Developing Resilience: Strategies to Adapt Within an Interprofessional Team.

Resilience can be defined as sustaining well-being in the face of adversity by harnessing internal and/or external resources. Many of the strategies that promote highly effective teams, such as regulating emotions, self-reflection, and inclusion, may also contribute to team resilience. Nurse leaders can facilitate social connections, optimism, self-care, mindfulness practices, and meaningful recognition as strategies to promote nurse resilience. Resilience may mitigate many of the harmful effects for nurses working in the high demanding health care work environment.

Management Strategies in the Intensive Care Unit to Improve Psychosocial Outcomes.

Critical care nurses work in challenging environments that are often sterile, impersonal, noisy, and frightening to patients and their families. Nurses act as liaisons between medical professionals and patients and their families in multiple specialty intensive care units. Critical care nursing practice, guided by the American Nurses Association Code of Ethics, respects patients' religious, spiritual, and cultural beliefs, contributing to holistic care delivery. Therapeutic psychosocial outcomes of holistic care delivery and patient advocacy are explored. Personalized psychosocial care through treating patients holistically will support and maintain positive psychosocial outcomes in intensive care units across the country.

Orthopedic Injuries: Protocols to Prevent and Manage Patient Falls.

Health care organizations must adopt a culture of safety and implement effective fall prevention protocols. The teach-back method is a useful strategy for health providers to determine patient understanding of information taught to maintain a safe environment and prevent falls. Purposeful rounding is a proactive approach to ensure that patient assessments are accurate and research supports that patients use the call light less when nurses participate in hourly rounding. This article provides the reader with evidence-based fall prevention interventions, tips for using the teach-back method, and fall prevention tools to safely care for patients of all ages.

Addressing Tobacco Dependence Through a Nurse-driven Tobacco Intervention Protocol.

Tobacco use contributes to the largest proportion of preventable disease, disability, and death. Use of tobacco products is at epidemic proportions in the United States. Estimates retrieved between 2012 and 2013 by the US Centers for Disease Control and Prevention reported that 1 in 5 adults used tobacco products. Tobacco use was greatest among men, young adults, those living in the Midwest and south, and those with less education. Cigarette smoking resulting in inhalation of tobacco and its by-products is the most common form of tobacco use. Tobacco use results in multiple diseases, including numerous cancers and chronic diseases.

Thoughtful nursing practice: reflections on nurse delegation decision-making.

This article discusses delegation challenges and legal and regulatory oversight associated with delegation in the clinical practice setting. The authors address moral and legal attributes of the roles and responsibilities of health care providers regarding delegating health care interventions. The article also explores guiding principles and rules of delegation within professional standards, national practice guidelines, and state nurse practice acts. Nurse experts provide thoughtful reflection on nursing models and the role of delegation, emphasizing the critical role of delegation in extending the role of the health care professional in patient care services.

Bacterial infections: management by acute and critical care nurses.

Acute and critical care nurses must maintain a current knowledge base for advancing science and providing direct care for patients. When an infectious process is involved, it is the practicing nurse who must be knowledgeable in treatment and prevention modalities. The integument is the body's first line of defense for invading bacteria. This barrier to bacteria is followed by inflammation and adaptive immunity, the second and third lines of defense against infectious bacteria. It is acute and critical care nurses, however, who should be the first line of defense in preventing the spread of infectious disease. Modern medicine and common sense interventions reviewed in this article are the patient's best defense to good health and wellness when used by nurses.

Antimicrobials: classifications and uses in critical care.

Patients in the critical care setting are at high risk for infection because their normal host defenses are compromised. Critical care patients frequently have complicated, multisystem, mixed infections that can be life threatening. Optimal patient outcomes are the result of (1) early identification of signs and symptoms of infection; (2) nursing knowledge about common antimicrobials and their side effects and adverse reactions; (3) obtaining cultures before starting empiric therapy with antimicrobials; (4) consulting as needed with the infection control team; (5) practicing basic measures of infection control, such as hand washing; and (6) using special isolation precautions when the patient's condition warrants special care. The nurse also needs to be vigilant to the signs of toxicity from antimicrobial therapy. These interventions can save the critical care patient's life, prevent others from becoming infected, and save the hospital precious fiscal resources.

