Facilitating scholarship among clinical faculty.

This article describes an evolving model of clinical scholarship for clinical-track faculty. Contemporary literature regarding scholarship emphasizes broader definitions of scholarship among university faculty, usually with an implicit focus on university faculty with doctoral degrees. Discussions of clinical scholarship focus on scholarship projects with clear application to improved patient care. Clinical-track faculty in university settings serve as exemplars of professional nurse clinicians for their students and for community-based colleagues, and also participate in university life as full faculty. Furthermore, scholarship for clinical faculty is consistent with their participation as academic scholars and as clinical scholars. An important strategy for fostering scholarship among clinical faculty in one school was the creation of a position, Director of Clinical Scholarship, with responsibilities for strengthening organizational support for scholarship activities among clinical-track faculty. Examples of activities and resources designed to foster scholarship are presented, along with preliminary evaluation of scholarship activities of clinical-track faculty. J Prof Nurs 17:141-146, 2001.

Community-based nursing education and nursing accreditation by the Commission on Collegiate Nursing Education.

The purpose of this article is to describe the application of accreditation standards of the Commission on Collegiate Nursing Education (CCNE) in community-based nursing education. In response to changes in the health care delivery system, involving increased implementation of managed care systems, greater use of outpatient services, and increased care provided in community-based settings, baccalaureate nursing education is changing to incorporate student learning experiences in community-based settings. Community-based nursing care is characterized by the development of community-education partnerships, implementation of nursing interventions for prevention and health promotion, and collaboration to ensure continuity of care. Changes in the delivery system to increase community-based care necessitate changes in professional nursing education to ensure that graduates of baccalaureate nursing programs are prepared to practice in community-based settings. Accreditation is a mechanism to evaluate quality in educational programs. Accreditation by CCNE offers a process for assessing the quality of nursing programs while encouraging flexibility and innovation in those programs. The CCNE accreditation standards can be interpreted in the context of community-based education. Descriptions of the CCNE standards and examples of application of the standards in community-based nursing education are included.

Issues in conducting intervention research in long-term care settings.

Originally we proposed a straightforward experimental design using quantitative data to test a series of hypotheses about how changes in the mealtime context and mealtime interactions would influence self-feeding behaviors and imposed disability. The design was clean and the interventions carefully delineated. We used a number of strategies for reducing threats to internal validity, some of which worked and some of which did not. Many of the problems we encountered in operationalizing this clinical experiment arose, not from the particular environment in which we worked, but from the nature of long-term care settings and the staffing patterns within those settings. To some degree, the problems we encountered are inherent to field experimentation in nursing in general. Often field experiments are reported as if no problems arose in implementation, yet no study is problem free. We believe acknowledging and understanding some of the sources of field noise in field experiments are almost as important as understanding the results of the study itself. The field noise is an indispensable part of the results.

Nursing intervention to promote functional feeding.

Results of this study suggest that specific nursing protocols can be designed to promote functional feeding for demented elders in nursing homes while enhancing the mealtime environment for both the demented elders and their caregivers. By nurses altering the feeding environment (context) alone, subjects received more food and drink, refused less food and showed more self-feeding. Major findings were that subjects demonstrated increased independence by refusing food more often and initiating self-feeding more frequently.

Nursing diagnoses and functional health patterns in patients receiving external radiation therapy: cancer of the digestive organs.

A descriptive study using clinical methodology was conducted to identify and describe core and site-specific symptoms reported by 15 patients with cancer of the digestive organs who received external radiation therapy. A 47-item Radiation Symptom Scale was designed by the investigators for this study. Symptoms identified by patients with a mean occurrence of at least "sometimes" were considered potential defining characteristics and were submitted to a panel of experts for identification of nursing diagnoses. Seventeen nursing diagnoses, with their associated defining characteristics, were identified and classified within eight Functional Health Patterns (FHP). Half of the nursing diagnoses were formulated within the Nutritional-Metabolic and Elimination patterns. Four of the FHPs were related to primarily functional patterns; four were primarily psychological-behavioral. Results of the study describe the nursing needs of patients who receive radiotherapy to the digestive organs.

Measurement of mealtime interactions among persons with dementing disorders.

Difficulty in eating and refusal to eat are common problems for severely demented persons. Feeding can be one of the most frustrating and complex daily tasks performed by caregivers of demented elders in institutional settings. This paper describes the development of a new method for measuring caregiver-elder feeding activities and interactions--the Feeding Traceline Technique (FTLT). The FTLT, which involves both the transcription of videotape recorded data and the coding of data for computer input, is designed to account for all mealtime behaviors of both feeders and elders, to account for the cyclic and repetitive nature of eating and to permit quantification of complex interactions between feeders and institutionalized residents. Data describing the reliability and validity of the method are presented. Issues discussed relate to the units of analysis, the time and energy expenditure of the method in comparison to the yield of information, and the effect of videotaping on measurement.

Feeding nursing home residents with Alzheimer's disease.

