Needs of adult family members of intensive care unit patients.

AIMS AND OBJECTIVES: The purpose of this research was to examine current perceptions of adult family members' needs of intensive care unit patients in the Midwest, USA. Examining family needs may help determine effectiveness of guideline implementation. BACKGROUND: Family needs of intensive care unit patients is a topic widely researched, but to date, the application of that research to the clinical practice guidelines is limited. Family members' of intensive care unit patients often experience stress and anxiety because of the high mortality rate of patients in intensive care. Family members are often involved with the patient's care especially as many units have open visitation policies. DESIGN: Survey. METHOD: The Critical Care Family Needs Inventory was distributed to a convenience sample of 50 family members from a Central Illinois, not-for-profit, 22-bed intensive care unit in the USA. RESULTS: Forty-five adult family members returned completed questionnaires. The majority of the sample was female (66·7%), 40% were 49-64 years old. The majority of the sample of family members was spouses (36%) or adult children (36%). Eighty per cent of these family members reported they had previously visited a patient in the intensive care unit. Results of the survey revealed family members perceived assurance as the highest needs categories and support as the least important need. CONCLUSIONS: Findings were consistent with earlier studies identifying assurance as a very important need. After publication of clinical practice guidelines for support of the family in the patient-centred intensive care unit, families continue to report the need for assurance. RELEVANCE TO CLINICAL PRACTICE: Nurses need to give increased attention to effectively implementing clinical practice guidelines in an effort to meet family members' needs, especially those related to assurance. Assurance may be expressed differently by various cultures.

Why is end-of-life care delivery sporadic?: A quantitative look at the barriers to and facilitators of providing end-of-life care in the neonatal intensive care unit.

PURPOSE: According to the Centers for Disease Control and Prevention Infant Mortality Statistics, 28 384 infants died in the United States in 2005. On examining the state of the science in providing end-of-life care for newborns, it is important to examine the practice of providing compassionate and dignified palliative care at the end of life. The purpose of this research study was to examine the barriers to and facilitators of providing a quality end-of-life care in one large Midwestern tertiary NICU. SUBJECTS: A convenience sample of 50 NICU registered nurses from a Level III Midwestern Facility participated. METHODS: A quantitative, prospective, cross-sectional design was used. Data were collected with the Neonatal Palliative Care Attitude Scale questionnaire. RESULTS: Five barriers and 8 facilitators to end-of-life care practice in the NICU were identified. The 5 barriers were the nurses' inability to express opinions values and beliefs regarding palliative care (M = 2.98, SD = 1.30), less than ideal physical environment (M = 2.70, SD = 1.31), technological imperatives (M = 3.22, SD = 1.11), parental demands (M = 3.46, SD = 1.07), and, finally, lack of education (M = 2.86, SD = 1.44). The 8 facilitators were supportive medical staff (M = 3.60, SD = 1.29), parental involvement of decisions (M = 3.76, SD = 1.17), parents informed of options (M = 3.32, SD = 1.22), support from medical team when palliative care is implemented (M = 3.20, SD = 1.28), staffing (M = 3.60, SD = 1.29), time spent with dying baby (M = 3.52, SD = 1.31), policies/guidelines supporting palliative care (M = 3.76, SD = 1.19), and available counseling (M = 3.566, SD = 1.26). CONCLUSIONS: Barriers and facilitators continue to exist within neonatal end-of-life care. There is significant importance for NICU nurses to recognize and understand the barriers to and facilitators of providing end-of-life care within their specific unit. Further research is warranted regarding implementation of end-of-life care education in the NICU to improve patient care.

Analysis of academic programs: comparing nursing and other university majors in the application of a quality, potential and cost model.

Nursing is often considered expensive in the cost analysis of academic programs. Yet nursing programs have the power to attract many students, and the national nursing shortage has resulted in a high demand for nurses. Methods to systematically assess programs across an entire university academic division are often dissimilar in technique and outcome. At a small, private, Midwestern university, a model for comprehensive program assessment, titled the Quality, Potential and Cost (QPC) model, was developed and applied to each major offered at the university through the collaborative effort of directors, chairs, deans, and the vice president for academic affairs. The QPC model provides a means of equalizing data so that single measures (such as cost) are not viewed in isolation. It also provides a common language to ensure that all academic leaders at an institution apply consistent methods for assessment of individual programs. The application of the QPC model allowed for consistent, fair assessments and the ability to allocate resources to programs according to strategic direction. In this article, the application of the QPC model to School of Nursing majors and other selected university majors will be illustrated.

Ethnopharmacology: understanding how ethnicity can affect drug response is essential to providing culturally competent care.

Ethnopharmacologic research has revealed that ethnicity significantly affects drug response. Genetic or cultural factors, or both, may influence a given drug's pharmacokinetics (its absorption, metabolism, distribution, and elimination) and pharmacodynamics (its mechanism of action and effects at the target site), as well as patient adherence and education. In addition, the tremendous variation within each of the broader racial and ethnic categories defined by the U.S. Census Bureau (categories often used by researchers) must be considered. Nurses need to become knowledgeable about drugs that are likely to elicit varied responses in people with different ethnic backgrounds, as well as the potential for adverse effects. The existing ethnopharmacologic research focuses primarily on psychotropic and antihypertensive agents, as does this article. Cultural assessment of every patient is vital; thus Leininger's Sunrise Model and Giger and Davidhizar's Transcultural Assessment Models are briefly described as well.

Ethnopharmacology.

Ethnopharmacologic research has revealed that ethnicity significantly affects drug response. Genetic or cultural factors, or both, may influence a given drug's pharmacokinetics (its absorption, metabolism, distribution, and elimination) and pharmacodynamics (its mechanism of action and effects at the target site), as well as patient adherence and education. In addition, the tremendous variation within each of the broader racial and ethnic categories defined by the U.S. Census Bureau (categories often used by researchers) must be considered. Nurses need to become knowledgeable about drugs that are likely to elicit varied responses in people with different ethnic backgrounds, as well as the potential for adverse effects. The existing ethnopharmacologic research focuses primarily on psychotropic and anti-hypertensive agents, as does this article. Cultural assessment of every patient is vital; thus Leininger's Sunrise Model and Giger and Davidhizar's Transcultural Assessment Models are briefly described as well.

Building transcultural knowledge through intercollegiate collaboration.

Although the importance of providing culturally congruent care is widely recognized among nurses, many nurses lack the skill and knowledge necessary to successfully provide culturally competent care. Nursing programs need to better prepare students in transcultural nursing. This article describes an innovative collaborative learning activity that was implemented between two different nursing programs in different states aimed at improving students' transcultural knowledge. Students worked in small groups and used the Internet to collaborate on case studies that focused on transcultural health care issues. Responses collected by anonymous evaluations at the end of three semesters identified both strengths and weaknesses of the project. Results and suggestions for improvement are reported.