A Delphi study on research priorities for trauma nursing.

OBJECTIVES: To identify and prioritize research questions of importance to trauma patient care and of interest to trauma nurses. METHOD: A three-round Delphi technique was used to solicit, identify, and prioritize problems for trauma nursing research. In round 1, experienced trauma nurses (N = 208) generated 513 problems, which were analyzed, categorized, and collapsed into 111 items for subsequent rounds. Round 2 participants rated each research question on a 1 to 7 scale on two criteria: impact on patient welfare and value for practicing nurses. Group median scores provided by 166 round 2 respondents and respondents' individual round 2 scores were indicated on the round 3 questionnaire. Subjects rated the questions again on the same criteria and indicated whether nurses, independently or in collaboration with other health professionals, should assume responsibility for that research. Median and mean scores and rank order were determined for each item. RESULTS: Respondents who completed all three rounds (n = 137) had a mean of 8.3 years of trauma experience. Nine research questions ranked within the top 20 on both criteria. The two research questions that ranked highest on both criteria were: What are the most effective nursing interventions in the prevention of pulmonary and circulatory complications in trauma patients? and What are the most effective methods for preventing aspiration in trauma patients during the postoperative phase? The third-ranked question regarding patient welfare was: What psychological and lifestyle changes result from traumatic injury? Regarding value for practicing nurses, What are the most effective educational methods to prepare and maintain proficiency in trauma care providers? ranked third. CONCLUSION: These research priorities provide impetus and direction for nursing and collaborative investigation in trauma care.

Adaptation six months after multiple trauma: a pilot study.

This pilot study investigated the functional and psychosocial adaptation of 18 survivors of multiple trauma who were in the home setting 6 months after discharge from a tertiary trauma center. Seventeen subjects reported complete functional independence and one reported the need for assistance with self-care activities as measured by the Modified Barthel Index. All subjects reported problems with psychosocial adaptation as measured by the Psychosocial Adjustment to Illness Scale (PAIS). Subjects with high PAIS scores (worst adaptation) reported problems in all domains of the PAIS, whereas those with low PAIS scores (best adaptation) reported most problems in health care orientation. Mann-Whitney U tests were significant for gender, household composition and employment status when compared with low PAIS scores (p < 0.05). An analysis of variance confirmed employment status was the best predictive factor for low PAIS scores.

Diabetes insipidus versus syndrome of inappropriate antidiuretic hormone.

Diabetes insipidus (DI) and the syndrome of inappropriate antidiuretic hormone (SIADH) are two endocrine disorders presenting a challenge to the critical care nurse. The challenge lies in the recognition and assessment of the effects on the patient's fluid balance and in the planning of interventions to prevent complications.

Myasthenia gravis: a nursing perspective.

Myasthenia gravis, a chronic neuromuscular disease, results in weakness of striated voluntary muscles. The muscles involved and the degree of weakness vary from patient to patient. Nursing care of the patient with muscle weakness from myasthenia gravis presents a challenge for the neuroscience nurse. Drug therapy and thymectomy treatments are discussed, along with their complications. Nursing interventions for other problems for the myasthenic patient, including impaired breathing patterns, inability to clear the airway, impaired communication, altered nutrition, self-care deficits, and impaired vision are described.

A survey of neuroscience nurses.

This survey identified and described the characteristics and perceptions of neuroscience nurses as well as the basic and master's level curriculum relating to neuroscience theory and clinical components. The major sources of stress as perceived by neuroscience nurses were identified, categorized and prioritized in accordance with their present roles. The information in this survey can be used to guide future studies on neuroscience nurses. More must be learned about the neuroscience nurse so that nurse educators and administrators can provide the necessary resources to facilitate learning and coping. This is essential to insure the provision of high standards of patient care.