Nurses' narratives of outcomes after delegation to unlicensed assistive personnel.

Although unlicensed assistive personnel (UAP) have been a part of health care teams for decades, today's UAP are assisting in the care of more acutely ill clients who are being discharged after shorter hospital stays. This qualitative study examined nurses' narratives of patient outcomes after delegation of activities to UAP and identified the factors leading to the outcomes.

Nurses' beliefs about their abilities to delegate within changing models of care.

Changing models of nursing care have resulted in a more diverse work force composition. Nurses (RNs and licensed practical and vocational nurses) have greater responsibilities for delegation and supervision of unlicensed assistive personnel providing direct nursing care. This study describes nurses' beliefs about their abilities to delegate and supervise direct nursing activities and explores differences based on professional and job-related factors. A national sample of 148 licensed nurses working in three practice settings was surveyed. In general, nurses reported a high level of comfort, frequency, preparedness, confidence, competence, and control. Differences found in nurses' beliefs were based on education, practice setting, and type of work responsibilities.

Factors influencing outcomes after delegation to unlicensed assistive personnel.

The authors discuss a national survey of licensed nurses that describes factors associated with patient outcomes when nursing activities are delegated to unlicensed assistive personnel (UAP). Licensed nurses' overall experience and UAP's experience in the current work setting were associated with more positive events. When the outcome of the delegated activity was determined by routine observation, more positive events occurred. However, when there was no direct supervision of the UAP, more negative events occurred. Recognition of the importance of the supervisory process has implications for educational opportunities that focus on strengthening licensed nurses' delegation competencies.

Research instrumentation and elderly subjects.

PURPOSE: To address instrumentation problems in conducting research with elderly subjects. SCOPE: The needs of older adults are considered with regard to instrument selection. Techniques for pretesting instruments are provided through illustrations from research reports and instrument development. Types of instruments are evaluated for use with older adults and methods for strengthening their applicability are provided. SIGNIFICANCE: Instrument development is sorely needed in gerontological research. Many of the instruments currently used to study elderly subjects lack adequate testing for applicability with old and very old populations. Knowledge about instrumentation can help researchers choose appropriate instruments for elderly subjects and strive to balance subject capacity and the demands of research. CONCLUSIONS: Four factors for consideration in selecting research instruments for use with older adults include subject (a) fatigue, (b) anxiety, (c) ethnic background, and (d) education. These factors are not adequately addressed in the current literature. Certain types of instruments may be more useful than others in studying the elderly.

Conceptualization of perceived enactment of autonomy in the elderly.

The eudaemonistic model of health is congruent with nursing's primary aim of practice and nursing's ethical imperative to support client autonomy. Although autonomy has been linked to holistic health, the definition of autonomy has been imprecise. This is especially problematic when working with the elderly. For clarification, a concept analysis of autonomy was completed. This led to further refinement and development of a new concept, perceived enactment of autonomy. This definition represents the subjective perceptions of the ability to act autonomously. Interventions derived from the nursing theory, Modeling and Role-Modeling (Erickson et al., 1983/1988), and supportive of perceived enactment of autonomy and environments conducive to healing within the eudaemonistic health paradigm are proposed.