Implementing a New Capstone Leadership Clinical Course.

BACKGROUND: Nurse educators are challenged to ensure clinical education meets the changing health care environments and needs. PROBLEM: New nurses remain unprepared for practice, have insufficient foundational leadership capacities, and lack systems-thinking awareness. APPROACH: Responding to educational gaps, increased enrollment, and scarce clinical placements, faculty used an eclectic education model to develop a new capstone leadership clinical course that included 5 types of experiences. The total acute care clinical hours were reduced, while adding leadership-focused experiences and simulated learning. OUTCOMES: Stakeholders' evaluations indicate the pilot provided opportunities to strengthen students' leadership capacity, systems thinking, and professional identity while still providing sufficient practice managing care of multiple patients, engaging in teamwork, and applying evidence. CONCLUSION: The new clinical course addressed students' transition into practice needs and enrollment capacity issues. Thoughtful planning by invested stakeholders, communication among faculty, and clear expectations are necessary to implement eclectic clinical models.

Rehospitalizations, early revisions, infections, and hospital resource use in the first year after hip and knee arthroplasties.

We examined 3 negative outcomes for 58 351 hip and knee arthroplasty patients: rehospitalization, revision and infection, and their impact on resource use in the year after surgery. In the year before surgery, 12.9% of elective hip and 10.2% of knee patients were hospitalized. In the year after, 14.8% of elective hip and 15.5% of knee patients were hospitalized, representing a 15% and 52% increase, respectively. Twenty-eight percent of emergent hip patients were hospitalized at least once preoperatively; this did not change after surgery. Revision occurred in 2.0% of emergent hip, 1.7% of elective hip, and 0.9% of knee patients. Joint infection was diagnosed in 1.3% of patients. The increased hospitalization after the elective hip and knee procedures represents an incremental cost of 10% over the index hospital stay.

The Wisconsin Pediatric Cardiac Registry: a mechanism for exploring etiologies of congenital heart defects.

On January 1, 2000, the Wisconsin Pediatric Cardiac Registry began registering families of infants born with a congenital heart defect (CHD) in Wisconsin. Pediatric cardiologists across the state developed the Registry as a database and as a research study exploring potential etiologies of CHDs. Participating pediatric cardiologists identify the infants and refer families to the Registry. Families are asked to participate by completing a comprehensive questionnaire that inquires into exposures and illnesses experienced during the 6 months prior to the pregnancy and during the pregnancy itself. A subset of families, based on the infant's diagnosis (hypoplastic left heart syndrome, conotruncal abnormalities, and Ebstein's anomaly) participates in DNA testing. This article describes the development of the Registry, family referral and participation to date, genetic advances in the etiology of CHDs, and research initiatives utilizing the data provided by families for the WPCR.