teaching knowledge these educators acquired and offer insight into how one may respond within the everyday encounters that characterize this area of teaching practice.

Recalibrating time and space: women's challenges of living with heart failure.

The progressive and demanding nature of heart failure has a significant impact on the daily life of all individuals. Gender-related differences exist in diagnosis, management and home-based support, whereby women's needs have been either managed less aggressively or overlooked. Minimal research has been conducted on the everyday challenges for women who are living in the community with heart failure. The researchers of this interpretive research encouraged the seven women who volunteered for this study to talk about their day-to-day challenges. The interviews were interpreted through a process informed by Heideggerian hermeneutics, whereby the three themes of recalibrating time and space, balancing pathways of wishing and hoping and practicality, and acknowledging loss in persevering through uncertainty were uncovered. The findings of this research may be utilized in assisting and preparing women to think and plan ahead by considering some decisions others make while taking on a new path in responding to the symptoms associated with heart failure.

Sustaining self: moving beyond the unexpected realities of teaching in practice.

Nurse educators who teach undergraduate students in clinical practice frequently encounter, or are thrown into situations that interrupt smooth activity, pausing to make sense of what is going on in order to respond in a manner that is consistent with their professional beliefs and values. In moving towards, within and beyond this interruption in smooth activity, identified within this research as an Unready-to-Hand immersion, these educators create a matrix of situational knowing and wisdom that surrounds propositional knowing. In striving to clarify the knowing that informs the clinical nurse educator's response to unexpected situations, I referred to philosophical literature on tacit knowledge, practice wisdom, smooth activity and the Unready-to-Hand mode of engagement. I carried out an interpretive research project involving reflections on personal experiences followed by two layers of interviewing with nurse educators teaching students in practice. The first layer of individual interviews was with eight nurse educators who in their role experienced Unready-to-Hand immersions. The second layer involved of three of these eight participants who chose to continue with more in-depth, unstructured interviews. One participant not involved in the original set of interviews approached me individually and asked to participate in the in-depth interviews, which they did. An interpretive analysis of these nurse educators' stories illuminated Unready-to-Hand as Adventure, highlighting the elements of attuning to difference, the domains of practice within Unready-to-Hand and three modes of unknowing. This paper focuses on one of the domains of practice: sustaining self.

Doing phenomenological research collaboratively.

Collaborative research between nurses employed in the academic and practice sectors is a cost-effective and innovative way to investigate aspects of clinical practice, articulate clinical and teaching expertise, and extend professional practice knowledge. In collaborative ventures, researchers from different institutional cultures often work together to investigate a particular area of interest. This poses challenges in relation to the perceptions, understandings, and interpretations of the research question and of the mode of inquiry, particularly when investigating through the qualitative paradigm. The purpose of this article is twofold. The first is to clarify some of the challenges experienced while conducting collaborative research and describe the steps taken to ensure consistency between the purpose of the research and the phenomenological research design used to explore the learning that nursing students acquire in their final clinical practicum. Second, it was thought that by illuminating this learning, registered nurses working as preceptors and those supporting new graduates could gain insight into the complexities of learning the skills of safe and competent practice from the student's perspective. This insight is essential in creating a strategy between education and practice to minimize the duplication of learning opportunities and lessen the cost of supporting newly registered nurses, which may be at the expense of investment in the professional development of experienced registered nurses.