The purpose of this exploratory, descriptive study was to identify and categorize the behaviors of caregivers and residents that elicit, sustain, or extinguish feeding. Although preliminary analysis yielded initial categories, mutually exclusive categories were difficult to distinguish. Relationships among identified cues and specific feeding behaviors are being examined in further analysis. The relationship between specific feeding behaviors and the environmental context of feeding is also being examined. The goals of studying feeding behaviors in nursing home residents with Alzheimer's disease are to enhance mealtime for both residents and caregivers and to encourage functional feeding behavior as much as possible. Identification of behaviors that elicit, sustain, and extinguish functional feeding can facilitate development of behavioral and environmental nursing interventions to promote functional feeding.

Nursing diagnoses and functional health patterns in patients receiving external radiation therapy: cancer of the head and neck.

A descriptive study using clinical methods was conducted to identify and describe core and site-specific symptoms reported by 15 patients with cancer of the head or neck who received external radiation therapy. A 45-item Radiation Symptom Scale (RSS) was designed by the investigators for this study. Symptoms identified by patients with a mean occurrence of at least "sometimes" were considered potential defining characteristics and were submitted to a panel of experts for identification of nursing diagnoses. Eighteen nursing diagnoses with their associated defining characteristics were identified and classified within eight Functional Health Patterns. Half of the nursing diagnoses were formulated within the Nutritional-Metabolic and Activity-Exercise health patterns. Four of the health patterns were primarily physiologic; four were primarily psychologic-behavioral. Results of the study describe the nursing needs of patients who receive radiotherapy to the head and neck and are formulated within a nursing diagnosis/Functional Health Pattern framework. These findings have implications for nursing assessment, nursing interventions, and evaluation of patient outcomes, and findings provide a beginning empiric basis for identifying nursing diagnoses and their associated defining characteristics for cancer patients who receive external radiation therapy.

Microteaching: developing tomorrow's teachers.

Microteaching is a technique for developing teaching skills. The authors report a study that assessed graduate students' perspectives of a microteaching experience. Information is provided to help current and potential faculty members to improve their teaching skills through microteaching.

Home health care--providing a missing link.

1. If nurses are to provide the continuity of care that helps patients at home achieve expected patient outcomes, nurses must diagnose actual and potential health problems and design a plan of care. 2. Before patient outcomes can be identified, nurses must first recognize, assess, and describe the patient's defining characteristics. 3. The study found that nurses use a limited range of nursing diagnoses and incompletely document the care they give. 4. Results of the study indicated that nurses provide continuity of care between the hospital and home; there is also a need for home-based health care to provide support for elderly caregivers whose health is less than good.

Evaluating audio-visual and computer programs for classroom use.

Appropriate faculty decisions regarding adoption of audiovisual and computer programs are critical to the classroom use of these learning materials. The author describes the decision-making process in one college of nursing and the adaptation of an evaluation tool for use by faculty in reviewing audiovisual and computer programs.

Prospective payment and baccalaureate nursing education: projections for the future.

The implementation of a prospective payment system has had a profound effect on health care delivery in the United States. Providing realistic nursing experiences for baccalaureate students has become a challenge in the new arena of increased patient acuity, decreased length of patient stay in acute care settings, and increased use of home care services. The purpose of this study was to describe changes in the health care system and projected changes in baccalaureate nursing education associated with prospective payment. The descriptive survey design used a mail questionnaire to which deans or their designees from 186 National League for Nursing (NLN) accredited baccalaureate nursing programs responded. Outcomes of the study indicated specific health care delivery changes in all geographic areas and all types of institutions. Projected changes in nursing education included curriculum, teaching methods, and clinical learning experiences.

Developing a system for documenting teaching effectiveness.

Faculty evaluation in nursing education is becoming increasingly important as economic realities and accountability efforts hit higher education. Efforts to document teaching effectiveness in nursing are essential to demonstrate nursing education's accountability to the profession and the public it serves. The purposes of faculty evaluation and its interface with the institutional mission and program goals are discussed. Characteristics of effective teaching, evaluation models, and the effects of teaching styles and student learning styles are presented. Also, variables in the instructional setting and evaluation participants re discussed. Components of teaching effectiveness evaluation including student, peer, self, and administrative evaluation are described. Finally, input, outcome and process measures are presented as a model for teaching effectiveness evaluation and guidelines are provided to assist with the development of a system for documenting effective teaching in nursing.

Topical application of insulin in decubitus ulcers.

When a pilot study provided evidence that insulin may increase the rate of healing of decubitus ulcers, this study attempted to answer the question: Is topical insulin therapy an effective treatment regimen for decubitus ulcers? The experimental study utilized a two-group, before-after design. Twenty-nine geriatric subjects were randomly assigned to either the experimental or the control group. The single independent variable was the topical application of ten units of regular insulin (U.S.P.) twice daily. The dependent variable was the surface area of the decubitus ulcer measured in square millimeters. Rate of healing was defined as decrease in surface area over time. Data were also gathered on extraneous variables believed to influence the healing process. The F test was used to test the research hypothesis that experimental subjects would have an increased rate of healing. When comparison of group means on day seven and day 15 revealed no significant differences, the research hypothesis was rejected. Pearson product moment correlation procedures were utilized to determine if there were differences between extraneous variables and the rate of healing. Females healed significantly (p less than .05) more slowly than males. Also, there was a direct correlation between the number of days of treatment and the rate of healing.