Consumer satisfaction with telehealth advice-nursing.

An increase in interest in the establishment of telephone advice services has resulted in the proliferation of call centers. Despite their wide usage, research for the most part has not addressed the quality of care in relation to consumer satisfaction. This paper examines consumer outcomes of satisfaction, and follow-up with recommendations, within a framework of the nursing process and its associated components of assessment (including problem identification), care planning, intervention, and evaluation. The data for the study were obtained from seven after-hours call centers operating under the auspices of health maintenance organizations, preferred provider organizations, and private insurance companies. A sample of 157 non-redundant telephone calls from adults with medical-surgical problems were audiotaped with providers' and callers' consent. Sociodemographic information of the advice nurses, and chief complaints of the callers were obtained. The quality of nursing of the audiotaped calls was rated through an implicit review method by registered nurse raters using an advice nurse structured implicit review (AN-SIR) form developed for the study. Follow-up information was obtained through telephone calls to ascertain the consumers' perceptions of satisfaction, helpfulness, and follow-through with recommendations. Results indicated that consumers calling with a variety of general complaints contacted 32 nurses in advice nurse call centers. The quality of nursing process was found to be the best in the area of intervention. Evaluation was also well above the midpoint on a transformed scale of zero to 100. Assessment, although slightly above midpoint, was the lowest of the three components of the nursing process examined. Consumer satisfaction was high with 95.4 percent of the consumers rating the calls as completely or at least somewhat satisfied, and 93.2 percent, stating the advice was very or somewhat helpful. Exploratory regression analysis showed that the component of intervention was significantly related to consumer satisfaction. The present study pioneers the way to rate the quality of the advice nurses' interactions with consumers, and lays the groundwork for further investigations of health care provider behavior and consumer outcomes. Further studies are recommended to investigate predictors of consumer satisfaction, and cost-benefit in terms of consumer expenditures of time, funds, and energy.

An appraisal of research utilization across the United States.

The success of research utilization (RU) is a function of how well it has been incorporated into the cultural norm of the organization. The authors describe current and future nursing research utilization activities in various clinical agencies across the United States and identify barriers and facilitators to those activities. The most frequent RU projects focused on pressure ulcers and pain management. Barriers included lack of resources, organizational culture, change, and nurses' education. Facilitators were leadership commitment, available resources, and a supportive organizational culture.

The scholarship of a practice discipline.

The article proposes that all nurses, as members of a discipline that is embedded in practice, share in the obligation to take part, in different capacities, in the generation of nursing scholarship. A model of scholarly inquiry that connects knowledge development and professional values to gather wisdom that benefits the health and well-being of society is advanced. Opportunity for all nurses to engage in a dialogue to create ownership of their scholarship is pivotal to its revisioning.

Care: the basis for a nursing ethic?

This article takes issue with the position in the recent general and cardiovascular nursing literature that care is the foundation for nursing's professional ethic. This literature is critically examined to support the determination that care is necessary but insufficient. Care without cure is incomplete in any health care discipline, including nursing. Any nursing ethic will be inadequate if it does not integrate the care/relationship and cure/justice/individual foundations.

Ethical issues in hospital-based nursing practice.

A professional nursing ethic is a living, dynamic set of standards for nurses' professional moral behavior. For a professional ethic to be adequate, it must address the ethical issues perceived as relevant to the profession. The purpose of this descriptive study was to identify the ethical issues hospital-based nurses face in their practice. The authors sought to determine whether there were any differences in these ethical issues over time or according to specialty practice, position, age, educational level, or years in practice. Different groups of nurses (N = 794) were surveyed on five separate occasions over 9 years. Data were analyzed using descriptive and chi 2 statistics. The most frequent ethical issue faced was pain relief and management. Over time, the percentage of nurses who reported being faced with ethical issues related to morphine drips increased. Implications for future research on development of a normative nursing ethic are discussed.

Wealth and the right to refuse ICU discharge. Part 1: the ethical case.

When a patient cannot be helped significantly by further ICU care, can the family refuse discharge of the patient because they are able to pay for further care? Here is an actual case situation submitted from one of our readers, followed by the ethical case analysis and suggestions on what to do in a similar situation.

Decreased cardiac output in the critical care setting.

The specific aim of this exploratory, descriptive study was to demonstrate that the nursing diagnosis, decreased cardiac output, contains at least seven separate and specific components. Forty critical care nurses completed a questionnaire about seven different case studies, or vignettes. Each vignette reflected one of the following: myocardial injury, arrhythmias, decreased preload, myocardial ischemia, increased afterload, drug effects, and cardiac surgery alterations. Mean scores were used to validate the specific subcategories. Analyses of variance were used to demonstrate statistically significant differences among them. Six of the labels were supported, providing preliminary evidence for the validity of these components of decreased cardiac output.

Moving beyond: a generative philosophy of science.

Philosophies of science are perhaps the most covert yet significant forces influencing the direction of change within disciplines. Although the era of logical positivism has waned for many disciplines, newer philosophies may not be satisfactory, especially for the applied disciplines. This article describes an alternative philosophy of science with special significance for nursing. This philosophy was influenced by several of the major existing philosophies, but especially by the paradigmatic view espoused by Thomas Kuhn. The generative philosophy of science was named because of its focus on generating growth among the applied disciplines. Members of these disciplines study questions with social significance and human application. This article defines major concepts, describes relationships among concepts and discusses implications for the development of nursing science and the nursing discipline.

Culpability and pain management/control in peripheral vascular disease using the ethics of principles and care.

