A collaborative research utilization approach to evaluate the effects of pain management standards on patient outcomes.

The generation of research-based knowledge is incomplete unless it reaches clinicians at the point of care. Despite major advances in clinical research related to pain management, inadequate pain relief has become a significant quality issue in hospitalized patients, which has created an imperative for research-based pain management. Using a collaborative research utilization model, multidisciplinary academic scientists were paired with clinicians and undergraduate and graduate students to form a partnership that (1) examined the research base in pain management, (2) generated a research-based standard for pain management, and (3) evaluated the effect of that standard on four patient outcome variables in a 230-bed teaching hospital. A 2-group, pretest-intervention-posttest, quasi-experimental clinical trial composed of 173 surgical and oncology subjects was conducted. Subjects whose caregiver used the new standard had less pain during their hospital stay, less interference by pain with quality-of-life indicators, and greater satisfaction with the interventions used as well as caregiver responsiveness to their pain. Interestingly, each of these improvements decreased after their discharge home. These results strongly suggest the need for better postdischarge preparation for pain management and for further development and testing of pain management standards in postdischarge settings. They also provide the basis for extending the model to address other situations in which there is a lag between the promising results of empirical research and their integration into practice.

Using a collaborative research utilization model to develop and test the effects of clinical pathways for pain management.

The article reports a study that tested a practical multidisciplinary approach to address the prevailing research-to-practice gap in pain management. By means of a collaborative research utilization model, academic scientists and students from two affiliating colleges of nursing were paired with clinicians from medicine, nursing, social work, pastoral care, and physical therapy to form three partnerships to develop and evaluate 14 pain management clinical pathways. Results showed that patients whose caregiver used the pathways had less pain across their hospital stay, less interference by pain in nearly all quality of life indicators, and greater satisfaction with caregiver responsiveness to their pain. Each of these improvements reversed after discharge, however.

Changing nurses' pain assessment practice: a collaborative research utilization approach.

It is not uncommon for a decade to pass between the time a research problem is identified and the time that research-based solutions are translated into standards for care. This quasi-experimental study demonstrated the effectiveness of a collaborative research utilization model directed towards the transfer of specific research-based knowledge (pain assessment) into practice for the purpose of helping to solve pain management problems. At the same time, nurses who participated in the model significantly improved their competency in research utilization and their attitudes towards research when compared to a control group who did not participate in the model.

A statewide consortium initiative to establish an undergraduate clinical internship program.

The amount of time and the type of experience needed by undergraduate students in the clinical setting to actually practice nursing has been the subject of many debates between nurses in academe and service. Rather than blaming each other for the culture shock and transition problems of neophyte nurses, members of the academic and practice community in Rhode Island decided to address the problem together. The development of the collaborative program described in this article grew out of a research study and was coordinated through the efforts of nurses from service and academe. The central outcome of this statewide consortium's project was to increase the students' level of nursing competencies. "Turf" issues that related to the colleges and the hospitals involved became secondary. Everyone involved believed that students from different collegiate programs working together presented exciting opportunities to share and learn from one another. In addition, other outcomes included increased recruitment and retention of these baccalaureate-prepared nurses in the hospitals, and greater ease in their orientation and transition. In addition, a cluster of three research studies were conducted by members of the consortium. This ongoing program, in which nurses in education and service are working together in a statewide consortium to break down the turf issues that separated them, is achieving outcomes that could not have been accomplished had it been undertaken independently. This article describes the process used to develop, implement, and evaluate such a program.(ABSTRACT TRUNCATED AT 250 WORDS)

Personal and work-milieu resources as variables associated with role mastery in the novice nurse.

The purpose of this study was to explore the relative contribution of eight independent variables in explaining novices' perceived variation in role mastery 3 months following their appointment. The study sample included 75 novice graduate nurses in a large tertiary teaching hospital. A correlational design using the multivariate procedure of step-wise multiple regression was used. On day one of orientation, the Schwerian Six-Dimensional Scale of Nursing Performance was administered to the novices, their preceptors, and head nurses. To obtain a measure of the nursing unit's collective expertise, its job satisfaction, and its role socialization, nurse educators rated their units using the Nursing Practice Group Role Mastery Assessment Scale. Participation in bicultural training was documented by attendance. Three months later, the novices were posttested using the Schwerian Scale as the criterion variable. Of the eight potential explanatory variables, only four entered the regression equation, explaining 40% of the variance (p less than .05). These were: entry-level role mastery, the nursing unit's collective expertise, its job satisfaction, and its role socialization. Interestingly, the head nurse's role mastery, and the three interventions used to address role transition problems were not predictors. Also, specific competency weaknesses in novices paralleled their experienced peers in the areas of assessing priorities, written communication, and skills salient to discharge planning.

Changing the locus of control of registered nurse students with a futuristic-oriented course.

Locus of Control research has established that college students are becoming more external, and that internality is preferable. If an external locus of control is associated with poor self-esteem, alienation, depression, and "burn out" in nurses as it is with other individuals, then we need to reverse this trend. Lefcourt (1976) tells us that in the future, methods fostering internality will be crucial. Toffler (1980) says that to break out of the rigid mentality of the Second Wave, future-oriented nurses must be self-responsible. Self-responsible, internally controlled practitioners will enable themselves and the nursing profession to grow as they will anticipate and participate in the selection of the knowledge, skills, and characteristics they need to grow. The purpose of this study was to determine if a course which explores the transition into a futuristic-oriented professional nursing role would move registered nurse students in a baccalaureate program toward stronger internality. A basic pretest-intervention-post test experimental design was used and results of an analysis of covariance significantly determined the efficacy of the course in encouraging greater internality, F (3,60) = 49.55, p less than .0001.