Supporting and Empowering Nurses Undergoing Critical Care Certification.

PURPOSE: Nurses working in critical care settings face multiple sources of stress, such as complex clinical situations and the use of new advanced technologies, which can affect their psychological health. Literature suggests that the promotion of educational activities, such as a certification process within a specialty, can contribute to nurses' empowerment, professional growth, and personal satisfaction. However, it is of utmost importance that the institutional organizations support nurses undergoing the certification process to optimize positive impacts of this educational activity on the nurses, on the patients, and within the institutions. DESCRIPTION OF THE PROJECT: In the course of a graduate studies stage, an educational program aiming at supporting and creating an empowering environment for nurses undergoing a critical care certification process was developed and implemented, in a Canadian intensive care unit, over a 7-month period. The Humanist model was used as a theoretical framework and was complemented by the problem-based learning pedagogical approach. OUTCOMES: A postintervention qualitative questionnaire revealed that the program was tailored to nurses' learning needs and that participants felt supported by their institution throughout the process. CONCLUSION: This program could help institutions support nurses in achieving higher professional and personal development levels through specialty certification.

Journal club in a critical care unit: an innovative design triggering learning through reading and dialogue.

Journal club has been used for decades to incorporate reading clinical and research articles into professional practice of numerous health care providers to disseminate knowledge and to bridge the gap between research and clinical practice. In this article, the authors describe how such activity was implemented by and for the nursing team of an intensive care unit. This journal club was designed to trigger dialogue among the nurses related to cardiac surgery topics, while providing an organizational support for them aimed to facilitate the incorporation of reading in their professional habits. More specifically, the design of this journal club was intended to create an opportunity for these nurses to keep their practice updated, to review physiological or pathological processes related to the cardiac surgery population, and to explore if how and why the results described in those research reports should be implemented in their own intensive care unit. The authors describe the phases of this project: the co-development of the journal club, the implementation of the activity and its results. The authors detail how this journal club format incorporated additional teaching aids during each session and used narrative pedagogy as a conceptual framework.

A clinical nurse specialist intervention to facilitate safe transfer from ICU.

PURPOSE/OBJECTIVES: The purpose of this article was to describe an innovative quality initiative implemented by the clinical nurses specialist in medicine to facilitate the transition process between the intensive care unit and the medical wards. BACKGROUND/RATIONALE: Safely transferring patients with complex health conditions from an area of high technology and increased monitoring, like the intensive care unit, to an area with lower nurse-to-patient ratio is an intricate process. The care of these patients, once transferred, also requires varying levels of expertise. As indicated in the nursing literature, this type of transition is often associated with high stress levels for the patient and family, as well as for the healthcare providers. To maximize patient safety and ensure optimal care for this patient population, well-defined mechanisms must be put in place. DESCRIPTION OF THE PROJECT/INNOVATION: The introduction of a formal assessment, consultation, and follow-up process conducted by a clinical nurse specialist (CNS). OUTCOMES: On average, 150 patients are assessed each year by the CNS. Among these patients, 15% are considered at high risk for complications upon transfer to the unit. INTERPRETATION/CONCLUSION/IMPLICATIONS: A systematic evaluation of patients by the CNS, before their transfer from the ICU to a medical unit, has been proven beneficial in ensuring a comprehensive patient care plan. Patients and families have verbalized that this intervention is helpful. Staff members have indicated that this safety initiative is useful in planning patient transfers. The next step would be to formally measure patient, family, and staff satisfaction with this initiative.

Development and implementation of the specialized nurse practitioner role: use of the PEPPA framework to achieve success.

In 2003, amendments to the Nurses' Act in Quebec, Canada, allowed for an expanded nursing role. Specialized nurse practitioners were introduced to the health-care system in 2005. By merging medical knowledge with advanced practice nursing, the specialized nurse practitioner is gaining in popularity and acceptance with staff members and patients. To guide our team through the process, we used the PEPPA (participatory, evidence-based, patient-focused process for guiding the development, implementation, and evaluation of advanced practice nursing) framework. By using a framework specifically designed for the development, implementation, and evaluation of an advanced practice nursing role, we were better prepared for the path that lay ahead. Ultimately, the goal of the implementation of the specialized nurse practitioner role is to improve the quality of care to a specific population of patients, whether it is through individualized clinical follow-up, evidence-based practice, patient teaching, or promoting continuous education for the nurses.

Knowledge level and coping strategies according to coagulation levels in older persons with atrial fibrillation.

The present study examined the knowledge level and the coping strategies of older persons with atrial fibrillation, who were on oral anticoagulant therapy. The relationship among knowledge level, problem and affective-oriented coping strategies, and the level of anticoagulant effectiveness were examined. We also compared differences between subjects who were within a therapeutic range for International Normalized Ratio levels with those who were not. The research design was descriptive and correlational. One hundred older persons completed the Jaloweic Coping Scale (a knowledge questionnaire) and socio-demographic, contextual and clinical characteristic questions. The findings suggested that the knowledge levels were low (53%), and problem-oriented coping strategies were most often used (32.62%) compared to affective-oriented coping strategies (18.96%). Other than praying and putting one's trust in God (P = 0.05), it appeared that no other significant coping strategies differentiated the subjects regarding their level of anticoagulant effectiveness. It is recommended that further examination of the reasons for older persons' low knowledge level, in regard to their oral anticoagulant therapy, occurs and that use of problem-oriented coping strategies, to improve self-care measures, be encouraged.