The purposes of this article were to provide insight into the process of ethics and ethical inquiry and to explore the ethical issues of culpability and pain management/control. Critical care nurses who currently care for vascular patients identified these issues as occurring frequently in their practice. Authors in critical care nursing generally have limited the process of ethical inquiry to a theoretical framework built around an ethic of principles. The message many critical care nurses heard was that this one type of theoretical ethical framework was the totality of ethics. The application of these principles was ethical inquiry. For some nurses, the ethic of principles is sufficient. For others, an ethic of principles is either incomplete or foreign. This second group of nurses may believe that they have no moral voice if the language of ethics is only the language of principles. The language of principles, however, is not the only theoretical framework available. There is also the ethic of care, and ethical inquiry can include the application of that framework. Indeed, the language of the ethic of care may give a voice to nurses who previously felt morally mute. In fact, these two theoretical frameworks are not the only frameworks available to nurses. There is also virtue ethics, a framework not discussed in this article. A multiplicity of ethical frameworks is available for nurses to use in analyzing their professional and personal dilemmas. Recognizing that multiplicity, nurses can analyze their ethical dilemmas more comprehensively and effectively. Applying differing ethical frameworks can result in the same conclusions. This was the case for the issue of culpability.(ABSTRACT TRUNCATED AT 250 WORDS)

Nursing research productivity in clinical settings.

Nurse administrators in the Los Angeles area complain that budgetary and staffing constraints hamper nursing research. They indicate that a research consortium would be an attractive solution as it would enable institutions to pool resources and effectively document nursing's contribution to patient care.

The dying patient in the critical care setting: making the critical difference.

Death is an inevitable fact in the critical care setting. This fact does not make it more comfortable for the nurse who is caring for a critically ill patient who is dying. Some health care providers have recommended that the critical care resources are better utilized for the patient whose prognosis is not death. This position can be countered with the perspective that there may be no better place to provide the intensive nursing care that the dying patient may need than the critical care setting. A new nursing diagnosis, Terminal Syndrome related to the dying process is introduced to assist the nurse in providing comprehensive care for what is often a complex patient care situation. The goal is to achieve for each dying individual in the critical care setting what she or he truly desires, an end to the life process, a death achieved with comfort and dignity.

Comparison of electrode site preparation techniques.

A posttest-only control group design was used to study the effects of two electrode site preparation techniques on reducing electrical potential across a pair of disposable skin electrodes. Sixty health volunteers were randomly divided into one control and two treatment groups of 20 subjects each. Within each group, the treatment was further assigned randomly to either the right or left forearm. Analysis of variance and paired t test analyses were used to compare group differences. Skin preparation by using One Step Skin Prep significantly decreased skin potentials (-1.90 mV) whereas the group in which ECG Prep Pads were used and the control group had no significant change.

Values, moral reasoning, and ethics.

The purpose of this exchange was to explore the domains of values, moral reasoning, and ethics. Values and moral reasoning reflect the "is." Moral reasoning is the mental process that nurses set in motion to come to some decision of right or wrong in any moral dilemma. Values are motivational preferences or dispositions. Moral values are those preferences that are integral to any moral reasoning process. Ethics reflect the oughts. It is the art-science that critically evaluates the "is." As such, ethics identifies the norms or standards of behaviors that either are or can become the values that are implemented through moral reasoning. Nursing is just beginning to identify its moral values and reasoning. Nevertheless, nursing seems to be further along in the identification of the "is" than it is with the "ought." The further development of nursing ethics will be of great benefit to nurse researchers and educators. The greatest benefit will be, however, to the practicing nurse as she/he struggles with giving excellent nursing care consistent with a positive nursing ethic.

Brain resuscitation. Ethical perspectives.

Brain resuscitation is the newest in a long line of treatment protocols that is designed to aid us in sustaining not just life, but quality life in the critical care setting. Like other, previously established protocols, it is not value free. Its implementation brings ethical considerations that must be addressed. If the issues are not addressed, there is the real danger that the resulting moral dilemmas will overwhelm the nurse. In brain resuscitation, there are at least three ethical issues that must be recognized. These are the role of resuscitation in the life process, allocation of scarce resources, and participation in research. To address these issues, nurses will have to be aware of the ethical principle and/or perspectives involved. For some of these issues, the solutions will have to come from nursing's national organizations, such as the American Association of Critical Care Nurses. Other solutions presented will require the nurse to come to an individual decision regarding the ethics of brain resuscitation. The journey to the conclusion of this discussion will end with disappointment for those who sought an algorhythm or decision tree with which to make definitive decisions in regard to ethical decisions about brain resuscitation. To have assumed that such an absolute discussion in regard to the ethical perspectives related to brain resuscitation is possible or even desirable would have been to deny the moral/ethical responsibilities of the nurse who practices in a critical care setting. While these ethical responsibilities can be overwhelmingly burdensome, they can also be opportunities. They can be positive opportunities for our health care colleagues, our patients, and ourselves.

Effects of conversation on intracranial pressure in comatose patients.

In this time series design study we investigated the effects of conversation on intracranial pressure (ICP). Two conversation types were used, and continuous measurements of ICP were recorded. Type 1 conversation was an emotionally referenced conversation that reflected an actual nursing report on the patient's current condition. Type 2 conversation was a predetermined dialogue unrelated to the patient. Two hypotheses were tested to determine the existence of differences between the ICP measurements at baseline and the ICP measurements during any conversation, and differences between the ICP measurements recorded during type 1 conversation and during type 2 conversation. Eight subjects served as their own control. T tests were performed between the mean scores of the minimum, maximum, and average ICP measurements before, during, and after both conversations. The hypotheses were not supported by the findings. There was, however, a statistically significant decrease in ICP when minimum ICP measurements before type 2 conversations were compared with measurements recorded during type 2 conversation. The data also demonstrated a wide variation of individual patient responses. The results of the current study suggest that the direction of influence from conversation on the ICP is individual and may be influenced greatly by the patient's level of consciousness.