Avian influenza: are we ready?

We cannot be certain when the next influenza pandemic will emerge, or even whether it will be caused by avian influenza (H5N1) or some unrelated virus. However, we can be certain that an influenza pandemic will occur. The United States is leading the scientific effort to contain the pandemic through vaccine studies and antiviral studies. The need for pandemic influenza preparedness is extensive and expensive. Planning entails increased development of antivirals and vaccines, effective surveillance systems not only for people, but in agriculture, effective communication systems, plans to continue essential services, identification of health care priorities, and thorough guidelines for care. Critical care nurses, as well as all health care professionals, need to consider where their personal and professional obligations meet and end. There should already be discussions of contingency plan of the institution in which they are employed and the community in which they live. Additionally, a personal plan for their families with regard to economics, safety, and optimizing personal health outcomes during such a crisis should be considered. As many have said, "It is not a matter of if, but rather of when." Although the pandemic might not be the avian flu, history has taught us that pandemics surface with little warning and can have devastating effects on human lives, and can over tax the already fragile health care system.

Osteoporosis: incidence, prevention, and treatment of the silent killer.

Osteoporosis is a nationwide health care concern affecting millions of Americans. Health care dollars to prevent and treat osteoporosis are needed. Osteoporosis-related injuries and resulting disabilities, and consequent admissions to hospitals, nursing homes, and long-term care facilities is costing billions of dollars for care and treatment. Healthy lifestyle choices including vitamin and mineral therapy; safe home environments; a diet replete with calcium, vitamin D, and protein; weight-bearing and resistance exercises; and fall prevention programs for home-bound and hospitalized elders are needed to prevent osteoporosis-related fractures and injuries. Nurses must educate the public on osteoporosis and osteoporosis-prevention activities. Research in nursing, pharmacy, and allied health fields such as physical therapy and nutrition must expand to improve understanding of the risks associated with osteoporosis and to evaluate health-promotion and disease- prevention activities. Interdisciplinary partnerships should be established to study the issues, prevention, and treatment modalities of this "silent killer."

Who will educate the next generation of nurses? A looming faculty shortage.

Nursing is a profession that has many career choices. This article highlighted some of the major issues that will affect practicing hospital nurses and nurse educators. The nursing shortage is no longer "impending"-it is here and there are no signs that there will be a reprieve for staffing at the bedside. The major point of concern made in this article is that we must prompt our best and brightest to consider a career in nurse education. We are leaving too many qualified applicants to nursing school behind due to a faculty shortage in U.S. schools and colleges of nursing. Every nurse is called upon to "think outside the box" and employ strategies of collaboration between the practice arena [whether hospital, long term care, or hospice] and the academic setting to manage the shortage of nurses and nurse faculty. Using existing resources in a different way may assist in educating our future nurses.

Delegation decision-making by registered nurses who provide direct care for patients with spinal cord impairment.

Delegation and coordination of patient care are critical skills for registered nurses (RN). Most educational programs and clinical experiences in nursing school have not prepared nurses to function in a delegation decision-making capacity. Nurses caring for individuals with spinal cord impairment (SCI) are especially challenged to provide partial or total assistance to meet the requisite care needs of this patient population. Hospital length of stay has decreased for individuals with SCI. RNs employed in long-term care (LTC) facilities have found admissions of patients with SCI occur more frequently with the onset of managed care and the increased longevity of Americans. Capitated markets within managed care require a nursing care delivery model that safely and judiciously uses nursing personnel to their fullest potential. Conger's (1993) Delegation Decision-Making Model (DDMM) utilizes all levels of personnel to their maximum potential while staying within the confines of individuals state nurse practice acts. The ability of RNs to direct the health care team is crucial to affect positive patient outcomes. The purpose of this descriptive comparative study was to ascertain baseline information on nurse delegation decision-making knowledge, job satisfaction, and level of comfort with this skill for RNs practicing in hospital and LTC settings. After reading a case study on a patient with SCI, RNs in the hospital and LTC facilities used Conger's (1993) DDMM. Scores for delegation decision-making were determined using the Nursing Assessment Decision Grid. Delegation knowledge scores were the same for RNs practicing in the hospital and LTC settings. Of interest was that RNs practicing in LTC settings cited learning delegation skills "on the job" 50% of the time compared to hospital nurses who reported learning these skills on the job 19% of the time. Additional research in the area of nurse delegation with this patient population needs to be investigated to support the findings of this study.

