Managing Health Care After Cancer Treatment: A Wellness Plan.

Many patients and health care providers lack awareness of both the existence of, and treatments for, lingering distress and disability after treatment. A cancer survivorship wellness plan can help ensure that any referral needs for psychosocial and other restorative care after cancer treatment are identified.

Integrating leadership and management content across the curriculum: a 3-course approach.

Leadership or management courses for undergraduate baccalaureate nursing students are often relegated to the last semester of study. The authors discuss how leadership and management constructs were integrated throughout the students' upper-division, 2-year nursing curriculum via 3 leadership/management courses. The purpose of this innovative leadership education model is to facilitate the acquisition of both leadership and management behaviors and provide opportunity for students to practice these skills in clinical settings. The authors describe the underpinnings of this model, exemplars of leadership and management principles used in this curriculum, and the barriers to implementing this curriculum.

Teaching undergraduate nursing research from an evidence-based practice perspective.

We revised the undergraduate nursing research course using levels of evidence as the template with which to organize the course content and learning activities. A primary purpose in restructuring the course using an evidence-based practice framework was to increase student interest and engagement, and to promote the development of practitioners who will continue to learn about and use research. Learning to systematically locate, evaluate, and use the best available research is the hallmark of evidence-based practice and quality improvement initiatives. Students developed these skills as they sought the answer to a specific clinical problem. One of the most significant outcomes of this approach was students' ability to integrate previously fragmented components of research knowledge and to see the relevance of research evidence for providing excellent patient care.

Can an alternative umbilical arterial catheter solution and flush regimen decrease iatrogenic hemolysis while enhancing nutrition? A double-blind, randomized, clinical trial comparing an isotonic amino acid with a hypotonic salt infusion.

OBJECTIVE: In the process of sampling blood through an umbilical arterial catheter (UAC), infant blood comes into stagnant contact with infusion solution in the "waste syringe" before being reinfused. We have previously demonstrated in vitro that this process is associated with less hemolysis of red blood cells (RBCs) with use of an isotonic solution compared with a hypotonic 0.25 normal saline (NS) solution. The objective of this study was to compare the in vivo effect on hemolysis of 2 UAC infusion/flush regimens (an isotonic regimen vs a hypotonic regimen) and to assess the early nutritional benefit of an amino acid solution as the isotonic UAC infusion solution. METHODS: Infants who had a birth weight of < or =1.5 kg and were expected to have a UAC for > or =3 days were enrolled within 24 hours of life into this prospective, double-blind, randomized, clinical trial of 2 UAC infusion solution/flush regimens. Power analysis demonstrated that 40 infants were needed to determine differences in hemolysis quantified by plasma-free hemoglobin (PFH) level. Nutrition from glucose was evaluated by measurement of daily dextrose calories. C-peptide was measured to evaluate endogenous insulin production. Adverse events and protein tolerance were tracked. RESULTS: Twenty-two infants (mean gestational age: 27 weeks; 945 g birth weight) were enrolled in each group, for an average of 4.2 days (range: 2.5-8 days). There were no group differences in demographics. PFH levels were lower for infants who received isotonic amino acid (IAA) in comparison with 0.25 NS (33 +/- 14 mg/dL vs 62 +/- 27 mg/dL, respectively). C-peptide was higher in those who received IAA, as were nonprotein calories received on days 4 to 6 of the study (51 +/- 11 kcal/kg/day vs 44 +/- 12 kcal/kg/day, IAA vs 0.25 NS, respectively). CONCLUSIONS: Lower PFH levels in IAA versus 0.25 NS group were consistent with our hypothesis of decreased hemolysis with an isotonic infusion/flush regimen. IAA use may also allow greater early glucose nutrition, as indicated by the higher level of endogenous insulin production and improved glucose tolerance. IAA seems to be a superior UAC solution to 0.25 NS in that it is associated with less hemolysis and improved nutrition.

Dual or dueling culture and commitment: The impact of a tri-hospital merger.

OBJECTIVES: This article addresses differences in RNs' commitment to their employing hospital versus the umbrella corporate organization, and the role of organizational culture during a tri-hospital merger. This study is the first to investigate the construct of dual commitment in healthcare organizations. BACKGROUND: Fiscal restraints, decreasing reimbursement, and increasing competition have made organizational mergers and acquisitions prevalent. As corporate culture changes, organizational variables previously related to organizational commitment may no longer apply. METHODS: RNs employed on general nursing units at 3 hospitals involved in a merger process completed 2 versions of Mowday's Organizational Commitment Questionnaire. Commitment to hospital and corporate system were examined. Semi-structured interviews, participant observation, and analysis of company documents assessed the organizational culture changes that have occurred. RESULTS: Thirty-one percent of the nurses returned completed questionnaires; 9 were interviewed. RNs from the acquiring hospital demonstrated a significantly stronger commitment to the corporate system than the nurses from the acquired hospitals. The RNs at all 3 hospitals showed significantly greater commitment to their own particular hospital than to the umbrella corporate system. CONCLUSIONS: Moderate level of commitment reflected uncertainty of job status, work overload, and feelings of unappreciation. These attitudes prevent nurses from exerting efforts on behalf of the organization.