Nursing in the next millennium. Leadership skills for surviving and thriving.

Consider the following case study: The setting is an acute care facility with a large obstetrical service delivery (6,000 babies annually.) The year was 1989. A nurse leader had been appointed manager of Women's Services. Major job responsibilities included staffing, hiring, employee performance evaluations, developing policies and protocols, and managing daily operations issues. The reimbursement for the patient population was more than 50 percent fee for service.

Study of mechanical versus manual/mechanical compression following various interventional cardiology procedures.

Knowledge and technology for cardiovascular disease are growing at a rapid rate. Interventional cardiology offers patients several options of therapy, including percutaneous transluminal coronary angioplasty, directional coronary atherectomy, and percutaneous transluminal coronary rotoblator angioplasty procedures. Patients with these procedures require femoral intra-arterial sheath insertion and postprocedure management of these sheaths. The best practice for sheath removal is a controversial issue. This article describes a study conducted at Presbyterian Hospital in Charlotte, North Carolina, comparing the use of manual/mechanical versus mechanical compression technique for sheath removal. Subjects included patients who had one of the previous procedures performed. Subjects were randomly assigned to one of two study groups: manual/ mechanical or mechanical compression. Variables such as size of sheath, anticoagulants, antiplatelets, and flat time after sheath removal were examined. The outcome measure reported was the development of a groin complication. Results indicated no significant difference in groin complication. As a result, practice at Presbyterian Hospital changed to mechanical compression for removing sheaths.

Determining the effectiveness of critical pathways for coronary artery bypass graft patients: retrospective comparison of readmission rates.

The article describes a study performed to determine whether the use of the critical path tool made a difference in the readmission rates of patients after coronary artery bypass graft (CABG) surgery compared with CABG patients cared for without the critical path tool. The sample for this retrospective study consisted of 780 specific patient medical records from the medical record department. Examination of the data revealed no statistically significant difference in readmission for CABG patients cared for with critical paths and those cared for without critical paths. A comparison of hospital length of stay and surgical length of stay between the two groups however, revealed statistically significant differences between the two groups. The critical path group had a significant decrease in hospital and surgical length of stay.

The Traveling Salvation Show. A performance-centered skills fair.

This article examines a successful, innovative, and cost-effective approach to reviewing high-risk/low frequency skills for critical care units in an 800-bed healthcare system. Benner's (1984) Novice to Expert concept was used in the development of a performance-centered learning experience that encouraged critical thinking. "The Traveling Salvation Show" incorporated games, music, and brightly colored posters into a relaxed, flexible atmosphere to involve the learner in hands-on practice and review of high-risk/low frequency skills to meet Joint Commission on Accreditation of Healthcare Organizations guidelines.

Unit-based advanced practice nurse in critical care.

This article describes the unit-based advanced practice nurse (APN). A review of the literature provides historic development of the concept. The unit-based APN role in the changing environment of health care reform is explored. The role components, with emphasis on the case management delivery model, are explained. A case example demonstrates the success of the role in terms of patient outcomes. Future trends for the APN are also explored.

Clinical paths for cardiac surgery patients: a multidisciplinary approach to quality improvement outcomes.

Implementation of clinical paths has resulted in a successful multidisciplinary approach for monitoring quality improvement outcomes in a select group of cardiovascular patients. This article defines clinical paths and explains their development, implementation, and evaluation. It also discusses how variances (which are defined as discrepancies between expected and actual events) were identified and how this information led to actions to improve patient outcomes. The roles of each health care professional are discussed in relation to clinical paths, and positive outcomes for the nurse, other health care professionals, and the institution are presented.

Relationship between arterial and venous activated partial thromboplastin time values in patients after percutaneous transluminal coronary angioplasty.

This quasi-experimental study was conducted to determine whether reliable activated partial thromboplastin time (APTT) values could be obtained from samples taken from indwelling arterial catheter lines. The 30 subjects, who were receiving heparin infusions after a percutaneous transluminal coronary angioplasty (PTCA), had femoral intraarterial lines. With use of a counterbalanced design, APTT values determined in two serial samples of venous and arterial blood were compared for the 30 subjects. The venous blood samples were drawn at the same time as the comparable arterial blood samples. The arterial blood samples were withdrawn after discarding arterial blood equal to four or six times the indwelling catheter volume. A significance level of 0.01 was established to increase statistical control. A histogram was developed from the differences between the arterial and venous blood samples for each of the two groups (four times and six times the discard volume). The histogram indicated that three of the 30 subjects had arterial-venous APTT differences that exceeded 19 seconds when four times the discard volume was used. In the samples where six times the discard volume were used, only one person had an APTT reading greater than 8 seconds. Paired t tests revealed statistically significant differences between the arterial and venous APTT values (t = 2.95, df = 29, p less than 0.01) for discards of four times the catheter dead space volume, whereas no statistically significant difference was found between the arterial and venous APTT values (t = 2.62, df = 28, p greater than 0.01) for discards of six times the dead space volume.(ABSTRACT TRUNCATED AT 250 WORDS)