Clinical Leadership: A Call to Action.

Clinical nurses are expected to assume leadership roles to enhance patient care and assure efficient work processes. Dimensions of clinical leadership and the essential knowledge and skills of the clinical leader are described.

Caregiver and nurse hopes for recovery of patients with acquired brain injury.

From the moment an adolescent with acquired brain injury (ABI) is admitted to the hospital, his or her caregiver develops hopes for the recovery and future of the patient; however, rehabilitation nurses have reported that these hopes are not always congruent with the nurse's observations of the adolescent's progression. The purpose of this study was threefold: (1) explore the caregiver's hope for recovery of his or her family member who has experienced an ABI, (2) compare the nurse's hopes for the patient with ABI to those of the caregiver, and (3) identify what caregivers and nurses do to maintain hope for recovery during the rehabilitation process. This qualitative study validated that in some cases there was a disconnect between caregivers' and nurses' hopes for recovery. Four themes related to the caregiver's maintenance of hope were identified: "the importance of family," "taking one day at a time," "knowing the patient better," and "spiritual strength brings me through." Enhancing the perceptual congruence between nurse and caregiver hope during rehabilitation will ultimately improve patient outcomes.

Nurses nurturing nurses: outcomes and lessons learned.

Retention of new graduate nurses is a challenge for acute care agencies. The Academy of Medical-Surgical Nurses sponsored a hospital-based formal mentorship program, Nurses Nurturing Nurses, for interested agencies. The outcomes and lessons learned from this project are presented.

Korean American mother and daughter communication on women's health topics.

The purpose of this study was to explore communication patterns about health behaviors and lifestyles between Korean mothers and daughters living in the United States. Demographic and general health information was also collected. Semi-structured interviews were conducted with nine Korean mother and daughter dyads. Korean mothers talked with their daughters about healthy diets and exercise but relied on daughters' schools to provide much of their daughters'health education information related to growth and developmental changes and women's health issues such as screening and HIV prevention practice. Intervention models to enhance mother/daughter health communication and to improve mothers' self care need to be investigated.

Nursing care of the person having bariatric surgery.

The increasing incidence of morbid obesity suggests that the quantity of bariatric surgical procedures will continue to multiply each year. Bariatric surgery has become an accepted approach to weight management with the additional benefit of resolution of several co-morbidities. However, quality nursing care and effective patient teaching are essential to achieve positive patient outcomes. Nursing care along the continuum of the bariatric surgical experience is key to positive outcomes for these patients. Throughout the process from selection for surgery to follow-up visits in the physician's office, the nurse can have a significant impact on the response of the patient and family to the surgical procedure. During the selection process, the nurse can explain the required diagnostic tests and their rationale and conduct a thorough medical history, informing the physician of pertinent information that might affect the patient's outcomes. Patient and family teaching begins at this stage with information about the peri-operative experience. Bariatric surgery results in a major lifestyle change for the patient. This change will evolve over time as weight is lost, and the patient adjusts to changes in eating patterns, body image, and the perceptions of others. The nurse should see that the patient has appropriate referral information for support services and should follow up to see that the patient and family availed themselves of these services. The patient's stay in acute care is usually very short. Clearly the patient and family need to go home with specific information about drinking/eating, caring for drainage tubes, skin and wound care, ambulation, self-care, and signs and symptoms that require medical attention. Nursing care should include written information and demonstrations of such activities as care of the wounds and drains. The nurse should assure that the patient leaves the hospital with a call number if questions arise at home. Ideally the nurse, patient, and family should have an opportunity for private education sessions prior to discharge. During the postoperative period, the nurse in the physician's office can serve as a source of information and a monitor of patient progress. Follow-up calls to patients and families after surgery are very helpful in determining the welfare of the patient, offering suggestions for managing the patient's care, and learning if any complications are developing. At the same time, the nurse can assess the psychological condition of the patient and his or her adjustment to a new way of living.

The effect of breast cancer screening messages on knowledge, attitudes, perceived risk, and mammography screening of African American women in the rural South.

