Building bridges: an innovative academic-service partnership.

Academic and service entities can create sustainable models of collaboration that realign relationships and resources to enhance the critical competencies essential for entry into practice. Our hospital and school collaborated to implement an innovative academic-service partnership model in which the academic and the care delivery enterprises intersected to accomplish goals of mutual interest and enhance and enrich the practice environment. Two existing resources-the staff nurse and faculty-were used to realign the educational process with the realities of nursing practice in an interpretive, contextual, live unfolding clinical environment that was relevant and memorable. The students were better integrated into the clinical operations and showed increased levels of critical thinking, clinical decision-making, and clinical inquiry skills. The model holds promise to improve transition to practice, make better use of existing resources, and foster collaborative relationships among the academic, practice, and regulatory enterprises.

A dialogue on the future of nursing practice.

PURPOSE: The challenges of health care; its safety, effectiveness, and efficiency; the quality of care; and the outcomes patients experience are issues central to nursing practice. This centrality needs to be affirmed as the profession shapes its practice over the next 50 years. The purpose of this article is to initiate a dialogue on the future of nursing practice. METHODS: The methods used are observation, reflection, dialogue, and proposed actions. FINDINGS: The results of this process are preliminary. They suggest that the establishment of nursing hospitals is a distinct possibility. CONCLUSIONS: This article concludes with a series of arguments for and against this position along with an invitation for your participation in this dialogue. NURSING IMPLICATIONS: The major implications of this article are not "nursing" implications per se but client and patient implications and the future contribution of nursing to improved health and patient care.

Is it time for a new category of nursing diagnosis?

Professional vigilance, the art of "watching out," is the essence of nursing. Vigilance is the mental process that makes the informed nursing actions of assessment, diagnosis, intervention, and evaluation possible and meaningful. Nursing vigilance must be described in our nursing terminology or it risks remaining invisible to others. We propose that the current definition of nursing diagnosis be expanded to include surveillance diagnoses for which the nurse has the responsibility for problem identification and ongoing monitoring. Inclusion of surveillance diagnoses in the NANDA International taxonomy will better reflect the breadth and depth of nursing practice.

Ethics education in MSN programs: a study of national trends.

The aim of this study was to determine the manner in which master's of science in nursing programs, accredited by either the National League for Nursing Accrediting Commission or the Commission on Collegiate Nursing Education, conduct ethics education. A survey method was employed to obtain requisite data. Among the main variables investigated were: the percentage of programs that require a course with formal ethics content; the average number of class hours a program or track dedicates to ethics education; required and actual credentials of instructors who teach ethics; and objectives, topics, teaching methods, and grading methods of required courses with formal ethics content. Results indicated that most programs do not require instructors to have completed formal ethics training. In terms of content, few common trends exist and there are important gaps in clinical ethics topics. Comparisons between school of medicine ethics content reported in the literature and MSN ethics content reported in this study indicate that medical schools are more exacting of their students. The study concludes with a call for the establishment of guidelines or standards relevant to ethics content in MSN curricula in the United States.

A profile of accelerated BSN graduates, 2004.

In 1971, Saint Louis University initiated a new type of baccalaureate nursing curriculum, the accelerated option. Since then, there has been an explosion of accelerated baccalaureate nursing (BSN) programs. Despite the popularity of these programs, there is little reported research on the type of students entering accelerated BSN programs and their degree of satisfaction with the programs. This descriptive study aimed to provide a profile of one graduating class of accelerated BSN students. Students in this study had a mean age of 28 and were most likely to have previous baccalaureate degrees in the physical or social sciences. Results indicated that students were, on the whole, satisfied with the accelerated BSN experience, but that the program does pose academic, financial, and personal challenges. Implications for recruitment and retention of accelerated BSN students are discussed.

Development and evaluation of evidence-based nursing (EBN) filters and related databases.

OBJECTIVES: Difficulties encountered in the retrieval of evidence-based nursing (EBN) literature and recognition of terminology, research focus, and design differences between evidence-based medicine and nursing led to the realization that nursing needs its own filter strategies for evidence-based practice. This article describes the development and evaluation of filters that facilitate evidence-based nursing searches. METHODS: An inductive, multistep methodology was employed. A sleep search strategy was developed for uniform application to all filters for filter development and evaluation purposes. An EBN matrix was next developed as a framework to illustrate conceptually the placement of nursing-sensitive filters along two axes: horizontally, an adapted nursing process, and vertically, levels of evidence. Nursing diagnosis, patient outcomes, and primary data filters were developed recursively. Through an interface with the PubMed search engine, the EBN matrix filters were inserted into a database that executes filter searches, retrieves citations, and stores and updates retrieved citations sets hourly. For evaluation purposes, the filters were subjected to sensitivity and specificity analyses and retrieval set comparisons. Once the evaluation was complete, hyperlinks providing access to any one or a combination of completed filters to the EBN matrix were created. Subject searches on any topic may be applied to the filters, which interface with PubMed. RESULTS: Sensitivity and specificity for the combined nursing diagnosis and primary data filter were 64% and 99%, respectively; for the patient outcomes filter, the results were 75% and 71%, respectively. Comparisons were made between the EBN matrix filters (nursing diagnosis and primary data) and PubMed's Clinical Queries (diagnosis and sensitivity) filters. Additional comparisons examined publication types and indexing differences. Review articles accounted for the majority of the publication type differences, because "review" was accepted by the CQ but was "NOT'd" by the EBN filter. Indexing comparisons revealed that although the term "nursing diagnosis" is in Medical Subject Headings (MeSH), the nursing diagnoses themselves (e.g., sleep deprivation, disturbed sleep pattern) are not indexed as nursing diagnoses. As a result, abstracts deemed to be appropriate nursing diagnosis by the EBN filter were not accepted by the CQ diagnosis filter. CONCLUSIONS: The EBN filter capture of desired articles may be enhanced by further refinement to achieve a greater degree of filter sensitivity. Retrieval set comparisons revealed publication type differences and indexing issues. The EBN matrix filter "NOT'd" out "review," while the CQ filter did not. Indexing issues were identified that explained the retrieval of articles deemed appropriate by the EBN filter matrix but not included in the CQ retrieval. These results have MeSH definition and indexing implications as well as implications for clinical decision support in nursing practice.

The art of watching out: vigilance in women who have migraine headaches.

The author used grounded theory methodology to explore the process of vigilance in women who had migraine headaches. Twenty-two women were interviewed. The basic social problem identified for women with migraines was the need to maintain function when faced with unpredictable bouts of pain and associated distress. One way women maximized their function was through the exercise of vigilance. Vigilance in these women can be conceptualized as the art of watching out. Watching out, the core category, had four subprocesses: assigning meaning to what is, calculating the risk, staying ready, and monitoring the results. Conditions for watching out were owning the label and making the connections. Deciding what to do and acting to maximize function were consequences of vigilance.