The NEECHAM Confusion Scale: construction, validation, and clinical testing.

This article reports the development of the NEECHAM Confusion Scale for rapid and unobtrusive assessment and monitoring of acute confusion. The scale was tested in two samples (N = 168 and 258, respectively) of elderly patients hospitalized for acute medical illness. Internal consistency and interrater reliability of the instrument were found to be high. The NEECHAM correlated well with the Mini-Mental State Examination and the sum of DSM-III-R positive items. Factor analyses identified and confirmed cognitive/behavioral and physiological domains. The NEECHAM provides a valid and reliable bedside assessment of acute confusion, particularly at its onset and in patients with "quiet" manifestations.

Barriers and facilitators of research utilization. An integrative review.

For over 20 years, nursing literature has discussed the gap between the conduct of research and the use of its findings to improve practice. Factors relating to the nurse, the setting, the research, and the way research is presented have been identified as barriers to research utilization. A combined approach that includes specialty organizations that take the lead in knowledge synthesis and dissemination, the creation of national on-line databases, and enhanced institutional supports and educational efforts is recommended.

Research utilization: reconnecting research and practice.

Barriers to the use of research in practice include problems with the availability of research, the manner in which it is presented, and the use of the research. They also include barriers in the setting and "shortcomings" of individual nurses. Most approaches to increasing research utilization have focused on the "shortcomings" of clinicians. A more useful approach is to make changes in both education and practice to rejoin researchers and clinicians and to reconnect the conduct and use of research.

Teaching cardiovascular assessment.

This article describes a learning module for teaching heart sound recognition and summarizes results of two studies testing the learning module. The module, built around a heart sound simulator, was effective with both graduate nursing students (n = 37) and experienced critical care nurses (n = 40). In each study, recognition of heart sounds improved significantly, and the knowledge gained was retained for at least 2 weeks.

Heart sound simulation: how useful for critical care nurses?

Forty critical care nurses participated in a 2-hour teaching program using a heart sound simulator to increase skill in recognition of heart sounds. Mean test scores increased 10 points from the pretest to the first posttest (t = 11.9, p = 0.0001), and this increase was maintained on the second posttest 3 weeks later. Medical intensive care unit and coronary care nurses scored higher than the other critical care nurses. There was a low correlation between recognition of sounds and years of critical care experience. The correlation between the subjects' self-rating of knowledge of heart sounds and their actual skills was also low. These findings suggest that a similar teaching program might be useful for critical care nurses.

Use of a heart sound simulator in teaching cardiac auscultation.

The use of a heart sound simulator in teaching recognition of heart sounds was tested in 37 graduate students. Subjects were randomly divided into two groups; one group received both auditory and tactile cues and the other group received only auditory cues. Students were tested at three times: (1) before use of the simulator, (2) after a short teaching session using the simulator, and (3) 2 weeks later. Recognition of heart sounds increased significantly after the teaching session with the simulator, and this knowledge was retained. There was no difference in sound recognition between the two groups.

Nutritional support in the critically ill elderly patient.

Optimal recovery of the critically ill elderly patient depends on an adequate nutritional state. Preventing and treating malnutrition is fundamental to the provision of good patient care, yet providing nutritional support to the critically ill elderly is challenging. Health care has not reached the state of sophistication in which a few simple rules suffice. Many of the current assessment techniques, diagnostic standards, and guides for intervention are based on studies of the young and middle aged. As the critically ill elderly population continues to grow, more specific assessment parameters need to be identified so that the elderly person's response to different nutritional therapies will be understood better. Carefully documented and published case studies will enrich the understanding of nutritional support in this vulnerable group of patients.