PURPOSE/OBJECTIVES: To determine the effect of three types of breast cancer screening messages (positive/upbeat, neutral/cognitive, and negative/fear) on knowledge, attitudes, perceived risk for breast cancer, and mammography screening of African American women. DESIGN: Repeated measures intervention. SETTING: Three rural counties in the South. SAMPLE: 450 African American women aged 45-65 who had not received a mammogram in the past 12 months. METHODS: Following completion of pretest knowledge and attitude surveys, the women participated in a 60-minute breast health intervention session that included watching one of three videos with varied affective tones (positive/upbeat, neutral/cognitive, negative/fear). Data on knowledge, attitudes, perceived risk for breast cancer, and mammography screening were collected before, after, and 12 months following the intervention. MAIN RESEARCH VARIABLES: Knowledge, attitudes, perceived risk for breast cancer, and mammography screening. FINDINGS: No significant difference was found among video groups on mammography screening and knowledge of and attitudes about breast cancer over the three measurement periods. CONCLUSIONS: The affective tone of the educational videos did not make a difference in mammogram screening, attitudes, and knowledge of breast cancer screening. More women received a mammogram 12 months postintervention than prior to the intervention; however, the influence of the intervention on this outcome is uncertain. IMPLICATIONS FOR NURSING: Nurses and health communication experts should design interventions that foster positive attitudes, increase knowledge about breast cancer screening, and stimulate women to participate in breast cancer screening as outlined by the American Cancer Society. These interventions need to be done in the context of the cultural norms and the education levels of the target population.

Mentorship: a key to retention and recruitment.

Currently there is renewed interest in the selection of nursing as a career. As nursing education programs graduate more new nurses, the challenge is passed to the clinical agencies to provide an environment in which these novice nurses can flourish and remain engaged in providing quality nursing care. Mentorship programs are essential strategies to retain them in clinical practice as they begin their evolution as professional nurses.

Health related behaviors and cancer screening of lesbians: results of the Boston Lesbian Health Project II.

This paper reports data on health related behaviors and cancer screening from the Boston Lesbian Health Project II (BLHP II), a replication of a national survey of lesbians on a variety of health-related variables completed in 1987. The findings suggest that lesbians have increased their use of primary care, including routine physical examinations, pap smear screening for cervical cancer, and mammography for breast cancer, but that rates continue to be lower than would be expected for women in general. Younger lesbians in this sample smoked at high rates. Smoking rates continue to be of concern in other age groups, although they are lower than national data from women in general. BLHP II data confirm other findings that lesbians are more likely to drink alcohol and to drink more heavily than other women. Implications for health care of lesbians and future research with this population are discussed.

Mentoring managers.

The realities of the nursing shortage, high patient acuity, and high patient-nurse ratios present challenges for today's health care environment. The need for excellent nurse managers cannot be understated if patient care units are to function smoothly. Yet new nurse managers often do not receive the support they need to succeed. A mentor relationship offers them a nurturing and protective environment where they are supported as they encounter management challenges and can flourish as managers who make significant contributions to patient care.

Adult-health/medical-surgical nurses' perceptions of students' contributions to clinical agencies.

The nursing shortage and accompanying increase in nurses' workloads could suggest that the presence of nursing students on clinical units would further increase nurses' responsibilities. Counterbalancing this concern is the need to adequately prepare the next generation of dedicated and skilled nurses. The question arises as to whether nursing students are an asset or liability to clinical agencies.

Does certification status of oncology nurses make a difference in patient outcomes?

PURPOSE/OBJECTIVES: To test hypotheses that patients cared for by Oncology Certified Nurses (OCNs(r)) have superior outcomes compared to those cared for by noncertified nurses. DESIGN: Descriptive ex post facto. SETTING: A homecare agency in the midwestern United States. SAMPLE: 20 nurses (7 certified and 13 noncertified) and charts for 181 of their patients. METHODS: Retrospective chart review. MAIN RESEARCH VARIABLES: Symptom management (i.e., pain and fatigue), adverse events (e.g., infection and decubitus ulcers), and episodic care utilization (e.g., visits to care facilities, admissions to care facilities, unscheduled home visits). FINDINGS: Contrary to hypotheses, the two groups did not differ with respect to assessment of pain at admission, number of pain assessments subsequent to admission, assessment of fatigue at admission, number of unplanned visits to care facilities, admissions to care facilities, and number of unscheduled home visits. As hypothesized, the OCNs(r) documented a higher number of postadmission fatigue assessments (p less than 0.05). Contrary to hypotheses, patients of OCNs(r) had a greater number of infections and fewer documented instances of patient teaching regarding infection. CONCLUSIONS: Little support was found for the hypothesis that nursing care by OCNs(r) results in superior patient outcomes in comparison to care by noncertified nurses. IMPLICATIONS FOR NURSING: Further research is needed to examine the dimensions of clinical practice that may demonstrate the benefits of care by OCNs(r).