The frontline clinical manager identifying direct reports' level of practice.

Patricia Benner applied the Dreyfus Model of Skill Acquisition to describe and interpret skill acquisition and clinical judgment in nursing practice. Operational definitions for the 5 levels of her original Novice to Expert Theory were used by the study participants in a large Midwestern pediatric hospital to self-identify their level of practice. The frontline clinical managers of these direct care registered nurses (RNs) used the same tool to rate their direct reports. The aim of this portion of a larger study was to determine if the clinical manager's perception of their direct reports was the same as that of the RNs. The results of this study are being used by one study unit's clinical managers as the basis for implementing the Hersey and Blanchard Situational Leadership Model. The clinical managers work with their direct reports depending on the level of practice and the details of the task to be performed. One example is creating therapeutic relationships with each other and with families to ensure a safe environment for all.

Guatemalan caregivers' perceptions of receiving and using wheelchairs donated for their children.

PURPOSE: The purpose of this qualitative study was to explore the experiences, perceptions, and needs of caregivers receiving wheelchairs donated for nonambulatory children in a less-resourced country. METHODS: A phenomenological research design was used with purposeful sampling of 14 participants living in urban and rural areas of Guatemala. Data were collected primarily by interviews and supplemented with observations in natural settings, photographs, and record reviews. RESULTS: Eight themes emerged uncovering the meaning and essence of caregivers' experiences: value of the wheelchair, relief for caregivers, enhancement of child participation, wheelchair as a form of "therapy," improvement of learning opportunities, challenges to inadequate disability awareness, impact of contextual barriers, and need for community-based supports. CONCLUSION: Caregivers in this sample perceived donated wheelchairs as beneficial to themselves and to their children. Support was found for the need to provide wheelchairs in collaboration with local services to support wheelchair use.