Improving critical thinking in nursing practice.

Nurse educators and practicing nurses agree that the complexity of health care demands critical thinking skills. In this article, the author describes critical thinking and its development both as knowledge based and practice bound. Included are strategies nurses can use to further develop critical thinking skills. Case scenarios are presented for educators to consider in promoting nurses' reflection and clinical reasoning skills in their practice settings.

Clinical reasoning strategies used during care planning.

This descriptive study provides insight into home health nurses' thinking processes as they planned care for chronically ill clients. The author interviewed five experienced home health nurses to elicit think-aloud data about 10 different chronically ill clients, obtaining 20 interviews. The researcher used verbal protocol analysis, a content analysis interpretive strategy, to unravel the concepts and label the cognitive processes used in the thinking task of planning nursing care. The following cognitive strategies were discovered: hypothesizing, cue logic, framing, reflexive comparison, prototype case reasoning, and testing. Findings support the importance of content, clinical context, and experience whenever reasoning to plan care. Findings did not support problem-solving models of thinking such as the nursing process. The findings for this study are applicable to staff development and education programs. Theoretical models of clinical reasoning need to be further developed and tested.

The use of an autochromatic tuner for the measurement of vocal fundamental frequency.

Comparative measures of vocal fundamental frequency were made with three different instruments, the Visi-Pitch. FLORIDA 1, and a Korg Autochromatic Tuner. The purpose of these measures was to determine whether an autochromatic tuner, a relatively inexpensive device designed to assist musicians in fast-tuning their instruments, would provide a valid and reliable measure of vocal fundamental frequency. Subjects for this study included 15 males and 15 females. They were recorded while sustaining vowels, reading a phonetically balanced passage, and singing to their lowest and highest pitch levels. Spearman's Rho correlations indicated that measures taken with the autochromatic tuner significantly correlated with measures taken with the other instruments. Results indicate that the use of an autochromatic tuner to measure vocal fundamental frequency is an effective and inexpensive alternative to other methods for clinical purposes.

Vestibulo-ocular and vestibulospinal function before and after cochlear implant surgery.

Vestibular function in cochlear implant candidates varies from normal to total absence of function. In patients with intact vestibular function preoperatively, invasion of the otic capsule places residual vestibular function at risk. Speech-processing strategies that result in large amplitude electrical transients or strategies that employ high amplitude broad frequency carrier signals have the potential for disrupting vestibular function. Five patients were tested with and without electrical stimulation via cochlear electrodes. Two patients experienced subjective vestibular effects that were quickly resolved. No long-term vestibular effects were noted for the two types of second generation cochlear implants evaluated. Histopathological findings from another patient, who had electrically generated vestibular reflex responses to intramodiolar electrodes, indicated that responses elicited were a function of several variables including electrode location, stimulus intensity, stimulus amplitude, and stimulus frequency. Differential auditory, vestibulocolic, and vestibulospinal reflexes were demonstrated from the same electrode as a function of stimulus amplitude, frequency, and duration.

Surgical evaluation of candidates for cochlear implants.

The customary presentation of surgical procedures to patients in the United States consists of discussions on alternative treatment methods, risks of the procedure(s) under consideration, and potential benefits for the patient. Because the contents of the normal speech signal have not been defined in a way that permits a surgeon systematically to provide alternative auditory signals to a deaf patient, the burden is placed on the surgeon to make an arbitrary selection of candidates and available devices for cochlear prosthetic implantation. In an attempt to obtain some information regarding the ability of a deaf patient to use electrical signals to detect and understand speech, the Good Samaritan Hospital and Neurological Sciences Institute cochlear implant team has routinely performed tympanotomies using local anesthesia and has positioned temporary electrodes onto the round windows of implant candidates. The purpose of this paper is to review our experience with this procedure and to provide some observations that may be useful in a comprehensive preoperative evaluation for totally deaf patients who are being considered for cochlear implantation.