Breaking through the glass ceiling: women in executive leadership positions--Part I.

Women have had their share of difficulties climbing the corporate ladder in their chosen professional roles. Excellent role models exist for nurses to look up to as role models for leadership and executive level positions. Nurses and women must strive to achieve their goals of attaining executive/management level positions in their respective organizations. The glass ceiling still exists; however, women are slowly eroding that glass barrier and reaching their professional goals. In reviewing the struggles that men in nursing have encountered in a predominantly female profession, one realizes that stereotypical attitudes do cross gender lines. The authors conclude that executive level positions need to be opened more to women, just as the nursing profession must be more welcoming to men. The profession of nursing will only become stronger with gender diversity. Women encounter barriers when aspiring to executive level positions. In the next issue of SCI Nursing, the authors will report on what the evidence says about women in leadership roles, and the challenges they have and will continue to face.

Spinal cord injury nursing and evidenced-based practice.

The importance of the dissemination of current data-based research findings cannot be said enough! Nurse researchers have an obligation to report their findings and potentially improve nursing practice and patient care outcomes. Conclusions drawn from the "evidence," whether good, bad, or indifferent, benefit nursing practice. Nurses need to know "what works," "what doesn't work," and the pluses and minuses of every finding. Reporting the "evidence" at national and international platforms can reach many health care providers. To reach the largest possible audience, however, research findings must be published in refereed journals. SCI Nursing is a refereed journal that reaches across our national boundary to other countries and the entire world. Publishing scholarly works is a responsibility of professional nurses!

Never underestimate the importance of networking: an imperative process for career success!

The importance of establishing connections to other powerful, intelligent people is extremely important to having a successful nursing career. Nurses can and will continue to learn the important aspects of career networking for themselves, other nurses, and their patients. Sharing information, whether it is clinical, administrative, educational, or research-based, is extremely important to maintain the current knowledge that is necessary to be successful in the profession. According to Christy (1987), sharing information and opportunities with colleagues has a synergistic effect. In short, we can increase our supply of information and be influential and powerful leaders by sharing that information. Nurses need to become better networkers to build successful careers. This will require breaking out of our zones of comfort and becoming players on the health care stage. Nurses, patients, and the public will all be beneficiaries of their greater involvement in all health care networks in our country!

Nurses as change agents in times of critical shortages.

SCI nurses care for people with demands for care, which may frequently exceed the supply for licensed caregivers. We need to not only provide safe and adequate care, but also provide quality in caregiving to patients and their families. During times of unprecedented shortages, nurses must be willing to change their "ways of doing" things. Routines that are outdated and don't serve the best interests of our consumers--persons with SCI--need to be replaced with current care initiatives. We must preserve precious nurse resources to meet the needs of our patients. In order to facilitate quality in our care delivery to persons with SCI, we must be willing to make the necessary changes to make that happen!

End of life issues: renewed meaning for care of the dying in America.

The subject of death is a topic that many Americans, including their health care providers, have avoided talking about for many decades. End-of-life care is capturing the attention of many in our country and rightfully so. Dying is one aspect of life that we will all face. Dying should be a culmination of one's life and not a dreaded subject, as many dying persons want to talk about their end of life, discuss their final wish, and say farewell to loved ones and family. Health care providers need to become more educated in end-of-life issues and look to becoming certified in palliative care. Comfort and closure are important attributes of providing "quality" palliative care. This issue is dedicated to raising members of the American Association of Spinal Cord Injury Nurses, and the American public's awareness of end-of-life issues. Our feature articles and some of our columns address this topic. Enjoy this issue and share it with your colleagues!